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Meta-Analysis
. 2013 Sep 24;2013(9):CD009020.
doi: 10.1002/14651858.CD009020.pub2.

Magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered

Mário Lenza  1 , Rachelle Buchbinder, Yemisi Takwoingi, Renea V Johnston, Nigel Ca Hanchard, Flávio Faloppa
Affiliations
Meta-Analysis

Magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered

Mário Lenza et al. Cochrane Database Syst Rev. .

Abstract

Background: Shoulder pain is a very common symptom. Disorders of the rotator cuff tendons due to wear or tear are among the most common causes of shoulder pain and disability. Magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA) and ultrasound (US) are increasingly being used to assess the presence and size of rotator cuff tears to assist in planning surgical treatment. It is not known whether one imaging method is superior to any of the others.

Objectives: To compare the diagnostic test accuracy of MRI, MRA and US for detecting any rotator cuff tears (i.e. partial or full thickness) in people with suspected rotator cuff tears for whom surgery is being considered.

Search methods: We searched the Cochrane Register of Diagnostic Test Accuracy Studies, MEDLINE, EMBASE, and LILACS from inception to February 2011. We also searched trial registers, conference proceedings and reference lists of articles to identify additional studies. No language or publication restrictions were applied.

Selection criteria: We included all prospective diagnostic accuracy studies that assessed MRI, MRA or US against arthroscopy or open surgery as the reference standard, in people suspected of having a partial or full thickness rotator cuff tear. We excluded studies that selected a healthy control group, or participants who had been previously diagnosed with other specific causes of shoulder pain such as osteoarthritis or rheumatoid arthritis. Studies with an excessively long period (a year or longer) between the index and reference tests were also excluded.

Data collection and analysis: Two review authors independently extracted data on study characteristics and results of included studies, and performed quality assessment according to QUADAS criteria. Our unit of analysis was the shoulder. For each test, estimates of sensitivity and specificity from each study were plotted in ROC space and forest plots were constructed for visual examination of variation in test accuracy. Meta-analyses were performed using the bivariate model to produce summary estimates of sensitivity and specificity. We were unable to formally investigate potential sources of heterogeneity because of the small number of studies.

Main results: We included 20 studies of people with suspected rotator cuff tears (1147 shoulders), of which six evaluated MRI and US (252 shoulders), or MRA and US (127 shoulders) in the same people. Many studies had design flaws, with the potential for bias, thus limiting the reliability of their findings. Overall, the methodological quality of the studies was judged to be low or unclear. For each test, we observed considerable heterogeneity in study results, especially between studies that evaluated US for the detection of full thickness tears and studies that evaluated MRA for the detection of partial thickness tears. The criteria for a positive diagnostic test (index tests and reference standard) varied between studies.Meta-analyses were not possible for studies that assessed MRA for detection of any rotator cuff tears or partial thickness tears. We found no statistically significant differences in sensitivity or specificity between MRI and US for detecting any rotator cuff tears (P = 0.13), or for detecting partial thickness tears (P = 1.0). Similarly, for the comparison between MRI, MRA and US for detecting full thickness tears, there was no statistically significant difference in diagnostic performance (P = 0.7). For any rotator cuff tears, the summary sensitivity and specificity were 98% (95% CI 92% to 99%) and 79% (95% CI 68% to 87%) respectively for MRI (6 studies, 347 shoulders), and 91% (95% CI 83% to 95%) and 85% (95% CI 74% to 92%) respectively for US (13 studies, 854 shoulders). For full thickness tears, the summary sensitivity and specificity were 94% (95% CI 85% to 98%) and 93% (95% CI 83% to 97%) respectively for MRI (7 studies, 368 shoulders); 94% (95% CI 80% to 98%) and 92% (95% CI 83% to 97%) respectively for MRA (3 studies, 183 shoulders); and 92% (95% CI 82% to 96%) and 93% (95% CI 81% to 97%) respectively for US (10 studies, 729 shoulders).Because few studies were direct head-to-head comparisons, we could not perform meta-analyses restricted to these studies. The test comparisons for each of the three classifications of the target condition were therefore based on indirect comparisons which may be prone to bias due to confounding.

Authors' conclusions: MRI, MRA and US have good diagnostic accuracy and any of these tests could equally be used for detection of full thickness tears in people with shoulder pain for whom surgery is being considered. The diagnostic performance of MRI and US may be similar for detection of any rotator cuff tears. However, both MRI and US may have poor sensitivity for detecting partial thickness tears, and the sensitivity of US may be much lower than that of MRI. The strength of evidence for all test comparisons is limited because most studies were small, heterogeneous and methodologically flawed, and there were few comparative studies. Well designed studies that directly compare MRI, MRA and US for detection of rotator cuff tears are needed.

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Conflict of interest statement

None known.

Figures

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1
Study flow diagram
2
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Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies
3
3
Methodological quality summary: review authors' judgements about each methodological quality item for each included study
4
4
Accuracy of MRA, MRI and US for detecting any rotator cuff tears (forest plot)
5
5
Study estimates of sensitivity and specificity with 95% confidence intervals plotted in ROC space for MRA for the detection of any rotator cuff tears
6
6
Study estimates of sensitivity and specificity, and summary points with 95% confidence regions plotted in ROC space for MRI and US for the detection of any rotator cuff tears
7
7
Accuracy of MRA, MRI and US for detecting full thickness rotator cuff tears (forest plot)
8
8
Study estimates of sensitivity and specificity, and summary points with 95% confidence regions plotted in ROC space for MRA, MRI and US for the detection of full thickness rotator cuff tears
9
9
Accuracy of MRI, US and MRA for detecting partial thickness rotator cuff tears (forest plot)
10
10
Study estimates of sensitivity and specificity with 95% confidence intervals plotted in ROC space for MRA for the detection of partial thickness rotator cuff tears
11
11
Study estimates of sensitivity and specificity, and summary points with 95% confidence regions plotted in ROC space for MRI and US for the detection of partial thickness rotator cuff tears
12
12
Paired comparison of MRI and US for detection of any rotator cuff tears. Connectling lines link study estimates of sensitivity and specificity for both tests in each study
13
13
Paired comparison of MRI and US for detection of full thickness rotator cuff tears. Connectling lines link study estimates of sensitivity and specificity for both tests in each study
14
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Paired comparison of MRI and US for detection of partial thickness rotator cuff tears. Connectling lines link study estimates of sensitivity and specificity for both tests in each study
1
1. Test
MRA for detection of any rotator cuff tears.
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2. Test
MRA for detection of full thickness tears.
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3. Test
MRA for detection of partial thickness tears.
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4. Test
MRI for detection of any rotator cuff tears.
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5. Test
MRI for detection of full thickness tears.
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6. Test
MRI for detection of partial thickness tears.
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7. Test
US for detection of partial thickness tears.
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8. Test
US for detection of full thickness tears.
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9. Test
US for detection of any rotator cuff tears.
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11. Test
MRA for detection of any subscapularis tendon tears.
See this image and copyright information in PMC

Comment in

References

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Flannigan 1990 {published data only}
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Fotiadou 2008 {published data only}
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    1. Vlychou M. Questions related with our inclusion criteria [personal communication]. Email to: M Vlychou 19 July 2011.
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Fritz 1992 {published data only}
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Furtschegger 1988 {published data only}
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Girard 1995 {published data only}
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Goergen 1996 {published data only}
    1. Goergen SK, Bradley WG Jr, Liu J, Tam JK, Dubin MD, Pema PJ, et al. Improving the diagnostic accuracy of MR in the detection of infraspinatus tendon injuries. Journal of Computer Assisted Tomography 1996;20(5):829‐33. - PubMed
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Hedtmann 2002 {published data only}
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Herzog 1998 {published data only}
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Hodler 1988 {published data only}
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Hodler 1992 {published data only}
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Homsi 1989 {published data only}
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Horii 1998 {published data only}
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Iannotti 1991 {published data only}
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Iyengar 2010 {published data only}
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Jacobson 2003 {published data only}
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Jacobson 2004 {published data only}
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Jaovisidha 1999 {published data only}
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Kaneko 1994 {published data only}
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Kluger 2003 {published data only}
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Kneeland 1987 {published data only}
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Kujat 1986 {published data only}
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Kurol 1991 {published data only}
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Lipman 1992 {published data only}
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Lucas 1991 {published data only}
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Mack 1988 {published data only}
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Magee 2003a {published data only}
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Magee 2003b {published data only}
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Magee 2006 {published data only}
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Magee 2007 {published data only}
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Magee 2009 {published data only}
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Malvestiti 1997 {published data only}
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Martin 2008 {published data only}
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Masaoka 1999 {published data only}
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Masciocchi 1989 {published data only}
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Meister 2004 {published data only}
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Mendieta‐Sevilla 2009 {published data only}
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Merl 1996 {published data only}
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Middleton 1993 {published data only}
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Miller 2008 {published data only}
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Montrucchio 1997 {published data only}
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Monu 1994 {published data only}
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Moosmayer 2005 {published data only}
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Moosmayer 2007 {published data only}
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Morrison 1990 {published data only}
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Narbona 2007 {published data only}
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Nogueira‐Barbosa 2002 {published data only}
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Norregaard 2002 {published data only}
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Paavolainen 1994 {published data only}
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Palmer 1994 {published data only}
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Pfirrmann 2004 {published data only}
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    1. Rutten MJ, Spaargaren GJ, Loon T, Waal Malefijt MC, Kiemeney LA, Jager GJ. Detection of rotator cuff tears: the value of MRI following ultrasound. European Radiology 2010;20(2):450‐7. - PMC - PubMed
Sahin‐Akyar 1998 {published data only}
    1. Sahin‐Akyar G, Miller TT, Staron RB, McCarthy DM, Feldman F. Gradient‐echo versus fat‐suppressed fast spin‐echo MR imaging of rotator cuff tears. AJM. American Journal of Roentgenology 1998;171(1):223‐7. - PubMed
Sartoris 1992 {published data only}
    1. Sartoris DJ. Diagnosing shoulder pain: What's the best imaging approach?. Physician and Sportsmedicine 1992;20(9):151‐6,159‐62,164. - PubMed
Sasaki 1990 {published data only}
    1. Sasaki M, Ehara S, Nakasato T, Tamakawa Y, Kuboya Y, Sugisawa M, et al. MR of the shoulder with a 0.2‐T permanent‐magnetic unit. American Journal of Roentgenology 1990;154(4):777‐8. - PubMed
Schneider 2003 {published data only}
    1. Schneider TL, Schmidt‐Wiethoff R, Drescher W, Fink B, Schmidt J, Appell HJ. The significance of subacromial arthrography to verify partial bursal‐side rotator cuff ruptures. Archives of Orthopaedic and Trauma Surgery 2003;123(9):481‐4. - PubMed
Schreinemachers 2009 {published data only}
    1. Schreinemachers SA, Hulst VP, Willems WJ, Bipat S, Woude HJ. Detection of partial‐thickness supraspinatus tendon tears: is a single direct MR arthrography series in ABER position as accurate as conventional MR arthrography?. Skeletal Radiology 2009;38(10):967‐75. - PMC - PubMed
Schultz 1994 {published data only}
    1. Schultz E. What is the significance on increased signal within the rotator cuff on T2‐weighted images in the coronal oblique plane?. American Journal of Roentgenology 1994;163(2):472. - PubMed
Seeger 1988 {published data only}
    1. Seeger LL, Gold RH, Bassett LW, Ellman H. Shoulder impingement syndrome: MR findings in 53 shoulders. American Journal of Roentgenology 1988;150(2):343‐7. - PubMed
Sheah 2009 {published data only}
    1. Sheah K, Bredella MA, Warner JJ, Halpern EF, Palmer WE. Transverse thickening along the articular surface of the rotator cuff consistent with the rotator cable: identification with MR arthrography and relevance in rotator cuff evaluation. American Journal of Roentgenology 2009;193(3):679‐86. - PubMed
Shellock 1996 {published data only}
    1. Shellock FG, Stoller D, Crues JV. MRI of the shoulder: a rational approach to the reporting of findings. Journal of Magnetic Resonance Imaging 1996;6(1):268‐70. - PubMed
Shellock 2001 {published data only}
    1. Shellock FG, Bert JM, Fritts HM, Gundry CR, Easton R, Crues JV, et al. Evaluation of the rotator cuff and glenoid labrum using a 0.2‐Tesla extremity magnetic resonance (MR) system: MR results compared to surgical findings. Journal of Magnetic Resonance Imaging 2001;14(6):763‐70. - PubMed
Shiv 1990 {published data only}
    1. Shiv VK, Marya SK, Taneja K, Mehrotra G, Mittal SK, Bhargava SK. Sonographic evaluation of rotator cuff injuries. Indian Journal of Radiology and Imaging 1990;44(3):197‐200.
Singer 1995 {published data only}
    1. Singer B, Cotten A, Chastanet P. Ultrasonography of the rotator cuff [Échographie de la coiffe des rotateurs]. Radiologie ‐ Journal du CEPUR 1995;15(5):11‐9.
Singson 1996 {published data only}
    1. Singson RD, Hoang T, Dan S, Friedman M. MR evaluation of rotator cuff pathology using T2‐weighted fast spin‐echo technique with and without fat suppression. American Journal of Roentgenology 1996;166(5):1061‐5. - PubMed
Skib 1998 {published data only}
    1. Skib RA. Magnetic resonance imaging assessment of the rotator cuff: is it really accurate?. Arthroscopy 1998;14(6):656‐8. - PubMed
Soble 1989 {published data only}
    1. Soble MG, Kaye AD, Guay RC. Rotator cuff tear: clinical experience with sonographic detection. Radiology 1989;173(2):319‐21. - PubMed
Sonin 1996 {published data only}
    1. Sonin AH, Peduto AJ, Fitzgerald SW, Callahan CM, Bresler ME. MR imaging of the rotator cuff mechanism: comparison of spin‐echo and turbo spin‐echo sequences. American Journal of Roentgenology 1996;167(2):333‐8. - PubMed
Sonnabend 1997 {published data only}
    1. Sonnabend D, Hughes HJ, Giuffre B, Farrell R. Ultrasound assessment of shoulder pathology. Surgery of the shoulder. 6th International Congress, Helsinki, Finland. 1995:13–7.
    1. Sonnabend DH, Hughes JS, Giuffre BM, Farrell R. The clinical role of shoulder ultrasound. Australian and New Zealand Journal of Surgery 1997;67(9):630‐3. - PubMed
Soto Araiza 1998 {published data only}
    1. Soto Araiza G, Arredondo Estrada JH, Onofre Castillo J, Arredondo Galán JH, Padilla Dieste A, Garza Montemayor M, et al. Ultrasound of the painful shoulder: study of 42 patients [El ultrasonido en el hombro doloroso: estudio de 42 pacientes]. Revista Mexicana de Radiología 1998;52(4):163‐7.
Steinbach 2000 {published data only}
    1. Steinbach LS, Gunther SB. Magnetic resonance imaging of the rotator cuff. Seminars in Roentgenology 2000;35(3):200‐16. - PubMed
Strauss 1998 {published data only}
    1. Strauss J, Krause D, Holtzmann P, Gonzalves M, Maillefert JF, Tavernier C. Correlations and discordante observations MRI versus arthroscopy in shoulder cuff tears [Correlations et analyse de discordances – IRM – Arthroscopie dans les ruptures de coiffe de l’epaule]. Rhumatologie 1998;50(8):266‐73.
Suder 1994 {published data only}
    1. Suder PA, Hougaard K, Frich LH, Rasmussen OS, Lundorf E. Intraarticular findings in the chronically painful shoulder. A study of 32 posttraumatic cases. Acta Orthopaedica Scandinavica 1994;65(3):339‐43. - PubMed
Sunde 2001 {published data only}
    1. Sunde P, Edenberg J. Diagnosis of rotator cuff injury [Diagnostikk av rotatorcuffskade]. Tidsskrift for Den Norske Laegeforening 2001;121(18):2203. - PubMed
Sunde 2008 {published data only}
    1. Sunde P, Tariq R. Ultrasound ‐ a good alternative to MR in shoulder problems [Ultralyd ‐ et godt alternativ til MR ved skulderlidelser]. Tidsskrift for Den Norske Laegeforening 2008;128(7):842. - PubMed
Taboury 1995 {published data only}
    1. Taboury J. Ultrasonography of the tendons of the rotator cuffs of the shoulder [Etude echographique des tendons des muscles rotateurs de l'epaule]. Annales de Radiologie 1995;38(5):275‐9. - PubMed
Takagishi 1993 {published data only}
    1. Takagishi K, Itoman M, Araki T, Nishimura A, Yamamoto M, Ikeda T. MR imaging of recurrent dislocation and impingement syndrome of the shoulder. Journal of Orthopaedic Surgery 1993;1(1):99‐101.
Takagishi 1996 {published data only}
    1. Takagishi K, Makino K, Takahira N, Ikeda T, Tsuruno K, Itoman M. Ultrasonography for diagnosis of rotator cuff tear. Skeletal Radiology 1996;25(3):221‐4. - PubMed
Teefey 2000 {published data only}
    1. Teefey SA, Hasan SA, Middleton WD, Patel M, Wright RW, Yamaguchi K. Ultrasonography of the rotator cuff: A comparison of ultrasonographic and arthroscopic findings in one hundred consecutive cases. Journal of Bone and Joint Surgery. American Volume 2000;82(4):498‐504. - PubMed
Teefey 2009 {published data only}
    1. Teefey SA, Petersen B, Prather H. Shoulder ultrasound vs MRI for rotator cuff pathology. PM & R : The Journal of Injury, Function, and Rehabilitation 2009;1(5):490‐5. - PubMed
Theodoropoulos 2010 {published data only}
    1. Theodoropoulos JS, Andreisek G, Harvey EJ, Wolin P. Magnetic resonance imaging and magnetic resonance arthrography of the shoulder: Dependence on the level of training of the performing radiologist for diagnostic accuracy. Skeletal Radiology 2010;39(7):661‐7. - PubMed
Tirman 1994 {published data only}
    1. Tirman PF, Bost FW, Steinbach LS, Mall JC, Peterfy CG, Sampson TG, et al. MR arthrographic depiction of tears of the rotator cuff: benefit of abduction and external rotation of the arm. Radiology 1994;192(3):851‐6. - PubMed
Torstensen 1999 {published data only}
    1. Torstensen ET, Hollinshead RM. Comparison of magnetic resonance imaging and arthroscopy in the evaluation of shoulder pathology. Journal of Shoulder and Elbow Surgery 1999;8(1):42‐5. - PubMed
Touzard 1991 {published data only}
    1. Touzard RC, Pigeau I, Doursounian L, Maigne JY, Vadrot D. Contribution of echogradient magnetic resonance imaging in the study of subacromial diseases. Surgical and arthrographic correlations [Apport de l'IRM par echo de gradient dans l'etude de la pathologie sous‐acromiale. Correlation chirurgicale et arthrographique]. Chirurgie 1991;117(7):569‐76. - PubMed
Toyoda 2005 {published data only}
    1. Toyoda H, Ito Y, Tomo H, Nakao Y, Koike T, Takaoka K. Evaluation of rotator cuff tears with magnetic resonance arthrography. Clinical Orthopaedics and Related Research 2005;(439):109‐15. - PubMed
Traughber 1992 {published data only}
    1. Traughber PD, Goodwin TE. Shoulder MRI: arthroscopic correlation with emphasis on partial tears. Journal of Computer Assisted Tomography 1992;16(1):129‐33. - PubMed
Traughber 1996 {published data only}
    1. Traughber P, Czech M. Accuracy of fat‐suppressed MR imaging of the shoulder for detection of partial‐thickness rotator cuff tears. Radiology 1996;198(1):293. - PubMed
Traughber 2006 {published data only}
    1. Traughber PD, Merandi S, Traughber KA. MR arthrography is not proven to be preferred baseline MRI examination. American Journal of Roentgenology 2006;186(1):265‐6. - PubMed
Tuite 1994 {published data only}
    1. Tuite MJ, Yandow DR, DeSmet AA, Orwin JF, Quintana FA. Diagnosis of partial and complete rotator cuff tears using combined gradient echo and spin echo imaging. Skeletal Radiology 1994;23(7):541‐5. - PubMed
Tuite 1995 {published data only}
    1. Tuite MJ, Yandow DR, Smet AA, Orwin JF, Quintana FA. Effect of field of view on MR diagnosis of rotator cuff tears. Skeletal Radiology 1995;24(7):495‐8. - PubMed
Tuite 1998 {published data only}
    1. Tuite MJ, Turnbull JR, Orwin JF. Anterior versus posterior, and rim‐rent rotator cuff tears: prevalence and MR sensitivity. Skeletal Radiology 1998;27(5):237‐43. - PubMed
Tuite 2001 {published data only}
    1. Tuite MJ, Asinger D, Orwin JF. Angled oblique sagittal MR imaging of rotator cuff tears: comparison with standard oblique sagittal images. Skeletal Radiology 2001;30(5):262‐9. - PubMed
Turrin 1997 {published data only}
    1. Turrin A, Cappello A, Mauri M, Zambelloni M. Echography of the shoulder with the patient supine in the diagnosis of rotator cuff rupture [L'ecografia della spalla con paziente supino nella diagnosi della rottura della cuffia dei rotatori]. Radiologia Medica 1997;94(3):170‐5. - PubMed
Vahlensieck 2001 {published data only}
    1. Vahlensieck M. On: Indirect MR arthrography in the diagnosis rotator cuff injuries [Zu: Indirekte MR‐Arthrographie in der Diagnostik von Rotatorenmanschettenlasionen]. ROFO. Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin 2001;173(2):161. - PubMed
Vander Maren 1995 {published data only}
    1. Vander Maren C, Shahabpour M, Willems S, Vande Berg B, Handelberg F, Malghem J. The value of MRI in the evaluation of lesions of the supraspinous muscle. Multicentric retrospective study of 66 records [Interet de l'I.R.M. dans le bilan lesionnel du supra‐epineux. Etude multicentrique retrospective de 66 dossiers]. Acta Orthopaedica Belgica 1995;61 Suppl 1:8‐13. - PubMed
Van Dyck 2009 {published data only}
    1. Dyck P, Gielen JL, Veryser J, Weyler J, Vanhoenacker FM, Glabbeek F, et al. Tears of the supraspinatus tendon: assessment with indirect magnetic resonance arthrography in 67 patients with arthroscopic correlation. Acta Radiologica 2009;50(9):1057‐63. - PubMed
Vanecek 2000 {published data only}
    1. Vanecek I, Kasparek R. Ultrasonographic examination of the rotator cuff of the shoulder: our eight‐year experience [Ultrasonograficke vysetreni rotatorove manzety ramenniho kloubu ‐ nase osmilete zkusenosti]. Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca 2000;67(5):316‐23. - PubMed
Van Holsbeeck 1995 {published data only}
    1. Holsbeeck MT, Kolowich PA, Eyler WR, Craig JG, Shirazi KK, Habra GK, et al. US depiction of partial‐thickness tear of the rotator cuff. Radiology 1995;197(2):443‐6. - PubMed
Van Moppes 1995 {published data only}
    1. Moppes FI, Veldkamp O, Roorda J. Role of shoulder ultrasonography in the evaluation of the painful shoulder. European Journal of Radiology 1995; Vol. 19, issue 2:142‐6. - PubMed
Waldt 2007 {published data only}
    1. Waldt S, Bruegel M, Mueller D, Holzapfel K, Imhoff AB, Rummeny EJ, et al. Rotator cuff tears: assessment with MR arthrography in 275 patients with arthroscopic correlation. European Radiology 2007;17(2):491‐8. - PubMed
Wallny 1999 {published data only}
    1. Wallny T, Wagner UA, Prange S, Schmitt O, Reich H. Evaluation of chronic tears of the rotator cuff by ultrasound. A new index. Journal of Bone and Joint Surgery. British Volume 1999;81(4):675‐8. - PubMed
Walz 2007 {published data only}
    1. Walz DM, Miller TT, Chen S, Hofman J. MR imaging of delamination tears of the rotator cuff tendons. Skeletal Radiology 2007;36(5):411‐6. - PubMed
Wang 1994 {published data only}
    1. Wang YM, Shih TT, Jiang CC, Su CT, Huang KM, Hang YS, et al. Magnetic resonance imaging of rotator cuff lesions. Journal of the Formosan Medical Association 1994;93(3):234‐9. - PubMed
Weinstabl 1988 {published data only}
    1. Weinstabl R, Gritzmann N, Hertz H. Significance of ultrasonography in the diagnosis of shoulder pathology [Stellenwert der Sonographie in der pathologischen Schulterdiagnostik]. Zeitschrift fur Unfallchirurgie, Versicherungsmedizin und Berufskrankheiten 1988;81(3):157‐64. - PubMed
Wiener 1993 {published data only}
    1. Wiener SN, Seitz WH Jr. Sonography of the shoulder in patients with tears of the rotator cuff: accuracy and value for selecting surgical options. American Journal of Roentgenology 1993;160(1):103‐7. - PubMed
Wilson 1994 {published data only}
    1. Wilson AJ. Is shoulder arthrography considered an acceptable alternative to MR imaging in the evaluation of rotator cuff tears?. American Journal of Roentgenology 1994;162(6):1495. - PubMed
Wnorowski 1997 {published data only}
    1. Wnorowski DC, Levinsohn EM, Chamberlain BC, McAndrew DL. Magnetic resonance imaging assessment of the rotator cuff: Is it really accurate?. Arthroscopy 1997;13(6):710‐9. - PubMed
Wu 2003 {published data only}
    1. Wu HP, Dubinsky TJ, Richardson ML. Association of shoulder sonographic findings with subsequent surgical treatment for rotator cuff injury. Journal of Ultrasound in Medicine 2003;22(2):155‐61. - PubMed
Yagci 2001 {published data only}
    1. Yagci B, Manisali M, Yilmaz E, Ozkan M, Ekin A, Ozaksoy D, et al. Indirect MR arthrography of the shoulder in detection of rotator cuff ruptures. European Radiology 2001;11(2):258‐62. - PubMed
Yamakawa 2001 {published data only}
    1. Yamakawa S, Hashizume H, Ichikawa N, Itadera E, Inoue H. Comparative studies of MRI and operative findings in rotator cuff tear. Acta Medica Okayama 2001;55(5):261‐8. - PubMed
Yeh 2003 {published data only}
    1. Yeh LR, Kuen‐Huang Chen C, Lai PH. MR arthrographic evaluation of the shoulder: Comparison of neutral position and ABER position. Chinese Journal of Radiology 2003;28(4):209‐16.
Yeu 1994 {published data only}
    1. Yeu K, Jiang CC, Shih TT. Correlation between MRI and operative findings of the rotator cuff tear. Journal of the Formosan Medical Association 1994;93(2):134‐9. - PubMed
Zehetgruber 2002 {published data only}
    1. Zehetgruber H, Lang T, Wurnig C. Distinction between supraspinatus, infraspinatus and subscapularis tendon tears with ultrasound in 332 surgically confirmed cases. Ultrasound in Medicine and Biology 2002;28(6):711‐7. - PubMed
Ziegler 2004 {published data only}
    1. Ziegler DW. The use of in‐office, orthopaedist‐performed ultrasound of the shoulder to evaluate and manage rotator cuff disorders. Journal of Shoulder and Elbow Surgery 2004;13(3):291‐7. - PubMed
Zlatkin 1989 {published data only}
    1. Zlatkin MB, Iannotti JP, Roberts MC, Esterhai JL, Dalinka MK, Kressel HY, et al. Rotator cuff tears: diagnostic performance of MR imaging. Radiology 1989;172(1):223‐9. - PubMed
Zlatkin 2004 {published data only}
    1. Zlatkin MB, Hoffman C, Shellock FG. Assessment of the rotator cuff and glenoid labrum using an extremity MR system: MR results compared to surgical findings from a multi‐center study. Journal of Magnetic Resonance Imaging 2004;19(5):623‐31. - PubMed

References to studies awaiting assessment

Engebretsen 1994 {published data only}
    1. Engebretsen L, Craig EV, Fritts HM. Evaluation of the rotator cuff with magnetic tomography [Evaluering av skulderens rotatormuskulatur med magnettomografi]. Tidsskrift for Den Norske Laegeforening 1994;114(6):682‐3. - PubMed
Farin 1990 {published data only}
    1. Farin P, Danner R, Jaroma H. The sonography of rotator cuff ruptures. The correlation of the sonographic, arthrographic and intraoperative findings in rotator cuff ruptures [Sonographie der Rotatorenmanschettenruptur. Korrelation sonographischer, arthrographischer und intraoperativer Befunde bei Rotatorenmanschettenrupturen]. ROFO. Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin 1990;153(6):711‐5. - PubMed
Guo 2000 {published data only}
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Habermeyer 1984 {published data only}
    1. Habermeyer P, Mayer R, Mayr B. Comparison of arthrography, computer tomography and ultrasonography in diagnosis of rotator cuff lesions [Vergleichende Diagnostik der Rotatoren‐verletzung durch Arthrographie, Computertomographie und Sonographie]. Zeitschrift fur Unfallchirurgie, Versicherungsmedizin und Berufskrankheiten 1984;77(3):121‐9. - PubMed
Hedtmann 1995 {published data only}
    1. Hedtmann A, Fett H. Ultrasonography of the shoulder in subacromial syndromes with disorders and injuries of the rotator cuff [Schultersonographie bei Subakromialsyndromen mit Erkrankungen und Verletzungen der Rotatorenmanschette]. Der Orthopäde 1995;24(6):498‐508. - PubMed
Heininger‐Biner 2000 {published data only}
    1. Heininger‐Biner K, Muller M, Hertel R. Diagnosis of rotator cuff rupture: correlation of clinical findings and magnetic resonance tomography with intraoperative findings [Diagnostik der Rotatorenmanschettenruptur: Korrelation des klinischen Befundes und der Magnetresonanztomographie mit dem intraoperativen Befund]. Zeitschrift fur Orthopadie und Ihre Grenzgebiete 2000;138(6):478‐80. - PubMed
Kayser 2005 {published data only}
    1. Kayser R, Hampf S, Pankow M, Seeber E, Heyde CE. Validity of ultrasound examinations of disorders of the shoulder joint [Validitat der sonographischen Untersuchung des Schultergelenkes ‐ Prospektive, randomisierte und doppelt blinde, arthroskopisch kontrollierte Studie an 239 Fallen]. Ultraschall in der Medizin 2005;26(4):291‐8. - PubMed
Kenn 2000 {published data only}
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Kumagai 1991 {published data only}
    1. Kumagai H, Mikasa M, Tanaka Y, Hashimoto S. MR arthrography with intraarticular Gd‐DTPA in the diagnosis of rotator cuff tears. Japanese Journal of Clinical Radiology 1991;36(4):455‐60.
Kumagai 1992 {published data only}
    1. Kumagai H. MR imaging of rotator cuff tears. Nippon Igaku Hoshasen Gakkai Zasshi 1992;52(2):172‐81. - PubMed
Kumagai 1995 {published data only}
    1. Kumagai H, Ito H, Kubo A. Comparison between T2*‐ and T2‐weighted images in diagnosing rotator cuff tears. Nippon Igaku Hoshasen Gakkai Zasshi 1995;55(3):133‐7. - PubMed
Labanauskaite 2002 {published data only}
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Manych 2007 {published data only}
    1. Manych M. MR arthrography enables accurate diagnosis of partial‐thickness rotator cuff tears [MR‐Arthrographie ermöglicht zuverlässige Diagnose]. RoFo. Fortschritte auf dem Gebiet der Rontgenstrahlen und der Bildgebenden Verfahren 2007;179(9):886.
Nagamori 1995 {published data only}
    1. Nagamori M, Okamura K, Usui M, Ishii S. Usefulness of MR imaging for rotator cuff tear. Hokkaido Journal of Orthopedic and Traumatic Surgery 1995;38(2):6‐9.
Qu 2008 {published data only}
    1. Qu N, Yao WW, Yang SX, Lu ZH. MR imaging diagnosis of shoulder joint injury. Chinese Journal of Radiology 2008;42(3):236‐41.
Rudolph 2000 {published data only}
    1. Rudolph J, Lorenz M, Schroder R, Sudkamp NP, Felix R, Maurer J. Indirect MR arthrography in the diagnosis of rotator cuff lesions [Indirekte MR‐Arthrographie in der Diagnostik von Rotatorenmanschettenlasionen]. RoFo: Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin 2000;172(8):686‐91. - PubMed
Sakuragi 1989 {published data only}
    1. Sakuragi K. Morphological and clinical study of shoulder joint diseases by ultrasonography. Journal of the Japanese Orthopaedic Association 1989;63(11):1330‐42. - PubMed
Sasaki 1991 {published data only}
    1. Sasaki T, Saito Y, Tarusawa K, Saikawa Y, Yodono H, Takekawa S, et al. MRI of the rotator cuff injury. Japanese Journal of Clinical Radiology 1991;36(4):461‐7.
Schedel 1990 {published data only}
    1. Schedel H, Hilbertz T, Fink U, Mayr B, Lehrberger K, Theermann R. Use of digital subtraction arthrography in lesions of the rotator cuff ‐‐ comparison with ultrasound [Einstz der Digitalen‐Subtraktions‐Arthrographie bei Lasionen der Rotatorenmanschette ‐ Vergleich mit Ultraschall]. Digitale Bilddiagnostik 1990;10(1):30‐5. - PubMed
Schroder 2003 {published data only}
    1. Schroder RJ, Bostanjoglo M, Kaab M, Herzog H, Hidajat N, Rottgen R, et al. Accuracy of routine MRI in lesions of the supraspinatus tendon ‐ comparison with surgical findings [Treffsicherheit der nativen und kontrastverstarkten MRT im Routineeinsatz bei Supraspinatussehnenrupturen ‐ Vergleich mit operativen Ergebnissen]. RoFo. Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin 2003;175(7):920‐8. - PubMed
Sell 1992 {published data only}
    1. Sell S, Konig H, Gutsche I, Kusswetter W. Nuclear magnetic resonance tomography and sonography in diagnosis of lesions of the rotator cuff [Die Kernspintomographie und Sonographie in der Diagnostik von Lasionen der Rotatorenmanschette]. Sportverletz Sportschaden 1992;6(1):20‐3. - PubMed
Sperner 1993 {published data only}
    1. Sperner G, Resch H, Golser K, Lener M, Seykora P. The value of sonography in ruptures of the rotator cuff [Die Wertigkeit der Sonographie bei Rupturen der Rotatorenmanschette]. Der Unfallchirurg 1993;96(3):119‐23. - PubMed
Vahlensieck 1996 {published data only}
    1. Vahlensieck M, Sommer T. Indirect MR arthrography of the shoulder. An alternative to direct MR arthrography? [Indirekte MR‐Arthrographie der Schulter. Alternative zur direkten MR‐Arthrographie?]. Der Radiologe 1996;36(12):960‐5. - PubMed
Wallny 2000 {published data only}
    1. Wallny T, Schild RL, Perlick L, Schultz Bertelsbeck D, Schmitt O. Three‐dimensional ultrasound evaluation of the rotator cuff. Preliminary results of clinical application [Die dreidimensionale Ultraschalluntersuchung der Rotatorenmanschette. Erste Ergebnisse in der klinischen Anwendung]. Ultraschall in der Medizin 2000;21(4):180‐5. - PubMed
Wang 2009 {published data only}
    1. Wang YL, Guo XG, Cheng LQ, Wei M, Xu X, Ma L. MR image‐guided anterior direct arthrography of the shoulder. Zhongguo Gu Shang 2009;22(9):665‐7. - PubMed

Additional references

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Bigliani 1991
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Bossuyt 2003
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Chu 2006
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Clark 1992
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