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. 2014 Nov 17;4(3):391-7.
eCollection 2014 Jul.

Classification of rotator cuff tendinopathy using high definition ultrasound

Hannah Hinsley  1 , Alex Nicholls  1 , Michael Daines  1 , Gemma Wallace  1 , Nigel Arden  1 , Andrew Carr  1
Affiliations

Classification of rotator cuff tendinopathy using high definition ultrasound

Hannah Hinsley et al. Muscles Ligaments Tendons J. .

Abstract

Background: ultrasound is a valid cost effective tool in screening for rotator cuff pathology with high levels of accuracy in detecting full-thickness tears. To date there is no rotator cuff tendinopathy classification using ultrasound. The aims of this study are to define a valid high-definition ultrasound rotator cuff tendinopathy classification, which has discriminate validity between groups based upon anatomical principles.

Methods: 464 women, aged 65-87, from an established general population cohort underwent bilateral shoulder ultrasound and musculoskeletal assessment. Sonographer accuracy was established in a separate study by comparing ultrasound findings to the gold standard intra-operative findings.

Results: there were 510 normal tendons, 217 abnormal tendons, 77 partial tears, and 124 full-thickness tears. There was no statistical difference in age or the proportion with pain between the abnormal enthesis and partial tear groups, however both groups were statistically older (p<0.001) and had a greater proportion with pain (p<0.001 & p=0.050) than normal tendons. The full-thickness tears were statistically older than normal tendons (p<0.001), but not abnormal/partially torn tendons. The proportion with pain was significantly greater than both groups (p<0.001 & p=0.006). Symptomatic shoulders had a larger median tear size than asymptomatic shoulders (p=0.006). Using tear size as a predictor of pain likelihood, optimum sensitivity and specificity occurred when dividing tears into groups up to 2.5cm and >2.5cm, which corresponds with anatomical descriptions of the width of the supraspinatus tendon.

Conclusion: the classification system is as follows: Normal Tendons; Abnormal enthesis/Partial-thickness tear; Single tendon full-thickness tears (0-2.5cm); Multi-tendon full-thickness tears (>2.5cm).

Keywords: classification; high-definition ultrasound; rotator cuff.

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