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From the RSNA Refresher Courses

US of the Rotator Cuff: Pitfalls, Limitations, and Artifacts¹

¹ From the Department of Radiology, Jeroen Bosch Hospital, Nieuwstraat 34, 5211 NL ‘s-Hertogenbosch, the Netherlands (M.J.C.M.R., G.J.J.); and the Department of Radiology, University Medical Center, Nijmegen, the Netherlands (J.G.B.). Presented as a refresher course at several RSNA Annual Meetings. Received July 28, 2004; revision requested September 22; final revision received August 26, 2005; accepted August 29. All authors have no financial relationships to disclose. Address correspondence to M.J.C.M.R. (e-mail: M.Rutten{at}JBZ.nl).

High-resolution ultrasonography (US) has gained increasing popularity as a diagnostic tool for assessment of the soft tissues in shoulder impingement syndrome. US is a powerful and accurate method for diagnosis of rotator cuff tears and other rotator cuff abnormalities, provided the examiner has a detailed knowledge of shoulder anatomy, uses a standardized examination technique, and has a thorough understanding of the potential pitfalls, limitations, and artifacts. False-positive sonographic findings of rotator cuff tears can be caused by the technique (anisotropy, transducer positioning, acoustic shadowing by the deltoid septum), by the anatomy (rotator cuff interval, supraspinatus-infraspinatus interface, musculotendinous junction, fibrocartilaginous insertion), or by disease (criteria for diagnosis of rotator cuff tears, tendon inhomogeneity, acoustic shadowing by scar tissue or calcification, rotator cuff thinning). False-negative sonographic findings of rotator cuff tears can be caused by the technique (transducer frequency, suboptimal focusing, imaging protocol, transducer handling), by the anatomy (nondiastasis of the ruptured tendon fibers, posttraumatic obscuration of landmarks), by disease (tendinosis, calcifications, synovial proliferation, granulation or scar tissue, bursal thickening, massive rotator cuff tears), or by patient factors (obesity, muscularity, limited shoulder motion).

© RSNA, 2006