Musculoskeletal injuries, particularly rotator cuff tears, are common in sport and can significantly impact athletes' performance and recovery. The rotator cuff stabilizes the glenohumeral joint, with the supraspinatus muscle the most susceptible to injury due to its central role in abduction and stabilization. Rotator cuff tears in athletes are in general the result of chronic microtrauma in an overused shoulder, but they can result after direct acute trauma. Sports-specific movements, such as overhead throwing, repetitive abduction, or heavy lifting, predispose athletes to different injury patterns. Magnetic resonance imaging plays a central role in the diagnosis and management of rotator cuff tears, providing detailed insight into tendon integrity, muscle changes, and associated labral or bone pathology. Return-to-play decisions depend on the severity of the injury, the management approach, and complex multidisciplinary considerations. Rehabilitation protocols are critical, with most athletes returning to sport, often at preinjury levels.

To develop and validate a deep learning system with guided diffusion-based data augmentation for grading partial-thickness supraspinatus tendon (SST) tears and to compare its performance with experienced radiologists, including external validation.

This retrospective study included 1150 patients with arthroscopically confirmed SST tears, divided into a training set (741 patients), validation set (185 patients), and internal test set (185 patients). An independent external test set of 224 patients was used for generalizability assessment. To address data imbalance, MRI images were augmented using a guided diffusion model. A ResNet-34 model was employed for Ellman grading of bursal-sided and articular-sided partial-thickness tears across different MRI sequences (oblique coronal [OCOR], oblique sagittal [OSAG], and combined OCOR+OSAG). Performance was evaluated using AUC and precision-recall curves, and compared to three experienced musculoskeletal (MSK) radiologists. The DeLong test was used to compare performance across different sequence combinations.

A total of 26,020 OCOR images and 26,356 OSAG images were generated using the guided diffusion model. For bursal-sided partial-thickness tears in the internal dataset, the model achieved AUCs of 0.99, 0.98, and 0.97 for OCOR, OSAG, and combined sequences, respectively, while for articular-sided tears, AUCs were 0.99, 0.99, and 0.99. The DeLong test showed no significant differences among sequence combinations (P=0.17, 0.14, 0.07). In the external dataset, the combined-sequence model achieved AUCs of 0.99, 0.97, and 0.97 for bursal-sided tears and 0.99, 0.95, and 0.95 for articular-sided tears. Radiologists demonstrated an ICC of 0.99, but their grading performance was significantly lower than the ResNet-34 model (P<0.001). The deep learning system improved grading consistency and significantly reduced evaluation time, while guided diffusion augmentation enhanced model robustness.

The proposed deep learning system provides a reliable and efficient method for grading partial-thickness SST tears, achieving radiologist-level accuracy with greater consistency and faster evaluation speed.

Trauma is a predominant cause of acute shoulder pain, commonly secondary to fractures (clavicle, scapula, or proximal humerus) or soft tissue injuries (typically involving the rotator cuff, acromioclavicular ligaments, or labroligamentous complex). Radiography is the imaging modality of choice for initial assessment of acute shoulder pain and identification of potential fractures. In cases where radiographs yield normal or inconclusive results, additional imaging modalities such as ultrasound, MRI, or CT of the shoulder without contrast, or MR or CT arthrography, may be useful to diagnose the underlying pathology. These modalities aid in the detection of conditions including nondisplaced fractures, tears of the labrum and rotator cuff, as well as detailed assessment of soft tissue and bony injury following glenohumeral joint dislocation. This document presents a comprehensive review of the evidence supporting or refuting the use of various imaging modalities in diagnosing acute shoulder pain. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Rotator cuff (RC) tears are a common cause of shoulder pain and, depending on the tear pattern, can substantially limit daily activities and affect quality of life. After a tendon tear, the RC muscle undergoes degenerative changes, including fatty degeneration and volume atrophy. The extent of fatty muscle degeneration has been associated with poorer functional and surgical outcomes after RC reconstruction, and the evaluation of the RC muscles is one of the most important factors for deciding whether to perform an RC repair. A variety of qualitative and quantitative methods are available to assess RC fatty muscle degeneration and volume atrophy based on MRI. This review provides a detailed overview of the RC muscle assessment, including qualitative measurements to assess the RC muscles, such as Goutallier grading, tangent sign, and fish backbone sign. Another focus is state-of-the-art quantitative MRI techniques, including chemical shift-based techniques such as single-voxel MR spectroscopy, multipoint water-fat separation, and MR relaxometry. Furthermore, the clinical relevance of qualitative and quantitative intramuscular fat assessment is addressed, and its potential importance for treatment planning and patient outcomes is discussed.

Subacromial pain syndrome has no universally accepted definition. Patients with shoulder pain are often diagnosed with subacromial pain syndrome without consideration of conflicting or concomitant diagnoses.

To investigate the prevalence of conflicting and concomitant diagnoses in patients with signs and symptoms of subacromial pain syndrome.

Cross-sectional study; Level of evidence, 3.

Using standardized diagnostic criteria, a prospective cohort of patients with signs and symptoms of subacromial pain syndrome was divided into 2 mutually exclusive groups: (1) patients with conflicting diagnoses-e.g., frozen shoulder or glenohumeral osteoarthritis (OA); (2) patients with subacromial pain syndrome. Patients with subacromial pain syndrome were further divided into 2 groups: (1) isolated subacromial pain syndrome; (2) subacromial pain syndrome with concomitant diagnoses-e.g., acromioclavicular OA, full-thickness rotator cuff tears, shoulder instability, long head biceps tendon pathology, labral lesions, and calcified tendinopathy. Standardized physical examination tests, radiographs, ultrasound, and magnetic resonance imaging scans were utilized. Tests were performed by experienced orthopaedic specialists in accordance with predefined standardized protocols.

We systematically screened 3321 patients, of whom 576 had signs and symptoms of subacromial pain syndrome (mean age, 56 years; 57% women). Of these, 168 (29%) patients had conflicting diagnoses, with frozen shoulder accounting for the majority of these diagnoses. The remaining 408 patients were diagnosed with subacromial pain syndrome. Of these, 172 (42%) had at least 1 concomitant diagnosis, and 55 (13%) had multiple concomitant diagnoses. In total, 22 different combinations of concomitant diagnoses were observed across the 172 patients. Acromioclavicular OA and full-thickness rotator cuff tears, particularly of the supraspinatus, were the most common concomitant diagnoses. Biceps tendon pathology, calcified tendinopathy, minor shoulder instability, and superior labrum anterior to posterior (SLAP) lesions were less common.

Patients presenting with signs and symptoms of subacromial pain syndrome have a high prevalence of conflicting and concomitant diagnoses. This heterogeneity is a clinical challenge that necessitates a systematic and transparent diagnostic approach in patients presenting with signs and symptoms of subacromial pain syndrome.ClinicalTrials.gov: NCT05549674.

This evidence-based clinical practice guideline (CPG) aims to guide clinicians with recommendations covering the assessment, treatment, and prognosis of adults with shoulder pain with suspected rotator cuff (RC) tendinopathy, the nonsurgical medical care and rehabilitation of adults with RC tendinopathy, as well as the return to function and sport for elite and recreational athletes. This CPG includes recommendations for managing RC tendinopathy with or without calcifications and partial-thickness RC tears. J Orthop Sports Phys Ther 2025;55(4):235-274. Epub 30 January 2025. doi:10.2519/jospt.2025.13182.

The etiology of subacromial pain syndrome (SAPS) remains enigmatic. It is theorized that the supraspinatus tendon and the subacromial bursa are the primary pain-generating structures. The supraspinatus tendon and the subacromial bursa are considered to be thickened in patients with SAPS but this assumption lacks validation. The aim of this study was to ultrasonographically measure the subacromial structures and evaluate the presence of impingement in patients with SAPS and to compare it with their asymptomatic shoulder.

Patients were recruited consecutively from an orthopedic outpatient clinic using validated criteria for SAPS. Patients with contralateral shoulder pain and patients with acromioclavicular osteoarthrosis, rotator cuff tears, calcified tendinopathy, biceps tendon, or labral pathology were excluded. Validated ultrasonographical methods were used. Thickness of the supraspinatus tendon and the subacromial bursa were measured perpendicular to the tendon longitudinal axis 2.0 cm from the lateral border of the supraspinatus tendon footprint with the shoulder in slight internal rotation. Acromio-humeral distance was measured as the shortest distance from the anterolateral acromion to the humerus with the shoulder in neutral position. Ultrasonographic impingement was defined as visual bulging of the subacromial bursa during active shoulder abduction and internal rotation.

We examined 58 patients with unilateral SAPS and intact rotator cuff tendons. We found significantly more cases of ultrasonographic impingement in painful shoulders compared to the pain-free (45 vs. 18, Chi-Square P < .001). There were no significant differences between affected and unaffected shoulders regarding supraspinatus tendon thickness (5.4 vs. 5.5 mm), subacromial bursa thickness (1.9 vs. 1.9 mm), or the acromio-humeral distance (11.1 vs. 11.0 mm). The mean age of the included patients was 51 years, 64% were women, the median symptom duration was 18 months, and the dominant shoulder was affected in 71% of cases.

In this cohort of patients with isolated unilateral SAPS, we found more cases of ultrasonographic impingement in affected shoulders compared to unaffected, but no significant differences in supraspinatus tendon thickness, subacromial bursa thickness, or acromio-humeral distance. These findings question ultrasonography's ability to discriminate between shoulders with and without SAPS based on measurements of subacromial structures alone.

Accurate pathoanatomic diagnosis of the cause of shoulder pain cannot rely solely on clinical tests. Similarly, diagnosis based on imaging results alone is not reliable due to the high prevalence of asymptomatic pathology. This study aims to assess the diagnostic accuracy of clinical testing with lidocaine injection and ultrasonography as a screening method for detecting supraspinatus disorders compared with magnetic resonance imaging (MRI).

Patients with supraspinatus-related shoulder pain were collected from outpatient clinics. Clinical tests, ultrasonography, and subacromial lidocaine injections were performed, with tests repeated post-injection. The results were confirmed with MRI findings.

Of 78 patients, the average age was 58±6 years, with 76.9% being normal weight females. Moderate shoulder pain was reported by 75.6% of participants, predominantly on the dominant right side (84.6%), with a significant correlation (P<0.05). The Hawkins-Kennedy test (0.73) and Neer sign (0.68) had the best sensitivity, while the drop arm test (0.93) showed the highest specificity for tendon pathology. For full-thickness tears, the Hawkins-Kennedy and empty can test (0.76) had the best sensitivity, and the drop arm test (0.82) had the best specificity. Lidocaine injection reduced sensitivity but increased specificity, with the drop arm test reaching 0.96. Supraspinatus ultrasonography was over 90% accurate compared with MRI, with a kappa value above 0.7.

Subacromial lidocaine injection reduces sensitivity but increases the specificity of clinical tests for supraspinatus tendon disorders. Ultrasonography can be used as a screening tool for supraspinatus tendon abnormalities. Level of evidence: IV.

Introduction Rotator cuff injury is a leading cause of musculoskeletal pain and the most common shoulder pathology. It is characterized by pain and limited mobility, particularly during overhead activities, and is associated with factors such as age, trauma, occupation, limb dominance, and cardiovascular risk. Diagnosis requires clinical evaluation and imaging, with ultrasound being a cost-effective and accessible option, whereas MRI is preferred for persistent or ambiguous cases. However, MRI access may be restricted by geographical and economic constraints. Methodology A retrospective census was conducted at a fourth-level hospital in Medellín, Antioquia (2015-2020), following research committee approval. Patients over 18 years old with suspected rotator cuff injury who underwent arthroscopy and had MRI and ultrasound reports within six months were included. Imaging and surgical data were retrieved from Xen RIS HIRUKO and Matrix systems. Ultrasound was performed using a General Electric Logiq S8 (15 MHz transducer) (General Electric Healthcare, Chicago, IL) and a Toshiba Aplio 400 (18 MHz transducer) (Toshiba Medical Systems Corporation, Tokyo, Japan). MRI was conducted on a Philips Achieva 1.5 T (Philips Healthcare, Eindhoven, Netherlands) with standard musculoskeletal protocols. Data were collected independently, processed in Excel (Microsoft Corporation, Redmond, WA), and analyzed using STATA 14 (StataCorp LLC, College Station, TX). Quantitative variables were reported as means and standard deviations, with normality assessed using the Kolmogorov-Smirnov test, while qualitative variables were expressed as frequencies. Results Twenty-four patients (62.4 ± 12.2 years) had 27 rotator cuff injuries; eight (33.3%) were traumatic (all men), and 16 (66.7%) were degenerative. Right-sided lesions occurred in 12 (50%), left-sided in nine (37.5%), and bilateral in three (12.5%). The most common arthroscopic finding was a complete supraspinatus rupture in 16 shoulders (59%), followed by subscapularis partial ruptures not exceeding 50% in 10 shoulders (37%) and supraspinatus partial ruptures exceeding 50% in seven shoulders (26%). For supraspinatus evaluation, ultrasound detected 79% of lesions and MRI detected 75%, both achieving 93.7% sensitivity for complete ruptures. For partial ruptures exceeding 50%, both modalities demonstrated good specificity and predictive values but low sensitivity (42.8%), with an area under the curve (AUC) of 0.78 for complete ruptures. Regarding the subscapularis, MRI detected 54.5% of lesions compared to 26.3% detected by ultrasound, demonstrating higher specificity. In the infraspinatus, both modalities detected only one of two complete ruptures, with several false positives. Agreement with arthroscopy was moderate for the supraspinatus (kappa: ultrasound = 0.59; MRI = 0.448) and low for the subscapularis (kappa: ultrasound = 0.25; MRI = 0.56), with ultrasound performing better in traumatic cases. Conclusions This study provides a direct comparison between ultrasound and MRI in the evaluation of rotator cuff injuries, with arthroscopy as the reference standard. While both modalities were effective in detecting complete supraspinatus tears, MRI demonstrated greater accuracy for subscapularis tendon assessment. These findings support the continued use of ultrasound as a practical and reliable tool, particularly in resource-limited settings.

To compare the diagnostic value of magnetic resonance arthrography (MRA) in different shoulder lesions using arthroscopy as gold standard.

We performed a comprehensive search in Cochrane, Scopus, PubMed, and Web of Science databases for articles that reported the diagnostic value of MRA in diagnosing labral tears, rotator cuff tears (RCTs), Hill-Sachs, and Bankart injuries. We used arthroscopic surgery as a reference standard for comparison. The quality of the studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies tool. We pooled the collected data and used Stata/MP17 to generate summary statistics.

We identified a total of 53 articles compromising 5,487 patients. The sensitivity and specificity for Hill-Sachs lesions were 0.94 (95% confidence interval [CI] 0.80-0.99) and 0.89 (95% CI 0.77-0.95), Bankart lesions were 0.94 (95% CI 0.89-0.97) and 0.99 (95% CI 0.90-1.00), anterior labral tears were 0.91 (95% CI 0.82-0.96) and 0.96 (95% CI 0.90-0.99), posterior labral tears were 0.74 (95% CI 0.58-0.86) and 0.98 (95% CI 0.86-1.00), superior labral tears were 0.77 (95% CI 0.62-0.88) and 0.83 (95% CI 0.54-0.95), SLAP lesions were 0.86 (95% CI 0.80-0.90) and 0.91 (95% CI 0.83-0.96), partial-thickness RCTs were 0.67 (95% CI 0.45-0.83) and 0.92 (95% CI 0.78-0.97), whereas full-thickness RCTs were 0.97 (95% CI 0.91-0.99) and 0.99 (95% CI 0.93-1).

In conclusion, MRA is a sensitive and specific imaging method for identifying anterior labrum lesions, full-thickness RCTs, Bankart, SLAP, and Hill-Sachs lesions, with lower accuracy in partial-thickness RCTs, both posterior and superior labrum.

Level III, meta-analysis of prospective and retrospective cohort and case-control studies.

Overhead throwing subjects the shoulder and elbow to substantial stresses, resulting in unique injury patterns that need to be recognized to allow appropriate treatment and return to sport. At the elbow, the ulnar collateral ligament (UCL) is the primary static restraint to valgus stress and the most commonly injured structure. UCL reconstruction is the most frequent surgical procedure in throwers and may be performed along with ulnar nerve transposition and flexor-pronator mass procedures. Posteromedial impingement and valgus extension overload syndrome are related entities that result in intra-articular pathology, such as osteophytes or bodies lodged within the olecranon fossa, also warranting excision at the time of UCL reconstruction. Shoulder injuries involve the rotator cuff (partial-thickness articular-sided tear), labrum (superior anteroposterior labral tear), and capsule (glenohumeral internal rotation deficit). Surgical options such as cuff repair, labral debridement or repair, and capsular release or tightening therefore target these structures.

Background: Non-calcific supraspinatus tendinopathy (SNCCT) is a frequent cause of shoulder pain, often associated with functional impairment and reduced quality of life. Recent advancements in diagnostic imaging, including shear wave elastography (SWE), provide quantitative data on tendon stiffness and thickness, facilitating more precise evaluations. Extracorporeal shockwave therapy (ESWT) has emerged as a minimally invasive and effective treatment for SNCCT, but its effects on tendon properties measured through SWE require further investigation. Objective: This retrospective observational study aimed to evaluate the impact of ESWT on supraspinatus tendon characteristics in patients with SNCCT by assessing tendon thickness, SWE velocity, and clinical outcomes. Methods: This observational study enrolled 39 patients with SNCCT, aged 30-75 years, who received three ESWT sessions over 3 weeks. The intervention was delivered using a Modulith SLK system at an energy level of 0.20 mJ/mm2 with 2400 pulses per session. SWE and conventional ultrasound were used to measure tendon thickness and SWEv at baseline (T0) and 6 months post-treatment (T1). Clinical outcomes were assessed using the Visual Analog Scale (VAS), Constant and Murley Score (CMS), and modified Roles and Maudsley scale. Data were analyzed using paired t-tests and correlation analyses. Results: At baseline, affected tendons exhibited increased thickness (7.5 ± 0.9 mm) and reduced SWEv (3.1 ± 0.7 m/s) compared to healthy tendons (4.5 ± 0.7 mm and 6.9 ± 1 m/s, respectively; p < 0.05). Six months after ESWT, tendon thickness decreased significantly (6.2 ± 0.9 mm, p < 0.05), and SWEv increased (5.7 ± 1.8 m/s, p < 0.05), indicating improved elasticity. Clinical outcomes improved significantly, with the VAS scores decreasing from 6.5 ± 1.4 to 3.2 ± 2.1, the CMS score rising from 59.1 ± 17.3 to 78.2 ± 17.7, and the modified Roles and Maudsley scale improving from 2.3 ± 0.6 to 1.5 ± 0.8 (p < 0.05 for all). SWEv positively correlated with the CMS (r = 0.4) and negatively with the VAS and the modified Roles and Maudsley scale (r = -0.6 and r = -0.5, respectively). Conclusions: ESWT significantly reduces tendon thickness and enhances elasticity, correlating with improvements in pain and functional scores. SWE proved to be a reliable method for monitoring structural and clinical changes in SNCCT. Further research, including randomized controlled trials, is recommended to confirm these findings and explore longer-term outcomes.

Skeletal fractures are traumatic injuries that are widely accepted as requiring acute treatment to avoid long-term disability and dysfunction. There are a number of soft-tissue injuries or non-traditional fractures, frequently treated by sports medicine surgeons, which additionally require treatment in an expedited fashion in order to optimize healing and function. Sports medicine injuries of the lower extremity requiring acute treatment include, but are not limited to, irreducible shoulder dislocations, acute traumatic rotator cuff tears, posterior sternoclavicular joint dislocations, high grade acromioclavicular joint dislocations, pectoralis major tendon ruptures, distal biceps tendon ruptures, and triceps tendon ruptures. The purpose of this manuscript is to review the sports medicine injuries of the upper extremity which require acute/urgent management to facilitate optimal treatment.

Carpal tunnel syndrome (CTS) is responsible for over 90 % of median nerve neuropathies. Though a clinical diagnosis, evaluation of nerve conduction via electrodiagnostic studies (EDX) and median nerve cross sectional area (CSA) through sonographic imaging provides supporting evidence and insight into disease severity. The advent of handheld ultrasound devices offers a portable, cost-effective and non-invasive method for median nerve assessment, yet its accuracy compared to traditional cart-based ultrasound has not been assessed in this setting.

43 consecutive patients who presented to an outpatient orthopedic clinic within a large academic institution for symptoms consistent with CTS between August 2023 and April 2024 were included. Handheld sonography was performed with the Clarius Convex L20 HD3 8-20 MHz transducer. The GE Venue Go with a 4-20 MHz linear transducer was used for conventional cart-based ultrasound evaluation. A paired t-test was performed to compare the mean cross-sectional area (CSA) measured with the GE machine to the mean CSA measured with the Clarius transducer (p < 0.05).

The average CSA measurement obtained with the GE was 14.21 ± 4.89 mm2. The average CSA measurement obtained with the Clarius handheld transducer was 13.54 ± 4.50 mm2. The mean difference between the GE and Clarius groups was 0.62 mm2 (95 % CI = -1.47 to 2.71), p = 0.55.

CSA measurements of the median nerve obtained by a handheld ultrasound transducer are comparable to those measured by a traditional cart-based ultrasound machine for carpal tunnel diagnosis. The adoption of handheld ultrasounds in clinical settings holds the potential for quicker, more precise diagnoses and broader access to imaging.

Background/Objectives: Rotator cuff lesions are common causes of shoulder pain. When not treated effectively, the functional loss associated with pain affects the quality of life and brings about psychosocial issues. In this study, prospective observational comparison of the effects of ultrasonography (USG) guided subacromial injection (SAI) versus subacromial injection combined with suprascapular nerve block (SSNB) on pain, functionality and sleep quality in the treatment of shoulder pain unresponsive to conservative treatments due to rotator cuff lesions is made. Methods: The data of 25 patients in both groups were compared prospectively. Patients were evaluated after 30 min, 1 week, 2 weeks, 1 month, and 3 months. Pain levels were measured with VAS, shoulder functions with SPADI and sleep quality with PSQI. Analgesic consumption and satisfaction were also recorded. Results: Both treatment groups effectively reduced pain at rest over the 3-month follow-up period. However, the SAI group did not achieve the targeted level of analgesia for pain control during movement. In comparison, the SAI + SSNB group demonstrated significantly superior outcomes, with lower VAS scores both at rest and during motion, as well as improved SPADI and PSQI scores. Additionally, analgesic consumption was significantly reduced in the SAI + SSNB group. No side effects or complications were observed during the treatment applications or the follow-up period. Conclusions: Pain control, shoulder functionality, sleep quality, and patient satisfaction were found to be higher in patients treated with SAI + SSNB in the short-to-medium term in the treatment of shoulder pain due to rotator cuff lesions, in addition to lower analgesic consumption.

Early surgical management of full-thickness traumatic rotator cuff tears (RCTs) may optimize functional outcomes, prioritizing timely diagnoses. Ultrasound and magnetic resonance imaging (MRI) are highly sensitive and specific modalities for RCT diagnosis, yet MRI remains the gold standard diagnostic tool despite increased costs and potential delays in care. Ultrasound can provide same-day diagnosis, thus possibly expediting care.

The use of diagnostic shoulder ultrasound alone in the orthopaedic surgeon's office could increase the efficiency of diagnosis and care of traumatic full-thickness RCTs compared with MRI.

Cohort study; Level of evidence, 3.

A retrospective chart review of patients with full-thickness traumatic RCT diagnosed via ultrasound or MRI who subsequently underwent rotator cuff repair with 1 of 2 ultrasound-trained surgeons between January 1, 2014, and December 31, 2019, was performed. Inclusion criteria included patients ≥18 years old, documentation of a first-time traumatic event, and the patient's desire to have immediate surgical management. Revision surgeries, long-term shoulder instability, and nontraumatic injuries were excluded. Basic demographic data were collected, and the number of preoperative office visits and the timing from initial evaluation to diagnosis and surgery were calculated for the ultrasound and the MRI cohorts. A power analysis of 0.8 with an alpha of .05 required 38 patients per group.

Overall, 133 patients were diagnosed via MRI compared with 76 via ultrasound. Besides body mass index, there were no significant differences in demographic variables or insurance status. Compared with the MRI cohort, patients in the ultrasound cohort received their diagnosis almost 2 weeks faster (P < .0001), were scheduled for surgery almost 3 weeks faster (P < .0001), and underwent surgery 2 weeks faster after initial evaluation (P < .0001) while requiring nearly half as many clinical visits (P < .0001). Regression analysis confirmed that ultrasound significantly reduced time to imaging, scheduling, and surgery after initial evaluation while requiring fewer clinical visits (P < .05).

The study findings indicated that ultrasound was a time-saving alternative diagnostic modality for traumatic RCT compared with MRI without compromising standard of care. These results were achieved independent of patient insurance status, disability index, or other demographic variables.

The prevailing view is that painful shoulders exhibit abnormal kinematics. This study explores the impact of symptomatic small-size supraspinatus tendon full-thickness tears on the three-dimensional (3D) kinematics of intentional, effortless shoulder movements. The hypothesis suggests that mechanical force buildup patterns, as indicated by motion jerk, will differ between healthy individuals and patients with symptomatic rotator cuff tendinopathy.

A comparative analysis was conducted on two groups: 10 patients with painful shoulders due to a Grade 1 small-size full-thickness tear of the supraspinatus tendon (Group A) and 10 healthy volunteers (Group B). Participants performed a standardized effortless shoulder movement task involving arm elevation and depression without external resistance, while an arm-attached accelerometer recorded movement data. The primary outcome was jerk (a derivative of acceleration), normalized to lean body mass (LBM), with comparisons made both within and between groups.

Vertical angular velocity was consistent across the study groups and in both arms of healthy volunteers, with mean values ranging from 70 to 86 degrees per second (deg/sec) (p = 0.79). No significant differences in jerk values were observed between groups or between dominant and non-dominant limbs in Group B (mean values: 0.001 to 0.004 m/sec³/kg LBM; p > 0.05).

This pilot study suggests that small supraspinatus tendon full-thickness tears, when pain is the primary symptom, do not significantly affect the 3D kinematics of effortless shoulder movements. These findings challenge the notion that pain from rotator cuff tears leads to altered shoulder kinematics, with potential implications for clinical decision-making and assessing functional disability. Larger studies are needed to confirm these results.

The gold standard diagnostic method for acute lateral ankle ligament sprain is magnetic resonance imaging (MRI). However, it is hardly accessible and is time-consuming. Therefore, additional diagnostic methods are warranted. Point-of-care ultrasound, on the other hand, is inexpensive, widely available, time-efficient testing method.

Therefore, the aim of this meta-analysis is to determine the diagnostic accuracy of ultrasound for acute ankle ligament injuries compared to MRI.

In our systematic review and meta-analysis, we followed the recommendations of the Cochrane Handbook. We searched the following databases from inception to March 31, 2022: Medline (PubMed), EMBASE, and Cochrane Library. Eligible studies investigated the diagnostic accuracy of US compared to MRI for diagnosing acute lateral ankle ligament injuries. Finally, we calculated pooled sensitivity and specificity with a 95 % confidence interval (CI).

Eight studies met our eligibility criteria, involving 434 patients. For anterior tibiofibular ligament (ATFL) injury, the summary sensitivity and specificity were Se = 0.97 (CI: 0.89-0.99) and Sp = 0.93 (CI: 0.84-0.97). For calcaneofibular ligament (CFL) injury, the summary sensitivity and specificity were Se.: Se = 0.81 (CI: 0.58-0.93) and Sp = 0.92 [0,81;0,97]. In addition, subgroup analysis based on US performed by different types of investigators was comparable between each other (radiologist group Se = 0.98, CI: 0.24-1, and Sp = 0.91, CI: 0.74-0.97, and the orthopedic/ emergency department group Se = 0.96, CI: 0-1, and Sp = 0.97, CI: 0-1).

Ultrasound showed high diagnostic accuracy for acute lateral ankle ligament injury, irrespective of the investigator. Therefore, based on the current available data, it could be used in primary diagnostics of acute lateral ankle ligament injury.

 Injuries to the shoulder and restricted range of motion often lead to decreased work productivity, increased use of medical resources, and impaired quality of life. The most frequent cause of shoulder discomfort and dysfunction is a disease related to the rotator cuff, such as bursitis, degenerative tears, and calcific tendinosis. This study evaluates ultrasonography's diagnostic efficacy in relation to magnetic resonance imaging (MRI).

 Prospective research was conducted at a hospital to compare MRI and ultrasonography for shoulder cases involving rotator cuff injuries. There were 53 patients in the sample. Those who presented with pain and dysfunction in the shoulder were given both an MRI and an ultrasound (USG). Comparing the results of the MRI and USG allowed for the calculation of the diagnostic tests' accuracy, sensitivity, specificity, and positive and negative predictive values.

 The results of the study demonstrated a substantial agreement (p value <0.05) between the identification of rotator cuff tears by MRI and USG shoulder imaging. With a total accuracy of 88.6%, the sensitivity and specificity of identifying rotator cuff tears were 91.2% and 81.8%, respectively.

 With similar sensitivity and specificity, MRI and USG are useful diagnostic techniques for rotator cuff injuries. USG is a great screening alternative due to its cost-effectiveness, noninvasiveness, and easy accessibility. However, when it comes to identifying the anatomical regions that need surgical repair, MRI is superior.

This study aims to diagnose Rotator Cuff Tears (RCT) and classify the severity of RCT in patients with Osteoporosis (OP) through the analysis of shoulder joint anteroposterior (AP) X-ray-based localized proximal humeral bone mineral density (BMD) measurements and clinical information based on machine learning (ML) models.

A retrospective cohort of 89 patients was analyzed, including 63 with both OP and RCT (OPRCT) and 26 with OP only. The study analyzed a series of shoulder radiographs from April 2021 to April 2023. Grayscale values were measured after plotting ROIs based on AP X-rays of shoulder joint. Five kinds of ML models were developed and compared based on their performance in predicting the occurrence and severity of RCT from ROIs' greyscale values and clinical information (age, gender, advantage side, lumbar BMD, and acromion morphology (AM)). Further analysis using SHAP values illustrated the significant impact of selected features on model predictions.

R1-6 had a positive correlation with BMD respectively. The nine variables, including greyscale R1-6, age, BMD, and AM, were used in the prediction models. The RF model was determined to be superior in effectively diagnosing RCT in OP patients, with high AUC scores of 0.998, 0.889, and 0.95 in the training, validation, and testing sets, respectively. SHAP values revealed that the most influential factors on the diagnostic outcomes were the grayscale values of all cancellous bones in ROIs. A column-line graph prediction model based on nine variables was constructed, and DCA curves indicated that RCT prediction in OP patients was favored based on this model. Furthermore, the RF model was also the most superior in predicting the types of RCT within the OPRCT group, with an accuracy of 86.364% and 73.684% in the training and test sets, respectively. SHAP values indicated that the most significant factor affecting the predictive outcomes was the AM, followed by the grayscale values of the greater tubercle, among others.

ML models, particularly the RF algorithm, show significant promise in diagnosing RCT occurrence and severity in OP patients using conventional shoulder X-rays based on the nine variables. This method presents a cost-effective, accessible, and non-invasive diagnostic strategy that has the potential to substantially enhance the early detection and management of RCT in OP patient population.

» Partial-thickness rotator cuff tears (PTRCTs) are a common pathology with a likely high asymptomatic incidence rate, particularly in the overhead athlete.» The anatomy, 5-layer histology, and relationship to Ellman's classification of PTRCTs have been well studied, with recent interest in radiographic predictors such as the critical shoulder angle and acromial index.» Depending on the definition of tear progression, rates of PTRCT progression range from 4% to 44% and appear related to symptomatology and work/activity level.» Nearly all PTRCTs should be managed conservatively initially, particularly in overhead athletes, with those that fail nonoperative management undergoing arthroscopic debridement ± acromioplasty if <50% thickness or arthroscopic conversion repair or in situ repair if >50% thickness.» Augmentation of PTRCTs is promising, with leukocyte-poor platelet-rich plasma having the most robust body of supportive data. Mesenchymal signaling cell biologics and the variety of scaffold onlay augments require more rigorous studies before regular usage.

Interventional radiology (IR) is a unique specialty that incorporates a diverse set of skills ranging from imaging, procedures, consultation, and patient management. Understanding how IR generates value to the healthcare system is important to review from various perspectives. IR specialists need to understand how to meet demands from various stakeholders to expand their practice improving patient care. Thus, this review discusses the domains of value contributed to medical systems and outlines the parameters of success. IR benefits five distinct parties: patients, practitioners, payers, employers, and innovators. Value to patients and providers is delivered through a wide set of diagnostic and therapeutic interventions. Payers and hospital systems financially benefit from the reduced cost in medical management secondary to fast patient recovery, outpatient procedures, fewer complications, and the prestige of offering diverse expertise for complex patients. Lastly, IR is a field of rapid innovation implementing new procedural technology and techniques. Overall, IR must actively advocate for further growth and influence in the medical field as their value continues to expand in multiple domains. Despite being a nascent specialty, IR has become indispensable to modern medical practice.

Background: Previous research has suggested that dyslipidemia may be a risk factor for rotator cuff syndrome (RCS), and lipid-lowering drugs may aid in its treatment, though conclusions have not been definitive. Mendelian randomization is a statistical method that explores the causal relationships between exposure factors and diseases. It overcomes the confounding issues inherent in traditional observational studies, thereby providing more reliable causal inferences. We employed this method to investigate whether hyperlipidemia is a risk factor for rotator cuff syndrome and whether lipid-lowering drugs can effectively treat this condition. Methods: Genetic variations linked to lipid traits low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), and total cholesterol (TC) were acquired from the UK Biobank and the Global Lipids Genetics Consortium (GLGC). Data on genetic variation in rotator cuff syndrome were obtained from FinnGen, including 24,061 patients and 275,212 controls. In the next step, we carried out two-sample Mendelian randomization analyses to determine whether lipid traits correlate with rotator cuff syndrome risk. Additionally, we performed drug-target Mendelian randomization (MR) analyses on 10 drug targets related to rotator cuff syndrome. For the drug targets that showed significant results, further analysis was done using Summary-data-based Mendelian Randomization (SMR) and colocalization techniques. We performed a mediation analysis to identify potential mediators between HMG-CoA reductase (HMGCR) and RCS. Results: No causative link was established between these lipid traits and rotator cuff syndrome. However, a significant association has been identified where HMGCR inhibition corresponds to a reduced risk of rotator cuff disease (OR = 0.68, [95% CI, 0.56-0.83], p = 1.510 × 10-4). Additionally, enhanced expression of HMGCR in muscle tissues is also linked to a decreased risk of rotator cuff syndrome (OR = 0.88, [95% CI, 0.76-0.99], p = 0.03). Body mass index (BMI) mediated 22.97% of the total effect of HMGCR on RCS. Conclusion: This study does not support low-density LDL-C, TG, and TC as risk factors for rotator cuff syndrome. HMGCR represents a potential pharmaceutical target for preventing and treating rotator cuff syndrome. The protective action of statins on the rotator cuff syndrome might not be associated with their lipid-lowering properties.

To establish an automated, multitask, MRI-based deep learning system for the detailed evaluation of supraspinatus tendon (SST) injuries.

According to arthroscopy findings, 3087 patients were divided into normal, degenerative, and tear groups (groups 0-2). Group 2 was further divided into bursal-side, articular-side, intratendinous, and full-thickness tear groups (groups 2.1-2.4), and external validation was performed with 573 patients. Visual geometry group network 16 (VGG16) was used for preliminary image screening. Then, the rotator cuff multitask learning (RC-MTL) model performed multitask classification (classifiers 1-4). A multistage decision model produced the final output. Model performance was evaluated by receiver operating characteristic (ROC) curve analysis and calculation of related parameters. McNemar's test was used to compare the differences in the diagnostic effects between radiologists and the model. The intraclass correlation coefficient (ICC) was used to assess the radiologists' reliability. p < 0.05 indicated statistical significance.

In the in-group dataset, the area under the ROC curve (AUC) of VGG16 was 0.92, and the average AUCs of RC-MTL classifiers 1-4 were 0.99, 0.98, 0.97, and 0.97, respectively. The average AUC of the automated multitask deep learning system for groups 0-2.4 was 0.98 and 0.97 in the in-group and out-group datasets, respectively. The ICCs of the radiologists were 0.97-0.99. The automated multitask deep learning system outperformed the radiologists in classifying groups 0-2.4 in both the in-group and out-group datasets (p < 0.001).

The MRI-based automated multitask deep learning system performed well in diagnosing SST injuries and is comparable to experienced radiologists.

Our study established an automated multitask deep learning system to evaluate supraspinatus tendon (SST) injuries and further determine the location of SST tears. The model can potentially improve radiologists' diagnostic efficiency, reduce diagnostic variability, and accurately assess SST injuries.

• A detailed classification of supraspinatus tendon tears can help clinical decision-making. • Deep learning enables the detailed classification of supraspinatus tendon injuries. • The proposed automated multitask deep learning system is comparable to radiologists.

The supraspinatus tendon is one of the most involved tendons in the development of shoulder pain. Extracorporeal shockwave therapy (ESWT) has been recognized as a valid and safe treatment. Sometimes the symptoms cannot be relieved, or a relapse develops, affecting the patient's quality of life. Therefore, a prediction protocol could be a powerful tool aiding our clinical decisions. An artificial neural network was run, in particular a multilayer perceptron model incorporating input information such as the VAS and Constant-Murley score, administered at T0 and at T1 after six months. It showed a model sensitivity of 80.7%, and the area under the ROC curve was 0.701, which demonstrates good discrimination. The aim of our study was to identify predictive factors for minimal clinically successful therapy (MCST), defined as a reduction of ≥40% in VAS score at T1 following ESWT for chronic non-calcific supraspinatus tendinopathy (SNCCT). From the male gender, we expect greater and more frequent clinical success. The more severe the patient's initial condition, the greater the possibility that clinical success will decrease. The Constant and Murley score, Roles and Maudsley score, and VAS are not just evaluation tools to verify an improvement; they are also prognostic factors to be taken into consideration in the assessment of achieving clinical success. Due to the lower clinical improvement observed in older patients and those with worse clinical and functional scales, it would be preferable to also provide these patients with the possibility of combined treatments. The ANN predictive model is reasonable and accurate in studying the influence of prognostic factors and achieving clinical success in patients with chronic non-calcific tendinopathy of the supraspinatus treated with ESWT.

Early diagnosis of rotator cuff tears is essential for appropriate and timely treatment. Although radiography is the most used technique in clinical practice, it is difficult to accurately rule out rotator cuff tears as an initial imaging diagnostic modality. Deep learning-based artificial intelligence has recently been applied in medicine, especially diagnostic imaging. This study aimed to develop a deep learning algorithm as a screening tool for rotator cuff tears based on radiography.

We used 2803 shoulder radiographs of the true anteroposterior view to develop the deep learning algorithm. Radiographs were labeled 0 and 1 as intact or low-grade partial-thickness rotator cuff tears and high-grade partial or full-thickness rotator cuff tears, respectively. The diagnosis of rotator cuff tears was determined based on arthroscopic findings. The diagnostic performance of the deep learning algorithm was assessed by calculating the area under the curve (AUC), sensitivity, negative predictive value (NPV), and negative likelihood ratio (LR-) of test datasets with a cutoff value of expected high sensitivity determination based on validation datasets. Furthermore, the diagnostic performance for each rotator cuff tear size was evaluated.

The AUC, sensitivity, NPV, and LR- with expected high sensitivity determination were 0.82, 84/92 (91.3%), 102/110 (92.7%), and 0.16, respectively. The sensitivity, NPV, and LR- for full-thickness rotator cuff tears were 69/73 (94.5%), 102/106 (96.2%), and 0.10, respectively, while the diagnostic performance for partial-thickness rotator cuff tears was low at 15/19 (78.9%), NPV of 102/106 (96.2%) and LR- of 0.39.

Our algorithm had a high diagnostic performance for full-thickness rotator cuff tears. The deep learning algorithm based on shoulder radiography helps screen rotator cuff tears by setting an appropriate cutoff value.

Level III: Diagnostic Study.

Rotator cuff injuries are a prevalent cause of atraumatic chronic shoulder pain, imposing a significant healthcare burden. This article reviews the clinical presentation, diagnostic imaging modalities, practice variations, and economic efficiency considerations in the evaluation of rotator cuff pathologies. Ultrasound (US) and magnetic resonance imaging (MRI) are the primary imaging methods for diagnosing rotator cuff injuries. US provides real-time visualization but has limited tissue penetration, while MRI offers detailed anatomical information but is not a dynamic process. Studies show that MRI is superior to US with higher sensitivity and specificity. MRI is the gold standard, particularly for surgical planning, but US remains relevant when MRI is not feasible. Both require standardized protocols for evaluating tear dimensions and muscle atrophy. With the operator-dependent nature of US, MRI offers a more comprehensive assessment of rotator cuff tears and predictive insights for clinical outcomes. Practice variations exist in the management of rotator cuff pathologies, with some countries favoring US as the primary imaging modality and others relying more on MRI. These variations are influenced by factors like resource availability and healthcare system nuances. In Australia, current guidelines lean toward conservative management, potentially leading to delayed diagnoses and increased costs. The United States often favors MRI, while Canada advocates for US as the initial choice. Economic considerations play a significant role in selecting imaging modalities. While US is cost-effective, it may necessitate subsequent MRI examinations, contributing to inefficiencies in the diagnostic process. Studies suggest that a combined approach of US and MRI is less efficient and cost-effective than MRI alone. However, the use of both modalities rather than MRI alone is common in clinical practice, adding to healthcare expenses. In conclusion, the choice of imaging modality for rotator cuff pathologies should consider factors such as diagnostic efficacy, cost-effectiveness, and resource availability. Radiologists play a pivotal role in guiding this selection and ensuring comprehensive evaluations. Future considerations should include the revision of management guidelines and the potential inclusion of shoulder pathologies in healthcare coverage to optimize patient care and healthcare expenditure.

In contrast to the standard shoulder arthroscopy, current radio-diagnostic techniques like magnetic resonance arthrography (MRA), and magnetic resonance imaging (MRI) provide less invasive intricate structural detail of shoulder anatomy.

Comparison of efficacy of MRA and MRI for diagnosing suspected rotator cuff injury.

Over the course of 4 years (from June 2017 to June 2021), a comparative study, including 100 individuals with suspected rotator cuff pathology, was conducted. For the evaluation of shoulder injuries, the assessment and comparison of MRA and MRI were done in terms of sensitivity (Sn), positive predictive value (PPV), and diagnostic accuracy (DA).

MRI and MRA were positive in 76 (76%) and 98 (98%) patients, respectively. The Sn and PPV of MRI for diagnosing the shoulder injury were 76% and 100%, respectively, whereas the Sn and PPV of MRA were 98% and 100%, respectively. MRA was better than MRI in terms of diagnostic accuracy (98% vs. 76%, P = 0.03).

MRA is a nonsurgical effective method in evaluating and diagnosing rotator cuff injuries in comparison to MRI.

Pathologies of the shoulder, i.e. rotator cuff tears and labral injuries are very common. Most patients receive MRI examination prior to surgery. A correct assessment of pathologies is significant for a detailed patient education and planning of surgery.

Sixty-nine patients were identified, who underwent both, a standardised shoulder MRI and following arthroscopic shoulder surgery in our hospital. For this retrospective comparative study, the MRIs were pseudonymised and evaluated separately by an orthopaedic surgeon and a radiologist. A third rater evaluated images and reports of shoulder surgery, which served as positive control. Results of all raters were then compared. The aim was an analysis of agreement rates of diagnostic accuracy of preoperative MRI by a radiologist and an orthopaedic surgeon.

The overall agreement with positive control of detecting transmural cuff tears was high (84% and 89%) and lower for partial tears (70-80%). Subscapularis tears were assessed with moderate rates of agreement (60 - 70%) compared to intra-operative findings. Labral pathologies were detected mostly correctly. SLAP lesions and pulley lesions of the LHB were identified with only moderate agreement (66.4% and 57.2%) and had a high inter-rater disagreement.

This study demonstrated that tears of the rotator cuff (supraspinatus, infraspinatus) and labral pathologies can be assessed in non-contrast pre-operative shoulder MRI images with a high accuracy. This allows a detailed planning of surgery and aftercare. Pathologies of the subscapularis tendon, SLAP lesions and biceps instabilities are more challenging to detect correctly. There were only small differences between a radiologic and orthopaedic interpretation of the images.

Rotator cuff tears are the most common upper extremity condition seen by primary care and orthopaedic surgeons, with a spectrum ranging from tendinopathy to full-thickness tears with arthritic change. Some tears are traumatic, but most rotator cuff problems are degenerative. Not all tears are symptomatic and not all progress, and many patients in whom tears become more extensive do not experience symptom worsening. Hence, a standard algorithm for managing patients is challenging. The pathophysiology of rotator cuff tears is complex and encompasses an interplay between the tendon, bone and muscle. Rotator cuff tears begin as degenerative changes within the tendon, with matrix disorganization and inflammatory changes. Subsequently, tears progress to partial-thickness and then full-thickness tears. Muscle quality, as evidenced by the overall size of the muscle and intramuscular fatty infiltration, also influences symptoms, tear progression and the outcomes of surgery. Treatment depends primarily on symptoms, with non-operative management sufficient for most patients with rotator cuff problems. Modern arthroscopic repair techniques have improved recovery, but outcomes are still limited by a lack of understanding of how to improve tendon to bone healing in many patients.

To assess the utility of using dynamic ultrasound for postoperative evaluation after superior capsular reconstruction (SCR) by evaluating graft integrity and its correlation with clinical outcomes at a minimum 2-year follow-up.

A retrospective chart review was conducted to identify patients who underwent SCR between July 2015 and July 2020 with a minimum 2-year clinical and ultrasound follow-up. Clinical outcome measures included Simple Shoulder (SS) and American Shoulder and Elbow Surgeon (ASES) scores. Integrity of the SCR graft was evaluated by dynamic ultrasound.

We evaluated 22 shoulders in 21 patients with a mean follow-up of 44.8 months (range, 24-71 months). The graft was found to be intact by ultrasound evaluation in 82% (18/22). Patients with intact grafts had higher mean SS (11.6 vs 7.8, P = .00079) and ASES (91.2 vs 64.1, P = .0296) scores at latest follow-up compared to those with failed grafts. Those with intact grafts also had significant improvement in SS (3.7 vs 11.6, P < .00001) and ASES (23.2 vs 91.2, P < .00001) scores at latest follow-up compared to their preoperative scores. In contrast, patients with graft failure had no significant improvement in SS (6.3 vs 9.0, P = .123) and ASES (40.4 vs 58.3, P = .05469) scores at latest follow-up compared to their preoperative scores. There was no difference between clinical outcomes at 6 to 12 months vs latest follow-up for both SS (P = .11, P = .5) and ASES (P = .27, P = .21) scores.

SCR grafts were found by ultrasound to be intact in 82% of cases. Patients with intact grafts on ultrasound had significant improvement in functional outcome scores while those with graft failure did not. Functional outcome scores suggest that maximal recovery from this procedure occurs by 6 to 12 months.

Level IV, therapeutic case series.

To determine the model performance of artificial intelligence (AI) in detecting rotator cuff pathology using different imaging modalities and to compare capability with physicians in clinical scenarios.

The review followed the PRISMA guidelines and was registered on PROSPERO. The criteria were as follows: 1) studies on the application of AI in detecting rotator cuff pathology using medical images, and 2) studies on smart devices for assisting in diagnosis were excluded. The following data were extracted and recorded: statistical characteristics, input features, AI algorithms used, sample sizes of training and testing sets, and model performance. The data extracted from the included studies were narratively reviewed.

A total of 14 articles, comprising 23,119 patients, met the inclusion and exclusion criteria. The pooled mean age of the patients was 56.7 years, and the female rate was 56.1%. The area under the curve (AUC) of the algorithmic model to detect rotator cuff pathology from ultrasound images, MRI images, and radiographic series ranged from 0.789 to 0.950, 0.844 to 0.943, and 0.820 to 0.830, respectively. Notably, 1 of the studies reported that AI models based on ultrasound images demonstrated a diagnostic performance similar to that of radiologists. Another comparative study demonstrated that AI models using MRI images exhibited greater accuracy and specificity compared to orthopedic surgeons in the diagnosis of rotator cuff pathology, albeit not in sensitivity.

The detection of rotator cuff pathology has been significantly aided by the exceptional performance of AI models. In particular, these models are equally adept as musculoskeletal radiologists in using ultrasound to diagnose rotator cuff pathology. Furthermore, AI models exhibit statistically superior levels of accuracy and specificity when using MRI to diagnose rotator cuff pathology, albeit with no marked difference in sensitivity, in comparison to orthopaedic surgeons.

Level III, systematic review of Level III studies.

Direct magnetic resonance arthrography (dMRA) is often considered the most accurate imaging modality for the evaluation of intra-articular structures, but utilization and performance vary widely without consensus. The purpose of this white paper is to develop consensus recommendations on behalf of the Society of Skeletal Radiology (SSR) based on published literature and expert opinion.

The Standards and Guidelines Committee of the SSR identified guidelines for utilization and performance of dMRA as an important topic for study and invited all SSR members with expertise and interest to volunteer for the white paper panel. This panel was tasked with determining an outline, reviewing the relevant literature, preparing a written document summarizing the issues and controversies, and providing recommendations.

Twelve SSR members with expertise in dMRA formed the ad hoc white paper authorship committee. The published literature on dMRA was reviewed and summarized, focusing on clinical indications, technical considerations, safety, imaging protocols, complications, controversies, and gaps in knowledge. Recommendations for the utilization and performance of dMRA in the shoulder, elbow, wrist, hip, knee, and ankle/foot regions were developed in group consensus.

Although direct MR arthrography has been previously used for a wide variety of clinical indications, the authorship panel recommends more selective application of this minimally invasive procedure. At present, direct MR arthrography remains an important procedure in the armamentarium of the musculoskeletal radiologist and is especially valuable when conventional MRI is indeterminant or results are discrepant with clinical evaluation.

The movements and stability of the human shoulder are a complex dynamic interaction between several joints, muscles and ligaments, which on the one hand enable extensive mobility and on the other hand must provide the necessary stability. Furthermore, the complexity of the shoulder is increased by a large number of normal variants. This article aims to explain the relevant anatomical structures and the radiological examination techniques necessary to visualize them.

Various modalities contribute to the examination of the shoulder. These include X‑rays, computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound.

It is important to use the various procedures appropriately. Especially with MRI arthrography, it is necessary to pay attention to suitable sequences and possibly additional examination positions.

The multimodal examination of the shoulder can contribute to the diagnosis of numerous clinical pictures. Anatomical and methodological foundations are essential for this.

The present prospective study was performed to evaluate the diagnostic efficiency of compressed sensing magnetic resonance imaging (CS-MRI) for rotator cuff tears.

Between December 1, 2021 and April 1, 2022, 62 patients with suspected rotator cuff tears were admitted to Affiliated Hospital of Jinggangshan University and received CS-MRI and arthroscopy to determine the diagnosis and the disease type of tears. Their medical data were obtained and analyzed to evaluate the clinical feasibility of CS-MRI in diagnosing rotator cuff tears.

Of the 62 cases of suspected rotator cuff tears, 45 were confirmed by arthroscopy, including 31 cases of total tears and 14 partial tears. Using arthroscopic findings as the gold standard for the diagnosis of rotator cuff tears, the sensitivity of clinical signs to diagnose rotator cuff tears was 66.67%, the specificity was 70.59%, and the accuracy was 67.74%, while the sensitivity of CS-MRI in diagnosing rotator cuff tears was 84.44%, the specificity was 88.24%, and the accuracy was 81.54%. The accuracy of CS-MRI was significantly higher than that of clinical signs as determined by chi-square test within groups (P=0.019).

CS-MRI provides high resolution for muscles, tendons, and soft tissues, significantly contributing to the diagnosis of soft tissue injuries. Although there were no significant differences in the sensitivity and specificity of CS-MRI for the clinical diagnosis of rotator cuff tears compared to the clinical signs, CS-MRI significantly improved the diagnostic accuracy.

Massive rotator cuff tears are a huge challenge for orthopaedic surgeons, as the patients may be in need of multiple operations, even including reverse total shoulder arthroplasty. The various repair methods for the rotator cuff, such as partial rotator cuff repair, patch-augmented rotator cuff repair, bridging rotator cuff reconstruction with graft interposition, tendon transfer, and superior capsular reconstruction, have always been the focus of research. During surgical intervention for failed rotator cuff repairs, complexity of tears, poor tissue quality, retained hardware, and adhesions are the problems routinely encountered. In this Technical Note, we describe the technique of interposition grafting using fascia lata autograft to reconstruct the rotator cuff after failed primary repair.

With the ageing population, the prevalence of dementia is increasing worldwide. There is an emphasis on early, timely diagnosis and treatment options for people with a dementia yet wait times from referral to diagnosis have increased. Neuroimaging performed by radiologists is utilised to support dementia diagnosis and some patients will already have a CT scan from a pre-existing condition such as stroke. The purpose of this commentary is to consider whether ACPs who specialise in dementia, are perfectly placed to re-report on pre-existing neuroimages to support the clinical diagnosis of dementia.

In diagnosing rotator cuff tears (RCTs), magnetic resonance imaging (MRI) is the imaging modality of choice, and its accuracy is improving constantly.

To evaluate the diagnostic performance of a high-resolution 3D double-echo steady-state (DESS) sequence with radial and paracoronal 3-T MRI regarding the grading of RCTs in correlation with conventional 2D MRI and arthroscopic findings.

We retrospectively compared arthroscopic findings of RCTs with preoperative MRI, including conventional 2D sequences and radial and paracoronal DESS images in 20 patients. Two observers evaluated supraspinatus (SSP), infraspinatus (ISP), and subscapularis (SSC) tendon tears using a grading system. For statistical analysis, arthroscopy was used as the reference standard.

Inter-observer agreement for detecting and grading SSP, ISP, and SSC tendon tears on radial and paracoronal sliced 3D DESS MRI was excellent (intraclass-correlation [ICC] = 0.92-0.98; all P < 0.001). Regarding the detection of SSP lesions, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 93.8%, 50%, 88.2%, and 66.7% for both radial and paracoronal DESS imaging. A sensitivity of 100%, specificity of 61.1%, PPV of 22.2%, and NPV of 100% were noted for detecting ISP tendon tears using radially reformatted DESS images. Regarding detecting SSC tendon tears using radially reformatted DESS images, sensitivity, specificity, PPV, and NPV were 100%, 81.3%, 50%, and 100%, respectively. The results with standard 2D MRI were similar.

The DESS technique with radially reformatted images provided excellent sensitivity and high inter-observer agreement in detecting RCTs. It showed a moderate to high correlation between MRI and arthroscopy for diagnosing SSP and SSC tendon tears.

Ultrasound imaging has emerged as one of the most useful tools for evaluating shoulder disorders. To date, the association between shoulder ultrasonography and a patient's work status has rarely been explored by antecedent studies.

This study aimed to investigate the association between sonographically diagnosed shoulder pathologies and job discontinuation and return to work.

A cross-sectional study.

Outpatient clinic in the university hospital.

Fifty-nine patients who were older than 20 years of age and had worked in a full-time job within the past three years.

All participants underwent clinical evaluation using the visual analog scale (for pain), Shoulder Pain and Disability Index, Pittsburgh Sleep Quality Index, and shoulder ultrasound examination. The work-related ergonomic risks, including dealing with heavy objects, repeated use and requiring forceful motion of the affected upper extremity, were assessed. The ultrasound-identified shoulder pathologies associated with job discontinuation, that is, sick leave due to painful shoulder for more than two consecutive months, were considered as the primary outcome. In the job discontinuation subgroup, we further investigated the association between return to work and the clinical/sonographic findings.

Univariate analysis revealed a positive association between job discontinuation and shoulder surgery or work types requiring forceful upper-limb movements. Multivariate analysis demonstrated that job discontinuation was positively associated with supraspinatus tendon full-thickness tears (risk ratio, 8.80; 95% CI, 1.77-10.56; P=0.018). Of the patients who received shoulder surgery, 46.6% had recurrent rotator cuff tears. Return to work was likely to be related to pain scores during overhead activities and shoulder function impairment but not to sonographic findings.

Job discontinuation is associated with shoulder surgery, work that necessitates forceful upper-extremity movements and supraspinatus tendon full-thickness tears detected by ultrasound.

Sonographic findings should not be used as the only standard for evaluating the patient's work capability.

The use of musculoskeletal ultrasound (US) among hand surgeons appears to be increasing. The purpose of this study was to determine the utilization patterns and attitudes regarding US among American Society for Surgery of the Hand (ASSH) members in 2020 as well as the changes in usage patterns since a previous survey in 2015.

In 2020, an updated and expanded 27-question survey was distributed to 4852 members of the ASSH. Questions assessed respondent demographics, training, and practice patterns, and access, utilization, training, and opinions pertaining to US.

A total of 418 surveys (8.6%) were analyzed. Compared to 2015, there was an increase in the percentage of respondents using US for diagnostic purposes (51%-68%), as well as having personal access to US machines (43% to 58%). US use to assist in diagnosing carpal tunnel syndrome increased from 19% to 27%. The most common reason for using US was convenience and practice efficiency, while the most common reasons for not using US was no machine access. In 2020, 33% of respondents performed US-guided injections.

Compared to 2015, the majority of responding upper extremity surgeons now have personal access to US machines. Utilization of diagnostic US appears to be increasing, and two-thirds of respondents believed that US use will continue to increase among upper extremity surgeons.

Acute shoulder pain is a common ED presentation with a wide range of pathologies that are often initially investigated with radiography. However, diagnosing rotator cuff injuries often requires further imaging for proper diagnosis and management. Bedside shoulder ultrasound is an application that allows for the evaluation of ligaments and tendons in addition to bony structures, all while utilizing direct patient feedback of focally tender areas, expediting diagnosis and therapeutic intervention. In this case series, we discuss our evaluation of patients with suspected rotator cuff pathology and the practice of using the stepwise shoulder ultrasound protocol. Four cases are presented that illustrate the use of shoulder ultrasound in diagnosing biceps tendon injury, supraspinatus tear, chronic supraspinatus tear with hemarthrosis, and subacromial-subdeltoid bursitis. This narrative highlights the valuable role of shoulder ultrasound for the expedited diagnosis and management of patients whose initial shoulder radiographs do not indicate any bony abnormalities.

A 70-year-old female presented with an 8-month history of right anterior shoulder pain and weakness, unresolved with conservative management. Among other shoulder pathology, the patient was diagnosed with a full-thickness supraspinatus tear and elected to proceed with the microfragmented adipose tissue procedure to treat the injured tendon and nearby relevant structures. Improvements in pain and function were documented along with progressive healing of the supraspinatus on ultrasound and MRI following the procedure. This case demonstrates the efficacy of microfragmented adipose tissue as a relatively novel approach to treating non-retracted, full-thickness rotator cuff tears.

Patients present to the orthopedic outpatient department with complaints of shoulder pain on movement or restriction of movement in the shoulder joint and are referred for magnetic resonance imaging (MRI) of the shoulder joint. Almost all the patients have similar complaints but may have a wide range of pathology affecting the joint and causing pain. Rotator cuff tears or tendinopathy are the most common causes of shoulder pain. Ultrasound (USG) and MRI are the most commonly used imaging modalities for assessing rotator cuff pathologies. There is a wide range of pathologies affecting the shoulder joint, other than rotator cuff tendinopathies or tears, for which USG is less sensitive and specific in detecting accurate pathology. MRI is the choice of imaging for shoulder joint pathologies. We present a pictorial review discussing and depicting MRI features of a wide list of pathologies of the shoulder joint complex that should be kept in mind when the patient presents with shoulder pain.

In the diagnosis of incomplete rotator cuff injuries (IRCI), magnetic resonance imaging (MRI) and ultrasound examination often have false-positive and false-negative results, while arthroscopy is expensive, invasive, and complex. From the strategy of predictive, preventive, and personalized medicine (PPPM), shoulder anatomical characteristics based on MRI have been demonstrated to accurately predict IRCI and their clinical applicability for personalized prediction of IRCI.

This study aimed to develop and validate a nomogram based on anatomical features of the shoulder on MRI to identify IRCI for PPPM healthcare strategies.

The medical information of 257 patients undergoing preoperative MRI examination was retrospectively reviewed and served as the primary cohort. Partial-thickness rotator cuff tears (RCTs) and tendinopathy observed under arthroscopy were considered IRCI. Using logistic regression analyses and least absolute shrinkage and selection operator (LASSO), IRCI was identified among various preoperative factors containing shoulder MRI and clinical features. A nomogram was constructed and subjected to internal and external validations (80 patients).

The following eight independent risk factors for IRCI were identified:AgeThe left injured sidesThe Goutallier classification of supraspinatus in oblique coronal positionThe Goutallier classification of supraspinatus in the axial positionAcromial thicknessAcromiohumeral distanceCoracohumeral distanceAbnormal acromioclavicular joint signalsThe nomogram accurately predicted IRCI in the development (C-index, 0.932 (95% CI, 0.891, 0.973)) and validation (C-index, 0.955 (95% CI, 0.918, 0.992)) cohorts. The calibration curve was consistent between the predicted IRCI probability and the actual IRCI ratio of the nomogram. The decision curve analysis and clinical impact curves demonstrated that the model had high clinical applicability.

Eight independent factors that accurately predicted IRCI were determined using MRI anatomical findings. These personalized factors can prevent unnecessary diagnostic interventions (e.g., arthroscopy) and can assist surgeons in implementing individualized clinical decisions in medical practice, thus addressing the goals of PPPM.

The online version contains supplementary material available at 10.1007/s13167-023-00333-5.

The purpose is to evaluate the trends in MR arthrogram utilization at a tertiary care academic institution and to determine if there are factors that can be implicated in the utilization trends. Number of MR arthrograms of the shoulder, hip, and elbow from 2013-2020 at our institution were identified (n = 1882). Patient demographics including age, sex, sports participation, history of prior surgery, and physician referral were obtained. Descriptive statistics were performed to determine the prevalence of MR arthrograms. Linear regression analyses were performed to determine the relationship of time with prevalence of arthrograms. Chi-square tests and posthoc analyses with Bonferroni correction were used to assess if categorical variables were different between the years. There was overall decrease in the prevalence of MR arthrograms of the shoulder, hip, and elbow despite an increase in the overall MR volume during the study period. Linear regression models significantly predicated decrease in arthrogram prevalence with each passing year (P < 0.001). The percentage of orthopedic referrals for arthrograms in the hip (P = 0.002) and shoulder (P = < 0.001) decreased significantly towards the end of the study period. None of the other variables assessed were significant. At our tertiary care academic institution, arthrogram utilization has been drastically decreasing over the past 8 years. The percentage of orthopedic referrals for shoulder and hip arthrograms significantly decreased at the end of the study period.