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Ultrasound: Can it replace MRI in the evaluation of rotator cuff tears?


Diagnostic ultrasound is more accessible than ever. Being able to combine imaging while performing a clinical orthopedic exam can help determine the best possible course of treatment, quickly. Multiple visits, waiting on an MRI and results, and following insurance-based protocols of stages of imaging and treatment, can slow down the diagnostic process and even prevent or delay a correct diagnosis of the causes for chronic shoulder pain.


There is a significant amount of research that has compared diagnostic ultrasound imaging for rotator cuff injuries with MRI. The consensus is that ultrasound rivals an MRI when looking for tears of tendons, full and partial thickness, as well as for inflammation and swelling.




“Ultrasound and MRI are comparable in both sensitivity and specificity. Since US is less expensive and more available, it could be considered as the screening method when rotator cuff integrity is the main question, if well-trained radiologists and high resolution equipments are available.” S Saraya


Why Ultrasound is not in every family practice, physical therapy and chiropractic clinic?


The learning curve with using ultrasound for diagnostic evaluation of musculoskeletal problems is difficult. There is an art form to holding the sound head and getting the best image possible. It also requires a high level of knowledge of 3D anatomy, especially from a cross-section view. It doesn’t take much to angle the sound waves obliquely and lose your place. Finding a radiologist that can assist in the diagnosis of rotator cuff damage can be difficult. 


“Tears of the supraspinatus can be identified using ultrasound and MRI with comparable accuracy.” A Apostolopoulos


Here is my perspective on diagnostic ultrasound in an orthopedic practice. We use ultrasound to routinely look at ‘normal’. When the signal is not within the norm then this helps us decide if we make a recommendation to a different specialist, request a steroid injection of the shoulder, or order an MRI. If the ultrasound is ‘normal’, then we know that this is a mechanical problem and manual medical treatments will have a very high chance of success, combined with dry needling and a home program of restoring movement.



Diagnostic Ultrasound has the same sensitivity and specificity as MRI for RTC tears



There is another component of the shoulder diagnostic ultrasound and that is for assessing muscle mobility, myofascial trigger points, and joint motion and mechanics. While the probe is placed longitudinally along the supraspinatus with the humeral head and acromial process are imaged. The patient is asked to abduct or elevate the shoulder 30 to 40 degrees. Humeral head mobility is assessed to see if there is a downward motion of the humerus and if the rotator cuff is being pinched. This grinding action of the humerus against the acromial process creates chronic rotator cuff inflammation that will degrade the tendons over time. This will weaken the tissue increasing the risk of a bigger injury and tearing of the rotator cuff. This finding is consistent with shoulder impingement and is a biomechanical problem that responds well to manual treatments. Here is a video of a personal trainer that tore his rotator cuff after years of chronic shoulder pain. His tear occurred during a bench press exercise.



Want to know more about the one finding that is common with every shoulder problem? Check out this link.




 “In-office shoulder ultrasonography had comparable accuracy to magnetic resonance imaging for detecting rotator cuff tears and lesions of the biceps tendon, as well as for classifying the size of rotator cuff tears” T. Kobayashi


Shoulder Ultrasound: What you need to know.


This article gives a nice overview of shoulder diagnostic ultrasound and the process of imaging the shoulder. Probe placement with images for reference are provided.


“Shoulder ultrasound is consistently used in the assessment of rotator cuff and is as accurate as magnetic resonance imaging in the detection of rotator cuff tear.”

J P Singh


The future is diagnostic ultrasound for orthopedic problems. Making this readily available for our clients will improve our shoulder evaluations and treatments.


Ultrasound: Can it replace MRI in the evaluation of rotator cuff tears?