PREVALENCE AND CHARACTERIZATION OF ROTATOR CUFF TEAR IN PATIENTS HAVING FROZEN SHOULDER BY ULTRASOUND AND MAGNETIC RESONANCE IMAGING

Main Article Content

Dr. Laxmidhara Padhy
Dr. Satyashree Ray
Dr. Swagat Soubhagya Mohapatra
Dr. Satyajeet Ray

Keywords

Rotator cuff tear, frozen shoulder, PTT(partial thickness tear), FTT(full thickness tear)

Abstract

Background: Clinical examinationof shoulder alone does not provide all diagnostic information required for treatment. Evaluation of patient with shoulder pain often involves assessment of the rotator cuff with a diagnostic test such as high-resolution ultrasonography or MRI. Sensitivity and specificity for both USG and MRI for diagnosis of rotator cuff tear are almost similar but they are strongly correlated with  detection of partial thickness tear and full thickness tear.


Methods: A Prospective study of thirty patients undergoing Ultrasonography and Magnetic resonance imaging for patients having Frozen shoulder at SCB Medical college hospital after ethical clearance from Institutional Ethics committee and consents taken from patients. Detailed history, clinical examinations and routine investigations were done prior to radiological investigations.


Results: Partial thickness tear (PTT) as detected by USG were 11 out of 30 with sensitivity,   specificity, PPV, NPV, Likelihood+ve, Likelihood-ve, disease prevalence,diagnostic accuracy and diagnostic odds ratio being 58.3%,100%,100%,78.2%,58.3,0.42,60%,83.3% and 138.8 respectively whereas that of MRI were 65%,78%,100%,60%,2.95,0.44,59.7%,80% and 6.7. ROC Curve of USG and MRI for diagnosis of PTT revealed AUC as 0.4 and 0.6 respectively which has no discrimination for USG but MRI with AUC 0.6 had discrimination for PTT. Similarly for Full thickness tear(FTT), the diagnostic accuracy tests of USG and MRI were compared. The ROC curve and AUC  which revealed 0.5 for USG and 0.5 for MRI which proves no discrimination for the tests


Conclusion: Disease prevalence for rotator cuff tear in ultrasonography differs from MRI as sensitivity, specificity and diagnostic accuracy were more in MRI. Partial thickness tear diagnosed by USG were confirmed by MRI which had revealed more sensitivity, specificity, disease prevalence and diagnostic accuracy. Most of the diseases /pathologies significantly correlated with the diagnosis by MRI.


 

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References

1. Millar NL, Meakins A, Struyf F, Willmore E, Campbell AL,Kirwan PD, Akbar M, Moore L,Ronquillo JC, Murrell GAC, Rodeo SA. Frozen shoulder. Nat Rev Dis Primers.2022 Sep 8;8(1):59. Doi:10.1038/s41572-022-00386-2PMID:36075904.
2. Moosikasuwan JB, Miller TT, Burke BJ. Rotator cuff tears: clinical, radiographic, and US findings. Radiographics.2005 Nov-Dec;25(6):1591-607. Doi:10.1148/rg.256045203. PMID:162841137.
3. Burge AJ, Nwawka OK, Berkowitz JL, Potter HG. Imaging of inflammatory Arthritis in Adults: Status and perspectives on the use of Radiographs, Ultrasound, and MRI . Rheum Dis Clin North Am.2016 Nov;42(4):561-585. Doi:10. 1016/j.rdc.2016.07.001. PMID: 27742015.
4. Brenneke SL, Morgan CJ. Evaluation of ultrasonography as a diagnostic technique in the assessment of rotator cuff tendon tears. Am J Sports Med. 1992 May-jun;20(3):287-9. Doi:10.1177/036354659202000309.PMID;1636859.
5. Labanauskaite G. Usefulness of ultrasonography in the diagnosis rotator cuff tears. Medicine 2002;38(2):131-4. Lithuanian. PMID:12474728
6. A prospective Comparative study of high resolution Ultrasound and MRI in the diagnosis of Rotator cuff tears in a tertiary hospital of north India. Pol J Radiol.2016:81:491-497. Doi10.12659/PJR.897830 PMID:27800039
7. Osborne JD, Gowda AL, Wiater B, Wiater JM. Rotator cuff rehabilitation: current theories and practice. Phys Sportsmed. 2016;44(1):85-92. doi: 10.1080/00913847.2016.1108883. Epub 2015 Nov 7. PMID: 26548634.
8. Brinkman JC, Zaw TM, Fox MG, Wilcox JG, Hattrup SJ, Chhabra A, Neville MR, Hartigan DE. Calcific Tendonitis of the Shoulder: Protector or Predictor of Cuff Pathology? A Magnetic Resonance Imaging-Based Study. Arthroscopy. 2020 Apr;36(4):983-990. doi: 10.1016/j.arthro.2019.11.127. Epub 2019 Dec 7. PMID: 31816365.
9. Kim SK, Kim HN, Moon ES, Lim KY, Cho NY, Kim MS. Corrigendum: Inflammatory Cytokine Expressions of the Subacromial Bursitis and Glenohumeral Joint Synovitis in the Patients with Full Thickness Rotator Cuff Tear. Clin Shoulder Elb. 2018 Mar 1;21(1):56. doi: 10.5397/cise.2018.21.1.56. Erratum for: Clin Shoulder Elb. 14:172. PMID: 33330152; PMCID: PMC7726369.
10. Salek KM, Mannan M, Chowdhury AZ, Haque MA, Kaiser MS, Nabi S, Ferdousee RA, Paul BK, Ahmed SM, Khan M, Begum M. Comparison between ultrasound and plain X-ray in evaluating the cause of shoulder pain. Mymensingh Med J. 2011 Jan;20(1):16-21. PMID: 21240157.
11. Crossan K, Rawson D. Shoulder Arthrogram. 2023 Apr 3. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 35593869.
12. Rutten MJ, Spaargaren GJ, van Loon T, de Waal Malefijt MC, Kiemeney LA, Jager GJ. Detection of rotator cuff tears: the value of MRI following ultrasound. Eur Radiol. 2010 Feb;20(2):450-7. doi: 10.1007/s00330-009-1561-9. Epub 2009 Sep 2. PMID: 19727754; PMCID: PMC2814028.
13. Fritz LB, Ouellette HA, O'Hanley TA, Kassarjian A, Palmer WE. Cystic changes at supraspinatus and infraspinatus tendon insertion sites: association with age and rotator cuff disorders in 238 patients. Radiology. 2007 Jul;244(1):239-48. doi: 10.1148/radiol.2441050029. PMID: 17581904.
14. Bianchi S, Martinoli C. Detection of loose bodies in joints. Radiol Clin North Am. 1999 Jul;37(4):679-90. doi: 10.1016/s0033-8389(05)70123-8. PMID: 10442075.
15. Hedtmann A, Fett H. Sonographie der Rotatorenmanschette [Ultrasound diagnosis of the rotator cuff]. Orthopade. 2002 Mar;31(3):236-46. German. doi: 10.1007/s00132-001-0266-9. PMID: 12017847.
16. Choo HJ, Lee SJ, Kim JH, Kim DW, Park YM, Kim OH, Kim SJ. Delaminated tears of the rotator cuff: prevalence, characteristics, and diagnostic accuracy using indirect MR arthrography. AJR Am J Roentgenol. 2015 Feb;204(2):360-6. doi: 10.2214/AJR.14.12555. PMID: 25615759.
17. Moosmayer S, Smith HJ, Tariq R, Larmo A. Prevalence and characteristics of asymptomatic tears of the rotator cuff: an ultrasonographic and clinical study. J Bone Joint Surg Br. 2009 Feb;91(2):196-200. doi: 10.1302/0301-620X.91B2.21069. PMID: 19190053.
18. de Jesus JO, Parker L, Frangos AJ, Nazarian LN. Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: a meta-analysis. AJR Am J Roentgenol. 2009 Jun;192(6):1701-7. doi: 10.2214/AJR.08.1241. PMID: 19457838.