Owen D. Williamson, MD
How accurate is diagnostic ultrasonography in adults with suspected subacromial disorders?
Included studies compared ultrasonography using linear array transducers with a frequency of ≥ 7.5 MHz with magnetic resonance imaging, surgery, or radiography in adults with suspected subacromial disorders, including subacromial bursitis or rotator cuff disorders of tendinopathy, calcifying tendonitis, and tears. Outcomes included sensitivity, specificity, and likelihood ratios.
MEDLINE, EMBASE/Excerpta Medica (2001 to June 2010), a previous systematic review (studies published between 1985 and October 2001), and reference lists of included studies were searched for studies that described the criteria for pathology, scanning techniques, and/or surgery or referred to established techniques; were published in English, French, German, or Dutch in peer-reviewed journals; and provided data required for generation of 2 x 2 tables. 23 studies (n = 2045, mean age 52 y) met the selection criteria. 22 studies reported full-thickness tears, 15 reported partial-thickness tears, 3 reported subacromial bursitis, and calcifying tendonitis and tendinopathy were each reported in 2 studies. 8 studies were prospective, 4 were retrospective, and 11 were unclear. Most patients had suspected rotator cuff disorders, and conservative treatment had failed.
47% of patients had full-thickness tears, and 24% had partial-thickness tears. The Table shows the diagnostic test characteristics of ultrasonography for rotator cuff tears. Data for subacromial bursitis, tendinopathy, and calcifying tendonitis were not pooled because each outcome was reported in < 4 studies. For subacromial bursitis, sensitivity ranged from 79% to 81% and specificity from 94% to 98%. Sensitivity for tendinopathy ranged from 67% to 93% and specificity from 88% to 100%. For calcifying tendonitis, sensitivity in both studies was 100%, and specificity ranged from 85% to 98%.
In adults with suspected subacromial disorders, ultrasonography has high sensitivity and specificity for diagnosing full-thickness rotator cuff tears and moderate sensitivity and high specificity for diagnosing partial-thickness tears.
Test characteristics of ultrasonography for diagnosing rotator cuff tears in adults with suspected subacromial disorders*
*CI and diagnostic terms defined in Glossary. The gold standard was magnetic resonance imaging or surgery.
Williamson OD. Review: Ultrasonography is accurate for diagnosing rotator cuff tears in adults. Ann Intern Med. 2011;154:JC4–11. doi: 10.7326/0003-4819-154-8-201104190-02011
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Published: Ann Intern Med. 2011;154(8):JC4-11.
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