Painful poststroke shoulder: Comparison of magnetic resonance imaging and high frequency ultrasonography

Background

The use of high frequency ultrasound has been increased in the diagnosis of musculoskeletal abnormalities.

Aim

To detect the structural abnormalities in patient with poststroke painful shoulder as a first objective, and the second objective to assess the diagnostic accuracy of US in detecting these abnormalities.

Patients and methods

The study included 106 patients (62 men; mean age, 57 ± 13 years) with shoulder pain after 1st attack of stroke, the patients examined separately by two radiologists, within three months of stroke development with ultrasound and MRI which was done in the same day or as maximum as three days after US examination, the images were reviewed for any abnormalities in rotator cuff, biceps tears, tendinopathies and atrophy, subacromial bursa fluid, and acromioclavicular capsular hypertrophy. MRI results were considered as gold slandered. Sensitivity, specificity, positive and negative predictive values kappa coefficients of the US in comparison with that of the MRI were measured.

Results

Different structural abnormalities detected in our patients and the agreement between ultrasound and magnetic resonance image in detecting these pathologies was good for rotator cuff tear, subacromial bursitis and glenohumeral effusion and very good for biceps tendon pathology, and it was poor for rotator cuff atrophy, ultrasound shows higher sensitivity (90.9%) in detecting full thickness tear of rotator cuff more than partial tear (80%) and with (98.6%) and (97.5%) specificity respectively. The sensitivity for both technique ranging from 90.9% for full thickness tear of rotator cuff to 64.3% for rotator cuff atrophy and the specificity between 98.9% and 97.1%.

Conclusion

high frequency ultrasound provide a high diagnostic accuracy in diagnosing poststoke shoulder pain and it was non expensive and less time-consuming, suitable as screening patients who are obese, have contraindication to MRI examination, allergy to contrast medium, or claustrophobic, and it can be done at bed side in critical patients.