European Journal of Radiology 35 (2000) 119 – 125 Imaging of degenerative and posttraumatic disease in the shoulder joint with ultrasound Marco Zanetti *, Juerg Hodler Department of Radiology, Orthopedic Uniersity Hospital Balgrist, Uniersity of Zurich, Forchstrasse 340, CH-8008 Zurich, Switzerland Received 5 May 2000; accepted 8 May 2000 Abstract This article reviews the examination technique of shoulder ultrasound, normal and abnormal ultrasound findings in acute (posttraumatic) and chronic (degenerative) lesions. Moreover, it reviews the effectiveness of ultrasound in relation to magnetic resonance (MR) imaging. Most authors report that full-thickness tears of the supraspinatus can reliably be diagnosed by ultrasound. However, the simple diagnosis of a full-thickness rotator cuff tear is no longer sufficient for surgical management. The precise localization and size of rotator cuff tears as well as the extent of muscle degeneration is important for surgical planning. For this aspect and for partial-thickness tears of the supraspinatus, for subscapularis lesions as well as for lesions of the long biceps tendons there is no consensus regarding the diagnostic value of ultrasound. To the present, ultrasound (contrary to MR imaging) has failed to demonstrate that it consistently influences the clinician’s degree of confidence in the clinical diagnosis or the treatment plan. Therefore, some orthopedic surgeons prefer MR imaging to ultrasound in the evaluation of rotator cuff tears and other abnormalities of the glenohumeral joint. Moreover, MR imaging, especially when combined with arthrography, represents a one-step investigation, which not only allows for assessment of rotator cuff lesion but also of lesions of the labrum (Bankart lesions, SLAP lesions), the joint capsule and the biceps tendon. It also demonstrates muscle atrophy, which represents an important predictor of surgical outcome in rotator cuff repair. © 2000 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Ultrasound; Ultrasound, comparative studies; Shoulder, US; Shoulder, MR; Shoulder, injuries; Shoulder, abnormalities www.elsevier.nl/locate/ejrad 1. Introduction Musculoskeletal ultrasound has several advantages when compared with competing imaging methods such as computed tomography (CT), CT arthrography, mag- netic resonance (MR) imaging, and MR arthrography. It is non-invasive, allows dynamic investigations, and is widely available and relatively inexpensive on a per-ex- amination basis. On the other hand, due to large num- bers of examinations performed the cost of ultrasound for the health care systems are significant. The total charges for ultrasound in Germany 1994 were higher than the costs for CT and MR imaging [1]. Therefore, the effectiveness of musculoskeletal ultra- sound should be proved in a similar fashion as has been required for CT and MR imaging. Fryback and Thorn- bury [2] emphasized that not only the technical quality of the images and the diagnostic accuracy has to be considered when the effectiveness of diagnostic imaging is assessed. It is more important to demonstrate the effect of the diagnostic information on the clinician’s thinking and on therapeutic procedures. This article reviews the examination technique of shoulder ultrasound, normal and abnormal ultrasound findings in acute (posttraumatic) and chronic (degener- ative) lesions. Moreover, it reviews the effectiveness of ultrasound in comparison to MR imaging. 2. Examination technique Currently, linear transducers with frequencies in the range 5–13 MHz are used for ultrasound of the muscu- loskeletal system. When frequencies in the range 9 – 13 MHz are employed an in-plane spatial resolution of 0.2–0.4 mm can be expected [3], which is even higher * Corresponding author. Tel.: +41-1-3861230; fax: +41-1- 3863319. E-mail address: mzanetti@balgrist.unizh.ch (M. Zanetti). 0720-048X/00/$ - see front matter © 2000 Elsevier Science Ireland Ltd. All rights reserved. PII:S0720-048X(00)00227-8