Local causes of painful shoulder joint: Assessment by high resolution ultrasonography and MRI

Abstract

Shoulder pain is one of the commonest musculoskeletal complaints presented to orthopedics and rheumatologists. Shoulder is a joint commonly affected by degenerative changes, overuse and traumatic lesions. Many imaging techniques could be used in assessment of painful shoulder joint, including plain radiographs, computerized tomography, magnetic resonance imaging and high resolution ultrasonography. High resolution ultrasonography has advantages over other modalities in term of patient comfort, availability, low cost compared to CT and MRI, in addition to its diagnostic potential: its ability to be performed in real time for correlation the exact site of patient complaint, comparison with the other healthy side, dynamic evaluation, its high resolution and power Doppler evaluation of different lesions. Ultrasonography also shows no hazards of radiation exposure compared to CT and plain radiographs, and no contraindications compared to MRI studies as for patients with pace maker. The aim of our study was to evaluate degree of inter-method agreement between high resolution ultrasonography and MRI in assessment of various causes of shoulder pain. This study included 30 patients, ranging in age from 19 to 70 year old. They were referred to the Radiology department at Ain Shams University hospitals, during the period from 2014 to 2016. Those patients were examined by high resolution ultrasound and MRI. In our study, high resolution ultrasonography could successfully identified and diagnose many cases of soft tissue lesions and bony cortical abnormality. The main limitation was bone marrow assessment and deep articular cartilaginous and soft tissue. Both modalities, ultrasound and MRI, has equivalent ability in evaluation of superficial structures like tendons. The choice between one of them is determined by availability, referring clinician and the presence of well trained operator. Ultrasound has higher ability than MRI in evaluation of soft tissue abnormalities adjacent to hardware, and evaluation of abnormalities that require specific dynamic movement or positioning to provide a diagnosis.