Full-thickness and partial-thickness supraspinatus tendon tears: value of US signs in diagnosis

PURPOSE: To determine which US signs are important in the diagnosis of a surgically identifiable supraspinatus tendon tear. MATERIALS AND METHODS: Fifty consecutive ultrasonographic (US) studies of the shoulder in patients who underwent arthroscopic follow-up were retrospectively reviewed by a musculoskeletal radiologist. US images of the supraspinatus tendon were evaluated for tendon nonvisualization, abnormal tendon echogenicity, tendon thinning, greater tuberosity cortical irregularity, cartilage interface sign, joint fluid, and subacromial-subdeltoid bursal fluid. US findings were compared with arthroscopic results. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for each US sign in the diagnosis of full-thickness tendon tear and again for any type of supraspinatus tendon tear. RESULTS: Arthroscopy revealed 21 full-thickness tears, five bursal surface partial-thickness tears, 10 articular surface partial-thickness tears, and 14 patients without tear of the supraspinatus tendon. The presence of greater tuberosity cortical irregularity and joint fluid was most important in the diagnosis of full-thickness supraspinatus tendon tear (sensitivity, 60%; specificity, 100%; positive predictive value, 100%; negative predictive value, 78%; accuracy, 84%). For diagnosis of any type of supraspinatus tendon tear (partial or full thickness), tendon nonvisualization, greater tuberosity cortical irregularity, and cartilage interface sign are most important, although a combination of signs did not improve accuracy. CONCLUSION: Secondary US signs, such as greater tuberosity cortical irregularity and joint fluid, are most valuable in the diagnosis of supraspinatus tendon tear.