Role of Ultrasonography in the Evaluation of Painful Shoulder

Abstract

Introduction: Shoulder pain is a common problem encountered in clinical practice. It is often disabling to the patient and results in considerable morbidity and unsatisfactory outcomes if therapy is not instituted effectively or delayed. Ultrasonography is a rapid, real time and cost effective alternative to MRI and diagnostic arthroscopy. Here, we compare sonographic diagnosis with clinical diagnosis in the diagnosis of the various causes of shoulder pain.

Methods: This descriptive study was done in the radiology department of Nepalgunj Medical College Teaching Hospital, Kohalpur during a time period of 18 months. About 30 cases of shoulder pain that had been evaluated clinically by a single examiner in the orthopedics OPD were diagnosed with the help of sonography. Correlation between clinical diagnosis and USG diagnosis was done.

Results: Clinically, most of these cases were provisionally diagnosed as Frozen shoulder 9 (30%) followed by Cuff tendinopathy 8 (26.66%) and Impingement syndrome 6 (20%). However, USG of the shoulder revealed rotator cuff tendinopathy and cuff tear (n=6 each) to be the main etiology behind shoulder pain. Supraspinatus calcific tendinopathy was found in 4 individuals. Hence, it was seen that the diagnosis of the causes of shoulder pain with clinical tests alone is unsatisfactory. Out of 30 cases, clinical examination could correctly diagnose only 20% of the time (n=6). 73% of the time (n=20), USG showed a different diagnosis compared to clinical examination whereas in 4 (7%) cases a more specific diagnosis was reached.
Conclusions: We conclude that USG is more specific and frequently leads to increased diagnostic accuracy when compared to clinical examination.