This prospective Level I diagnostic study enrolled 71 consecutive patients with shoulder pain, each undergoing both ultrasound and noncontrast MRI before arthroscopy. It asks whether the two modalities differ in accuracy for detecting and sizing full- and partial-thickness rotator cuff tears, using intraoperative measurement as the gold standard.
The question of which test to order for a suspected rotator cuff tear assumes one modality is better — this paper answers definitively that neither is, at centers with experienced readers.
For a full-thickness tear, either test works. When you need to evaluate the labrum, capsule, or muscle atrophy to guide repair planning and prognosis, order MRI. When the patient has an implanted device, is claustrophobic, or cost is a genuine concern, a high-quality ultrasound by an experienced sonographer gives you equivalent information for the tear itself.
The universal caveat: neither noncontrast MRI nor ultrasound adequately rules out a partial-thickness tear. Both miss roughly one-third of them. In a patient with persistent impingement symptoms and a negative study, consider MR arthrography (which the authors note outperforms noncontrast MRI for partial tears) or diagnostic arthroscopy.
These results are center-dependent. The accuracy reported here reflects operators with over a decade of dedicated musculoskeletal experience. Ultrasound performance degrades sharply without that expertise. A critical caveat when applying this equivalence to your own institution.
This prospective Level I diagnostic study enrolled 71 consecutive patients with shoulder pain, each undergoing both ultrasound and noncontrast MRI before arthroscopy. It asks whether the two modalities differ in accuracy for detecting and sizing full- and partial-thickness rotator cuff tears, using intraoperative measurement as the gold standard.
The question of which test to order for a suspected rotator cuff tear assumes one modality is better — this paper answers definitively that neither is, at centers with experienced readers.
For a full-thickness tear, either test works. When you need to evaluate the labrum, capsule, or muscle atrophy to guide repair planning and prognosis, order MRI. When the patient has an implanted device, is claustrophobic, or cost is a genuine concern, a high-quality ultrasound by an experienced sonographer gives you equivalent information for the tear itself.
The universal caveat: neither noncontrast MRI nor ultrasound adequately rules out a partial-thickness tear. Both miss roughly one-third of them. In a patient with persistent impingement symptoms and a negative study, consider MR arthrography (which the authors note outperforms noncontrast MRI for partial tears) or diagnostic arthroscopy.
These results are center-dependent. The accuracy reported here reflects operators with over a decade of dedicated musculoskeletal experience. Ultrasound performance degrades sharply without that expertise. A critical caveat when applying this equivalence to your own institution.