Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 21, Issue 7, pp 1593–1597 | Cite as

Learning curve of office-based ultrasonography for rotator cuff tendons tears

  • Ji-Hoon Ok
  • Yang-Soo KimEmail author
  • Jung-Man Kim
  • Tae-Wook Yoo



To compare the accuracy of ultrasonography and MR arthrography (MRA) imaging in detecting of rotator cuff tears with arthroscopic finding used as the reference standard.


The ultrasonography and MRA findings of 51 shoulders that underwent the arthroscopic surgery were prospectively analysed. Two orthopaedic doctors independently performed ultrasonography and interpreted the findings at the office. The tear size measured at ultrasonography and MRA was compared with the size measured at surgery using Pearson correlation coefficients (r). The sensitivity, specificity, accuracy, positive predictive value, negative predictive value and false-positive rate were calculated for a diagnosis of partial-and full-thickness rotator cuff tears. The kappa coefficient was calculated to verify the inter-observer agreement.


The sensitivity of ultrasonography and MRA for detecting partial-thickness tears was 45.5 and 72.7 %, and that for full-thickness tears was 80.0 and 100 %, respectively. The accuracy of ultrasonograpy and MRA for detecting partial-thickness tears was 45.1 and 88.2 %, and that for full-thickness tears was 82.4 and 98 %, respectively. Tear size measured based on ultrasonography examination showed a poor correlation with the size measured at arthroscopic surgery (r = 0.21; p < 0.05). However, tear size estimated by MRA showed a strong correlation (r = 0.75; p < 0.05). The kappa coefficient was 0.47 between the two independent examiners.


The accuracy of office-based ultrasonography for beginner orthopaedic surgeons to detect full-thickness rotator cuff tears was comparable to that of MRA but was less accurate for detecting partial-thickness tears and torn size measurement. Inter-observer agreement on the interpretation was fair. These results highlight the importance of the correct technique and experience in operation of ultrasonography in shoulder joint.

Level of evidence

Diagnostic study, Level II.


Rotator cuff tear Ultrasonography Accuracy Partial tear 


Conflict of interest

There was no external funding source in this investigation.


  1. 1.
    Al-Shawi A, Badge R, Bunker T (2008) The detection of full thickness rotator cuff tears using ultrasound. J Bone Joint Surg Br 90(7):889–892PubMedGoogle Scholar
  2. 2.
    Co S, Bhalla S, Rowan K, Aippersbach S, Bicknell S (2011) Comparison of 2-and 3-Dimensional shoulder ultrasound to magnetic resonance imaging in a community hospital for the detection of supraspinatus rotator cuff tears with improved worktime room efficiency. Can Assoc Radiol J. doi: 101016/jcarj201102003 PubMedGoogle Scholar
  3. 3.
    de Jesus JO, Parker L, Frangos AJ, Nazarian LN (2009) Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: a meta-analysis. AJR Am J Roentgenol 192(6):1701–1707CrossRefPubMedGoogle Scholar
  4. 4.
    Houtz CG, Schwartzberg RS, Barry JA, Reuss BL, Papa L (2011) Shoulder MRI accuracy in the community setting. J Should Elb Surg 20:537–542CrossRefGoogle Scholar
  5. 5.
    Iannotti JP, Ciccone J, Buss DD, Visotsky JL, Mascha E, Cotman K, Rawool NM (2005) Accuracy of office-based ultrasonography of the shoulder for the diagnosis of rotator cuff tears. J Bone Joint Surg Am 87(6):1305–1311CrossRefPubMedGoogle Scholar
  6. 6.
    Miller BS, Downie BK, Kohen RB, Kijek T, Lesniak B, Jacobson JA, Hughes RE, Carpenter JE (2011) When do rotator cuff repairs fail? Serial ultrasound examination after arthroscopic repair of large and massive rotator cuff tears. Am J Sports Med 39(10):2064–2070CrossRefPubMedGoogle Scholar
  7. 7.
    Nelson MC, Leather GP, Nirschl RP, Pettrone FA, Freedman MT (1991) Evaluation of the painful shoulder. A prospective comparison of magnetic resonance imaging, computerized tomographic arthrography, ultrasonography, and operative findings. J Bone Joint Surg Am 73(5):707–716PubMedGoogle Scholar
  8. 8.
    Rutten MJ, Jager GJ, Blickman JG (2006) From the RSNA refresher courses: US of the rotator cuff: pitfalls, limitations, and artifacts. Radiographics 26(2):589–604CrossRefPubMedGoogle Scholar
  9. 9.
    Rutten MJ, Spaargaren GJ, van Loon T, de Waal Malefijt MC, Kiemeney LA, Jager GJ (2010) Detection of rotator cuff tears: the value of MRI following ultrasound. Eur Radiol 20(2):450–457CrossRefPubMedGoogle Scholar
  10. 10.
    Rutten MJCM, Jager GJ, Kiemeney LALM (2010) Ultrasound detection of rotator cuff tears: observer agreement related to increasing experience. AJR Am J Roentgenol 195(6):W440CrossRefPubMedGoogle Scholar
  11. 11.
    Singisetti K, Hinsche A (2011) Shoulder ultrasonography versus arthroscopy for the detection of rotator cuff tears: analysis of errors. J Orthop Surg 19(1):76–79Google Scholar
  12. 12.
    Sipola P, Niemitukia L, Kröger H, Höfling I, Väätäinen U (2010) Detection and quantification of rotator cuff tears with ultrasonography and magnetic resonance imaging—A prospective study in 77 consecutive patients with a surgical reference. Ultrasound Med Biol 36(12):1981–1989CrossRefPubMedGoogle Scholar
  13. 13.
    Smith T, Back T, Toms A, Hing C (2011) Diagnostic accuracy of ultrasound for rotator cuff tears in adults: a systematic review and meta-analysis. Clin Radiol 66:1036–1048CrossRefPubMedGoogle Scholar
  14. 14.
    Smith TO, Daniell H, Geere JA, Toms AP, Hing CB (2012) The diagnostic accuracy of MRI for the detection of partial-and full-thickness rotator cuff tears in adults. J Magn Reson Imaging 30:336–346CrossRefGoogle Scholar
  15. 15.
    Strobel K, Zanetti M, Nagy L, Hodler J (2004) Suspected rotator cuff lesions: tissue harmonic imaging versus conventional US of the shoulder. Radiology 230(1):243–249CrossRefPubMedGoogle Scholar
  16. 16.
    Teefey SA, Hasan SA, Middleton WD, Patel M, Wright RW, Yamaguchi K (2000) Ultrasonography of the rotator cuff. A comparison of ultrasonographic and arthroscopic findings in one hundred consecutive cases. J Bone Joint Surg Am 82(4):498–504PubMedGoogle Scholar
  17. 17.
    Teefey SA, Rubin DA, Middleton WD, Hildebolt CF, Leibold RA, Yamaguchi K (2004) Detection and quantification of rotator cuff tears. Comparison of ultrasonographic, magnetic resonance imaging, and arthroscopic findings in seventy-one consecutive cases. J Bone Joint Surg Am 86-A(4):708–716PubMedGoogle Scholar
  18. 18.
    Vlychou M, Dailiana Z, Fotiadou A, Papanagiotou M, Fezoulidis I, Malizos K (2009) Symptomatic partial rotator cuff tears: diagnostic performance of ultrasound and magnetic resonance imaging with surgical correlation. Acta Radiol 50(1):101–105CrossRefPubMedGoogle Scholar
  19. 19.
    Ziegler DW (2004) The use of in-office, orthopaedist-performed ultrasound of the shoulder to evaluate and manage rotator cuff disorders. J Should Elb Surg 13(3):291–297CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Ji-Hoon Ok
    • 1
  • Yang-Soo Kim
    • 1
    Email author
  • Jung-Man Kim
    • 2
  • Tae-Wook Yoo
    • 1
  1. 1.Department of Orthopedic Surgery, Seoul St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulKorea
  2. 2.Orthopaedic DepartmentBumin HospitalSeoulKorea

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