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. 2026 Jan 7;27(1):98.
doi: 10.1186/s12891-026-09487-5.

Clinical application of multi-parameter ultrasonic assessment for grading rotator cuff injuries: development and validation of a novel scoring system

Xiaona Cai  1 , Chenying Su  2 , Yu Zhan  1 , Rongrong Miao  1 , Chenxian Su  3
Affiliations

Clinical application of multi-parameter ultrasonic assessment for grading rotator cuff injuries: development and validation of a novel scoring system

Xiaona Cai et al. BMC Musculoskelet Disord. .

Abstract

Background: Rotator cuff injuries, a leading cause of shoulder pain and dysfunction, present significant diagnostic challenges. While MRI is the diagnostic gold standard, ultrasonography (US) offers a cost-effective alternative but lacks standardization. This study addresses this gap by developing and validating a novel multiparameter ultrasonic scoring system to increase the diagnostic accuracy and clinical applicability of shoulder ultrasonography for rotator cuff pathology.

Methods: A retrospective diagnostic accuracy study of 252 patients with suspected rotator cuff injury was analyzed. Independent predictors identified through multivariable logistic regression included tear width, tendon swelling, synovial effusion, and vascular score, which were integrated into a weighted composite scoring system. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis.

Results: The scoring system demonstrated excellent discriminative ability, with an area under the ROC curve (AUC) of 0.92. An optimal diagnostic threshold of > 4 points yielded a sensitivity of 82.2% and a specificity of 94.0%. This system enabled risk stratification into three tiers. Multivariate analysis confirmed tear width, degree of tendon swelling, synovial effusion, and vascular score as key diagnostic indicators.

Conclusion: This ultrasonic scoring system introduces a standardized, quantitative approach to rotator cuff diagnostics, designed to reduce interobserver variability and enhance diagnostic reliability. By stratifying patients into risk categories, it facilitates personalized treatment planning. However, as this represents the initial development and internal validation phase, further prospective and external validation studies are warranted to confirm its broader applicability.

Keywords: Multiparameter ultrasonic assessment; Novel scoring system; Rotator cuff injuries.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Clinical Research Ethics Committee of the First Affiliated Hospital of Wenzhou Medical University (No. KY2025-R152) and study adhered to the Declaration of Helsinki. According to the regulations of the Clinical Research Ethics Committee of the First Affiliated Hospital of Wenzhou Medical University, and in compliance with the relevant provisions of China’s Good Clinical Practice (GCP) and the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use - Good Clinical Practice (ICH-GCP): “If the study only involves the collection of previously obtained medical treatment information/specimens for retrospective research purposes, informed consent can be waived.” This research has been approved by the Clinical Research Ethics Committee of the First Affiliated Hospital of Wenzhou Medical University and is considered to meet the requirements for informed consent exemption. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Ultrasound, magnetic resonance imaging (MRI) images, and intraoperative photographs of typical rotator cuff tendon tears. A Ultrasound image of a full-thickness tear of the rotator cuff. The arrow indicates the site of the tendon tear. B Intraoperative images of the patient during the arthroscopic surgery. The arrow indicates the site of the tendon tear. C Magnetic resonance transverse image of full-thickness tear of the rotator cuff. The arrow indicates the site of the tendon tear. D Magnetic resonance coronal image of full-thickness tear of the rotator cuff. The arrow indicates the site of the tendon tear
Fig. 2
Fig. 2
Comparative ROC analysis of multivariate diagnostic indicators for rotator cuff injury: Validation of a comprehensive scoring system. ROC curve analysis demonstrated excellent diagnostic performance, with an AUC of 0.923 (95% CI 0.887–0.959). ROC: receiver operating characteristic; AUC: area under the ROC curve; RA: rheumatoid arthritis.
Fig. 3
Fig. 3
Scatter plot showing the distribution of scores between the positive group and the negative group. A total scores > 4 indicates a high probability of rotator cuff injury. In the group with scores > 4, there were a total of 194 cases, among which 175 were positive cases, and the PPV was 90.2%. In the group with scores ≤ 4, which consisted of 58 cases, the NPV was 91.4%.
See this image and copyright information in PMC

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