Rotator cuff tears: the diagnostic role of ultrasonography

The overlap of symptomatology due to various shoulder pathologies such as inflammatory processes, degenerative conditions and traumatic entities, makes the clinical diagnosis of rotator cuff tears challenging and difficult. However recent advances in diagnostic technology have greatly improved the diagnosis of rotator cuff tears in the developed countries. On the other hand developing countries are non-beneficiary of modern diagnostic technologies such as magnetic resonance imaging and arthroscopy. They are too expensive to acquire and maintain and also they require highly skilled manpower. Therefore they are compelled to look for cheap but reliable diagnostic technologies. It is the author's opinion that, this cheap and reliable diagnostic technology, at the present time is ultrasonography. Ultrasonography is used routinely as a screening diagnostic procedure for rotator cuff tears at the Schulthess clinic in Switzerland. In the period of October to December 1999, 50 consecutive patients were ultrasonographically diagnosed to have rotator cuff tears. These patients were then investigated by magnetic resonance imaging. Operation for rotator cuff tears was subsequently performed only on those with positive MRI findings. The operation findings confirmed the preoperative ultrasonography and MRI diagnosis. Ultrasonography was therefore, found to have a diagnostic sensitivity of 100 percent in this study and also proved to be appreciably accurate in predicting the location and extent of the cuff tear. It is recommended from the basis of this study that ultrasonography should be adopted for the diagnosis of rotator cuff pathology at the Muhimbili Orthopaedic Institute.