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European Radiology

, 21:1858 | Cite as

Detection and quantification of glenohumeral joint effusion: reliability of ultrasound

  • Veronika Zubler
  • Nadja Mamisch-Saupe
  • Christian W. A. Pfirrmann
  • Bernhard Jost
  • Marco Zanetti
Ultrasound

Abstract

Objectives

To evaluate reliability of ultrasound for detection and quantification of glenohumeral joint effusion.

Methods

With institutional review board approval and informed consent ultrasound of 30 consecutive patients before and after MR arthrography of the shoulder was performed. Presence and width of any anechoic collection was noted within various locations (biceps tendon sheath, subscapular recess (neutral position and internal rotation), posterior glenohumeral joint recess (neutral position and external rotation)). Injected fluid (8–12 ml) into the glenohumeral joint served as gold-standard. Widths of anechoic collections were correlated (Spearman rank correlation) with injected fluid.

Results

Glenohumeral anechoic collection was consistently seen in the posterior glenohumeral joint recess with the arm in external rotation (100%, 30/30), and in the biceps tendon sheath (97%, 29/30). Ultrasound was not sensitive at other locations (7%–17%). Mean width in anterior-posterior direction of anechoic collection in the posterior glenohumeral joint recess was 7 mm (range: 3–18 mm), 2 mm (range: 1–7 mm) in the biceps tendon sheath. Significant correlation (R = 0.390, p = 0.033) was found between width of anechoic collection and injected fluid in the posterior glenohumeral joint recess.

Conclusions

Glenohumeral joint effusion can be detected and quantified most reliably in the posterior glenohumeral joint recess with the arm in external rotation.

Keywords

Effusion Glenohumeral joint Ultrasound Quantification of joint effusion Shoulder infection 

References

  1. 1.
    Middleton WD, Edelstein G, Reinus WR, Melson GL, Murphy WA (1984) Ultrasonography of the rotator cuff: technique and normal anatomy. J Ultrasound Med 3:549–551PubMedGoogle Scholar
  2. 2.
    Middleton WD, Teefey SA, Yamaguchi K (1998) Sonography of the shoulder. Semin Musculoskelet Radiol 2:211–222PubMedCrossRefGoogle Scholar
  3. 3.
    Strobel K, Zanetti M, Nagy L, Hodler J (2004) Suspected rotator cuff lesions: tissue harmonic imaging versus conventional US of the shoulder. Radiology 230:243–249PubMedCrossRefGoogle Scholar
  4. 4.
    Moosikasuwan JB, Miller TT, Burke BJ (2005) Rotator cuff tears: clinical, radiographic, and US findings. Radiographics 25:1591–1607PubMedCrossRefGoogle Scholar
  5. 5.
    Martinoli C, Bianchi S, Prato N et al (2003) US of the shoulder: non-rotator cuff disorders. Radiographics 23:381–401, quiz 534PubMedCrossRefGoogle Scholar
  6. 6.
    Papatheodorou A, Ellinas P, Takis F, Tsanis A, Maris I, Batakis N (2006) US of the shoulder: rotator cuff and non-rotator cuff disorders. Radiographics 26:e23PubMedCrossRefGoogle Scholar
  7. 7.
    Zanetti M, Hodler J (2000) Imaging of degenerative and posttraumatic disease in the shoulder joint with ultrasound. Eur J Radiol 35:119–125PubMedCrossRefGoogle Scholar
  8. 8.
    Crass JR, Craig EV, Thompson RC, Feinberg SB (1984) Ultrasonography of the rotator cuff: surgical correlation. J Clin Ultrasound 12:487–491PubMedCrossRefGoogle Scholar
  9. 9.
    Teefey SA, Middleton WD, Yamaguchi K (1999) Shoulder sonography. State of the art. Radiol Clin North Am 37:767–785PubMedCrossRefGoogle Scholar
  10. 10.
    Seibold CJ, Mallisee TA, Erickson SJ, Boynton MD, Raasch WG, Timins ME (1999) Rotator cuff: evaluation with US and MR imaging. Radiographics 19:685–705PubMedGoogle Scholar
  11. 11.
    Bouffard JA, Lee SM, Dhanju J (2000) Ultrasonography of the shoulder. Semin Ultrasound CT MR 21:164–191PubMedCrossRefGoogle Scholar
  12. 12.
    Crass JR, Craig EV, Bretzke C, Feinberg SB (1985) Ultrasonography of the rotator cuff. Radiographics 5:941–953PubMedGoogle Scholar
  13. 13.
    Lin J, Jacobson JA, Fessell DP, Weadock WJ, Hayes CW (2000) An illustrated tutorial of musculoskeletal sonography: part 2, upper extremity. AJR Am J Roentgenol 175:1071–1079PubMedGoogle Scholar
  14. 14.
    Redondo MV, Berna-Serna JD, Campos PA et al (2008) MR arthrography of the shoulder using an anterior approach: optimal injection site. AJR Am J Roentgenol 191:1397–1400PubMedCrossRefGoogle Scholar
  15. 15.
    Bureau NJ, Chhem RK, Cardinal E (1999) Musculoskeletal infections: US manifestations. Radiographics 19:1585–1592PubMedGoogle Scholar
  16. 16.
    Luukkainen R, Sanila MT, Luukkainen P (2007) Poor relationship between joint swelling detected on physical examination and effusion diagnosed by ultrasonography in glenohumeral joints in patients with rheumatoid arthritis. Clin Rheumatol 26:865–867PubMedCrossRefGoogle Scholar
  17. 17.
    Naredo E, Aguado P, De Miguel E et al (2002) Painful shoulder: comparison of physical examination and ultrasonographic findings. Ann Rheum Dis 61:132–136PubMedCrossRefGoogle Scholar
  18. 18.
    Schmidt WA, Schicke B, Krause A (2008) Which ultrasound scan is the best to detect glenohumeral joint effusions? Ultraschall Med 29(Suppl 5):250–255PubMedCrossRefGoogle Scholar
  19. 19.
    Strunk J, Lange U, Kurten B, Schmidt KL, Neeck G (2003) Doppler sonographic findings in the long bicipital tendon sheath in patients with rheumatoid arthritis as compared with patients with degenerative diseases of the shoulder. Arthritis Rheum 48:1828–1832PubMedCrossRefGoogle Scholar
  20. 20.
    Arslan G, Apaydin A, Kabaalioglu A, Sindel T, Luleci E (1999) Sonographically detected subacromial/subdeltoid bursal effusion and biceps tendon sheath fluid: reliable signs of rotator cuff tear? J Clin Ultrasound 27:335–339PubMedCrossRefGoogle Scholar
  21. 21.
    Neumann CH, Holt RG, Steinbach LS, Jahnke AH Jr, Petersen SA (1992) MR imaging of the shoulder: appearance of the supraspinatus tendon in asymptomatic volunteers. AJR Am J Roentgenol 158:1281–1287PubMedGoogle Scholar
  22. 22.
    Schmidt WA, Schmidt H, Schicke B, Gromnica-Ihle E (2004) Standard reference values for musculoskeletal ultrasonography. Ann Rheum Dis 63:988–994PubMedCrossRefGoogle Scholar
  23. 23.
    Koski JM (1989) Axillar ultrasound of the glenohumeral joint. J Rheumatol 16:664–667PubMedGoogle Scholar
  24. 24.
    Koski JM (1991) Validity of axillary ultrasound scanning in detecting effusion of the glenohumeral joint. Scand J Rheumatol 20:49–51PubMedCrossRefGoogle Scholar
  25. 25.
    Seltzer SE, Finberg HJ, Weissman BN, Kido DK, Collier BD (1979) Arthrosonography: gray-scale ultrasound evaluation of the shoulder. Radiology 132:467–468PubMedGoogle Scholar
  26. 26.
    Schmidt WA, Volker L, Zacher J, Schlafke M, Ruhnke M, Gromnica-Ihle E (2000) Colour Doppler ultrasonography to detect pannus in knee joint synovitis. Clin Exp Rheumatol 18:439–444PubMedGoogle Scholar
  27. 27.
    Bruyn GA, Pineda C, Hernandez-Diaz C et al (2010) Validity of ultrasonography and measures of adult shoulder function and reliability of ultrasonography in detecting shoulder synovitis in patients with rheumatoid arthritis using magnetic resonance imaging as a gold standard. Arthritis Care Res (Hoboken) 62:1079–1086CrossRefGoogle Scholar
  28. 28.
    Moss SG, Schweitzer ME, Jacobson JA et al (1998) Hip joint fluid: detection and distribution at MR imaging and US with cadaveric correlation. Radiology 208:43–48PubMedGoogle Scholar

Copyright information

© European Society of Radiology 2011

Authors and Affiliations

  • Veronika Zubler
    • 1
  • Nadja Mamisch-Saupe
    • 1
  • Christian W. A. Pfirrmann
    • 1
  • Bernhard Jost
    • 2
  • Marco Zanetti
    • 1
  1. 1.Department of RadiologyOrthopedic University Hospital BalgristZurichSwitzerland
  2. 2.Department of Orthopedic SurgeryOrthopedic University Hospital BalgristZurichSwitzerland

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