ULTRASOUND AND OPERATIVE EVALUATION OF ARTHRITIC SHOULDER JOINTS

Objective-To assess the diagnostic value of ultrasonography (US) in th e evaluation of arthritic shoulder joints. Methods-Twenty shoulders of 20 inpatients with arthritis were evaluated by US one day before the shoulder operation. Changes in the subacromial-subdeltoid bursa, bicep s tendon and tendon sheath, rotatof cuff, and glenohumeral joint were recorded and compared with findings at operation. Results-In the detec tion of effusion/hypertrophy in the subacromial-subdeltoid bursa, US h ad a sensitivity of 93% and a specificity of 83%. For a biceps tendon rupture US had a sensitivity of 70% and a specificity of 100%. US miss ed three intraarticular biceps tendon ruptures. For effusion/hypertrop hy in the biceps tendon sheath US had a sensitivity of 100% and a spec ificity of 83%. For a rotator cuff tear US had a sensitivity of 83% an d a specificity of 57%. US missed two small longitudinal rotator cuff tears. Three thin membranous, but intact, rotator cuff tendons were cl assified as full thickness tears by US. Synovial effusion/hypertrophy was detected by US and at operation in all of the 12 glenohumeral join ts that were evaluable at surgery. Conclusion-US is a reliable method in experienced hands for the evaluation of inflammatory changes of an arthritic shoulder. In advanced stages of rheumatoid shoulder joints, however, US is not useful, because destructive bone changes and tendon ruptures change the normal anatomy and restrict shoulder motions, lim iting the visibility of US.