Shoulder disorders

The shoulder is the most often anatomical region evaluated by ultrasound. It includes the systematic study of the rotator cuff tendons, the long head tendon of the biceps, subacromial subdeltoid bursa, acromioclavicular joints, intra-articular effusion and dynamic research of shoulder impingement syndrome. It assesses the presence or absence of inflammatory diseases, tears and calcifications and their type, size and number. A recent study showed a comparable sensitivity and specificity of ultrasound and MRI for the detection and characterization of tears in the rotator cuff.

The prevalence of shoulder disorders is very high in adults and the type of injury varies by age group. Patients between the age of 20 and 40 years old, suffer more frequently from injuries related to instability of the shoulder. The MRI arthrography is the modality of choice for investigating these patients. The tears of the rotator cuff, chronic tendinopathy and the subacromial bursopathy, with or without an impingement syndrome, gradually increase with age, starting from 40 years old.Asymptomatic rotator cuff tears become very common after the age of 65 years old.

Shoulder calcified tendinitis Shoulder calcified tendinitis have a female predominance. It primarily affects the shoulders of 30 to 60 years old persons. The pain is usually associated with large calcifications (> 1cm) located mostly in the supraspinatus tendon (on the top of the shoulder). They cause a thickening of the tendon associated with an impingement syndrome causing irritation of the tendon (chronic tendinopathy). Eventually, if no action is taken, these calcifications soften and eventually rupture and resolve spontaneously causing a sharp pain for a few days followed by a gradual improvement. Ultrasound will evaluate these tendon calcifications and the need to perform a percutaneous ultrasound guided aspiration for calcifications > 1cm).

Idiopathic adhesive capsulitis usually affects women between 40 and 60 years while capsulitis associated with diabetes occurs with equal frequency in men and women and is usually bilateral (up to 40-50% of cases ). Adhesive capsulitis schematically evolves in three phases: A painful phase of gradual onset with a pain of varying intensity, especially at night; a phase of stiffness objectified by a limitation of active and passive elevation and external rotation with stop feeling at clinical examination; and a recovery phase lasting several months. The diagnosis of the adhesive capsulitis is clinical. The semiotics of capsulitis at ultrasound and MRI exams is still inconsistent and not very specific. The ultrasound examination will however be preferred as it allows to exclude a pathology of the rotator cuff and evaluate the range of motion.

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