Sonography of the rotator cuff in painful shoulders performed without knowledge of clinical information: results from 58 sonographic examinations with surgical correlation

PURPOSE: To assess the value of sonography as an isolated diagnostic test for the detection and quantification of rotator cuff tears. METHODS: Preoperative sonographic examination was performed on 58 shoulders. Key biases on sonographic interpretation such as history-taking, physical examination, or concurrent imaging examinations were excluded by way of blinding. Tears of the rotator cuff were the positive findings of interest. Assessment of tear size and localization was done sonographically, and the results were compared with operative findings. RESULTS: All 24 full-thickness tears observed at surgery had been diagnosed correctly via sonography. In 19 of 20 cases with an intact rotator cuff, preoperative sonography was negative. Thirteen of 14 partial-thickness tears were not detected via sonography; 1 was misinterpreted as a full-thickness tear. Location of the tears relative to the rotator cuff tendons was described correctly in 21 of 25 cases. For tear size measurement, the 95% range of agreement was less than +/-1 cm. CONCLUSIONS: Blinded sonographic examination is effective in the detection and quantification of full-thickness tears of the rotator cuff but lacks sensitivity in the detection of partial-thickness tears.     

Interobserver variation in sonography of the painful shoulder

PURPOSE: This study was conducted as a prospective assessment of interobserver variability in the sonographic evaluation of the rotator cuff. METHODS: Three musculoskeletal radiologists who had different levels of scanning experience each performed shoulder sonography on 24 consecutive patients during 1 patient visit. The diagnostic criteria full-thickness rotator cuff tear, tendon calcification, tendinosis of the supraspinatus, subacromial fluid, subacromial synovial/bursal thickening, dynamic signs of impingement, and abnormality in the long head of biceps tendon were scored, with independent observers recording the data. Statistical analysis was performed using Cohen's kappa test, with significance assessed at p values of less than 0.05. RESULTS: There was good agreement (kappa >0.60, p <0.01) between the experienced operators for full-thickness rotator cuff tear, tendon calcification, dynamic signs of impingement, and abnormality of the long head of biceps tendon. There was no significant agreement between the experienced operators and the less experienced operator in several categories, including (and importantly) full-thickness rotator cuff tears (kappa=0.18-0.21). CONCLUSIONS: In experienced hands sonography of the rotator cuff is a reproducible diagnostic test, but agreement is poor when there is marked disparity between the operators' experience levels. Our findings suggest a need for a more clearly defined training curriculum for sonography of the shoulder in radiology training programs.     

Fine‐tuning the Diagnosis of Fetal Scalp Cysts

Objective. The purpose of this series is to emphasize the importance of an exhaustive and appropriately conducted sonographic examination in the correct diagnosis of fetal cystic scalp lesions and the place of magnetic resonance imaging (MRI) in the diagnostic sequence. Methods. Transabdominal and transvaginal 2‐ and 3‐dimensional sonography with color and power Doppler imaging as well as 3‐dimensional rendering techniques such as inversion and Doppler angiography were used. In 1 case, an MRI study was performed. Results. In 1 case, the MRI missed and the different sonographic techniques correctly made the diagnosis of a meningocele. In the second case, sonography was sufficient to establish the diagnosis of an epidermal cyst. Conclusions. These 2 cases show the value of going the distance with the newly available high‐frequency sonography. Ultimately, the correct diagnoses were made with the tools offered by sonography without the need for any other imaging modality.     

Posttraumatic Painful Hip

Objective. Nondisplaced hip fractures may be radiographically occult and require magnetic resonance imaging (MRI) or bone scintigraphy for diagnosis. Both examinations are expensive and are not readily available in many hospitals. Our objective was to evaluate sonography as a screening tool for occult hip fractures in posttraumatic painful hips in elderly patients. Methods. We prospectively evaluated 30 patients (mean age, 73 years), who were admitted for painful hips after having low‐energy trauma with nondiagnostic hip radiographs. After inclusion, patients underwent sonography of both hips for signs of injury. After completion of the sonographic examination and analysis of the results, patients underwent MRI of both hips. The sonographic findings were compared with the MRI findings, which served as the reference standard for accurate detection of a hip fracture. Results. Ten hip fractures were diagnosed by MRI. Sonography showed trauma‐related changes in all of those patients and in 7 additional patients, 3 of whom had pubic fractures. Sonography correctly identified 13 patients without hip fractures. The sensitivity of sonography was found to be 100%, whereas the specificity for hip fractures was 65%. Conclusions. Sonography for posttraumatic hip pain with negative radiographic findings did not result in a single missed hip fracture. Therefore, sonography may serve as an effective screening tool, mandating MRI only for cases with positive findings, whereas patients with negative sonographic findings need no further investigation. Sonography may therefore be very useful in hospitals around the world, where MRI may not be readily affordable or available.     

Sonographic Findings of High‐Grade and Non–High‐Grade Ductal Carcinoma In Situ of the Breast

Objective. The purpose of this study was to differentiate between high‐grade and non–high‐grade ductal carcinoma in situ (DCIS) of the breast on sonography. Methods. From October 2003 to August 2009, 76 DCIS lesions in 73 women who underwent sonography and mammography were included in this study. Lesions were confirmed by mastectomy, breast‐conserving surgery, or surgical biopsy. Images were analyzed by 2 radiologists with consensus and were correlated with histologic grades. Results. Of the 76 lesions, 44 were classified as high‐‐grade and 32 as non–high‐grade DCIS. Fifty‐seven lesions (75.0%) were identified on sonography, which revealed a mass in 30 cases, microcalcifications in 20, ductal changes in 4, and architectural distortion in 3. All cases with false‐negative findings on sonography (n = 19) showed microcalcifications on mammography. On sonography, masses were more frequently found in non–high‐grade (62.5%) than high‐grade DCIS (22.7%; P < .01). No significant difference was seen in the sonographic features of masses between high‐grade and non–high‐grade DCIS. Microcalcifications were more common in high‐grade (43.2%) than non–high‐grade (3.1%) DCIS (P = .02). Most sonographically visible microcalcifications had associated findings such as ductal changes (n = 11), a mass (n = 7), or a hypoechoic area (n = 5). The detection rate of microcalcifications on sonography was higher in high‐grade (62.9%) than non–high‐grade DCIS (25.0%; P = .023). Conclusions. Microcalcifications with associated ductal changes (11 of 31 [35.5%]) were the most common sonographic findings in high‐grade DCIS. An irregular hypoechoic mass with an indistinct and microlobulated margin (13 of 26 [50.0%]) was the most frequent finding in non–high‐grade DCIS.     

Localization of Parathyroid Adenomas by Sonography and Technetium Tc 99m Sestamibi Single‐Photon Emission Computed Tomography Before Minimally Invasive Parathyroidectomy

Objective. The purpose of this study was to determine the utility of radiologist‐performed sonography as the principal modality for parathyroid localization before minimally invasive parathyroidectomy. Methods. Both sonography and technetium Tc 99m sestamibi single‐photon emission computed tomography (SPECT) are commonly performed during imaging evaluation of patients with primary hyperparathyroidism (HPTH). Sonographic examinations ordered during the study period were performed by 1 author (M.E.T.), and results were immediately reported. Findings of a subsequent Tc 99m sestamibi study were recorded blinded to the sonographic results. The sensitivity and specificity of sonography and Tc 99m sestamibi SPECT were assessed with the use of surgery and pathology reports as a reference standard. The 2007 global Medicare reimbursement rates were used to assess the costs of preoperative localization. Results. Parathyroidectomy was performed in 144 of 172 patients evaluated by both modalities. The sensitivity, specificity, and positive predictive value of sonography for identifying abnormal parathyroid glands were 74%, 96%, and 90%, respectively. Sonography correctly localized a single adenoma or suggested multiglandular disease in 112 of 144 patients (78%). The sensitivity, specificity, and positive predictive value of SPECT were 58%, 96%, and 89%. Technetium 99m sestamibi SPECT correctly predicted an adenoma or multiglandular disease in 88 of 144 patients (61%). Five patients with negative sonographic findings were shown to have uniglandular disease on Tc 99m sestamibi SPECT. Selective use of Tc 99m sestamibi SPECT (ie, when sonographic findings were negative or equivocal) would have decreased the cost of imaging by 53%. Conclusions. Radiologist‐performed sonography may potentially be used as a principal imaging modality for patients with HPTH. Selective use of Tc 99m sestamibi in cases with negative or equivocal sonographic findings can decrease the cost of imaging before parathyroid resection considerably.     

Sonography in the Evaluation of Acute Appendicitis

Objective. The purpose of this study was to evaluate the negative predictive value (NPV) of sonography in the diagnosis of acute appendicitis. Methods. Right lower quadrant sonograms of 193 patients (158 female and 35 male; age range, 3–20 years) with suspected acute appendicitis over a 1‐year period were retrospectively reviewed. Sonographic findings were graded on a 5‐point scale, ranging from a normal appendix identified (grade 1) to frankly acute appendicitis (grade 5). Sonographic findings were compared with subsequent computed tomographic (CT), surgical, and pathologic findings. The diagnostic accuracy of sonography was assessed considering surgical findings and clinical follow‐up as reference standards. Results. Forty‐nine patients (25.4%) had appendicitis on sonography, and 144 (74.6%) had negative sonographic findings. Computed tomographic scans were obtained in 51 patients (26.4%) within 4 days after sonography. These included 39 patients with negative and 12 with positive sonographic findings. Computed tomography changed the sonographic diagnosis in 10 patients: from negative to positive in 3 cases and positive to negative in 7. Forty‐three patients (22.2%) underwent surgery. The surgical findings were positive for appendicitis in 37 (86%) of the 43 patients who had surgery. Patients with negative sonographic findings who, to our knowledge, did not have subsequent CT scans or surgery were considered to have negative findings for appendicitis. Seven patients with negative sonographic findings underwent surgery and had appendicitis; therefore, 137 of 144 patients with negative sonographic findings did not have appendicitis. On the basis of these numbers, the NPV was 95.1%. Conclusions. Sonography has a high NPV and should be considered as a reasonable screening tool in the evaluation of acute appendicitis. Further imaging could be performed if clinical signs and symptoms worsen.     

Sonographically detected subacromial/subdeltoid bursal effusion and biceps tendon sheath fluid: reliable signs of rotator cuff tear?

PURPOSE: Our purpose was to determine the association between sonographically detected subacromial/subdeltoid (SA/SD) bursal and biceps tendon sheath effusions and arthrographically proven rotator cuff tears. METHODS: Shoulder sonography reports and sonograms of 105 shoulders in 102 patients who also underwent arthrography were retrospectively reviewed for the presence of fluid within the biceps tendon sheath and SA/SD bursa. Reports and sonograms for 151 asymptomatic shoulders were also reviewed. RESULTS: Biceps tendon sheath effusion and/or bursal fluid were detected in 50 (48%) of 105 shoulders. Fifty-one patients had rotator cuff tears; 28 of them had effusions at 1 or both sites. The sensitivity, specificity, and positive predictive value (PPV) of biceps tendon sheath effusions for diagnosing rotator cuff tear were 35%, 74%, and 56%, respectively. For SA/SD bursal effusions, the sensitivity, specificity, and PPV were 8%, 94%, and 57%, respectively. For combined biceps tendon sheath and bursal effusions, the sensitivity, specificity, and PPV were 12%, 91%, and 54%, respectively. There was no statistically significant association between rotator cuff tears and effusions in the biceps tendon sheath, SA/SD bursa, or both. Among the 151 asymptomatic shoulders, 12 (7.9%) had biceps tendon sheath fluid, 5 (3.3%) had SA/SD bursal effusion, and 2 (1.3%) had both biceps tendon sheath and bursal effusions. CONCLUSIONS: The sonographic detection of intraarticular fluid, SA/SD bursal fluid, or both has a low sensitivity and PPV in the diagnosis of rotator cuff tears. Isolated intra-articular and/or SA/SD bursal effusions are not reliable signs of rotator cuff tear.     

Sonography of the shoulder after arthrography (arthrosonography): preliminary results.

PURPOSE: The purpose of this study was to verify whether arthrosonography improves diagnostic accuracy in diseases of the shoulder and provides additional information for therapeutic planning, compared with conventional sonography. METHODS: We prospectively studied 113 consecutive patients with chronic shoulder pain. Sonography was performed before and after arthrography, with the radiologist blinded to the results of arthrography. When a rotator cuff tear was detected sonographically, its type, location, and size were recorded; we also evaluated any changes in the subacromial-subdeltoid bursa and any abnormalities in the biceps tendon sheath. The diagnostic accuracy of conventional sonography and arthrosonography was compared with that of arthrography for rotator cuff tear. Changes in the subacromial-subdeltoid bursa and biceps tendon sheath seen on conventional sonography were also compared with those seen on arthrosonography. RESULTS: The sensitivity and specificity of conventional sonography in the diagnosis of rotator cuff tear were 86% (25/29) and 95% (80/84), respectively; for arthrosonography, the values were 97% (28/29) and 95% (80/84), respectively. The differences in sensitivity and specificity for the 2 sonographic techniques were not statistically significant (p > 0.05). The accuracy in localizing the tear was also not significantly different between the 2 sonographic techniques. Synovial proliferation was more easily detected with arthrosonography than it was with conventional sonography in the subacromial-subdeltoid bursa (p < 0.01) and in the biceps tendon sheath (p < 0.0001). CONCLUSIONS: Our preliminary results suggest that although arthrosonography was not superior to conventional sonography in the diagnosis of rotator cuff tears, it may provide a better assessment of the size of tears and additional information about synovial proliferation in the subacromial-subdeltoid bursa and the biceps tendon sheath.     

Second‐Trimester Genetic Sonography After First‐Trimester Combined Screening for Trisomy 21

Objective. The purpose of this study was to evaluate the trisomy 21 screening performance of the first‐trimester combined test followed by second‐trimester genetic sonography. Methods. This retrospective cohort study included all women with singleton pregnancies undergoing combined screening followed by genetic sonography at 17 to 21 weeks from January 1, 2005, to January 31, 2008. Combined test trisomy 21 risks were multiplied by positive or negative likelihood ratios based on the second‐trimester sonographic findings to determine the final trisomy 21 risk. Sonography was evaluated as the second part of (1) a stepwise sequential test applied to combined screen‐negative pregnancies and (2) an integrated test applied to all combined screen patients regardless of the latter results. A final trisomy 21 risk of 1:270 or higher was considered screen‐positive. Results. A total of 2231 pregnancies underwent combined screening, which detected 7 of 8 Down syndrome cases (87.5%) at a 9.6% screen‐positive rate. A total of 884 of these patients (39.6%), including 2 having fetuses with Down syndrome, had genetic sonography. Combined screening detected 1 of these trisomy 21 fetuses (50%) at a 15.7% screen‐positive rate. Integrated ultrasound‐based aneuploidy screening detected both trisomy 21 cases (100%) at a 22.7% screen‐positive rate, whereas stepwise sequential ultrasound‐based aneuploidy screening also detected both trisomy 21 fetuses (100%) but at a 28.3% screen‐positive rate (P < .0001). Conclusions. Second‐trimester genetic sonography after first‐trimester combined screening may improve trisomy 21 detection at the expense of increasing screen‐positive rates.     

Detection of muscle atrophy on routine sonography of the shoulder.

OBJECTIVE: To describe the utility of sonography in visualizing muscle atrophy during routine sonographic examination of the shoulder for evaluation of the rotator cuff tendons. METHODS: A retrospective review of 199 shoulder sonographic examinations performed by 2 musculoskeletal radiologists trained in musculoskeletal sonography with knowledge of the typical sonographic findings of muscle atrophy was performed. Reports were reviewed for the presence of muscle atrophy. If atrophy was present, the reports from those examinations were rereviewed for concomitant rotator cuff abnormalities. RESULTS: Forty-five examinations (23%) showed atrophy in at least 1 muscle on the basis of the criteria of increased echogenicity and decreased bulk. There were a total of 81 individual muscles that showed atrophy, with the following distribution: 16% supraspinatus (n = 13), 31% infraspinatus (n = 25), 36% teres minor (n = 29), 2% subscapularis (n = 2), and 6% biceps brachii (n = 5). In 34 of the 45 examinations with muscle atrophy, there were 57 concomitant full-thickness tendon tears: 64% supraspinatus (n = 29), 38% infraspinatus (n = 17), 7% subscapularis (n = 3), 0% teres minor (n = 0), 16% long head of biceps (n = 7), and 2% deltoid (n = 1). CONCLUSIONS: Although primary sonographic evaluation of the painful shoulder concentrates on the tendons of the rotator cuff, we suggest that examination of the muscles should become a standard component of the comprehensive shoulder sonographic examination, particularly given the potential clinical implications of muscle atrophy on the outcome of rotator cuff surgery.     

The Nipple‐Areolar Complex

Objective. The purpose of this presentation is to show the radiologic findings of normal variants and benign and malignant diseases that affect the nipple‐areolar complex. Methods. We evaluated the imaging findings of nipple‐areolar complex lesions, using multiple breast imaging modalities including mammography, sonography, galactography, contrast‐enhanced magnetic resonance imaging (MRI), and positron emission tomography/computed tomography. Results. Radiologic features of nipple‐areolar complex lesions, including Montgomery tubercles, nipple inversion, benign calcifications, inflammation, duct dilatations, intraductal papillomas, fibroadenomas, neurofibromatosis, dermatosis of the nipple, and breast malignancy, have been illustrated. Conclusions. A clinical examination is essential and an appropriate imaging evaluation with multiple modalities is often necessary to accurately diagnose an underlying abnormality of the nipple‐areolar complex. Given the limitations of conventional mammography, supplemental mammographic views often are needed, and sonography may be performed to further characterize a mammographic or clinical finding. Also, contrast‐enhanced MRI may be useful for additional evaluation.     

In vivo dynamic acromiohumeral distance in shoulders with rotator cuff tears

BackgroundThere are no previous studies on the acromiohumeral distance in shoulders with large-to-massive full-thickness rotator cuff tears. In this study, the acromiohumeral distance in rotator cuff tear and healthy shoulders was measured using 3D-to-2D model-to-image registration techniques.MethodsThe dynamic glenohumeral kinematics during scapular plane abduction and axial rotation were analyzed in 11 rotator cuff tear patients and 10 healthy control subjects. Periodic radiographic images of scapular plane abduction and axial rotation were taken using a flat-panel radiograph image detector. Movements of the shoulder joint were assessed using radiographic images and computed tomography-derived digitally reconstructed radiographs. The acromiohumeral distance was defined as the shortest 3D distance between the acromion and the proximal humerus.FindingsFor scapular plane abduction, the rotator cuff tear group had significantly smaller acromiohumeral distance than the control group at 15°, 30°, 45°, 60°, 75°, 135°, and 150° of humeral abduction (P < 0.05 at each measured angle). For axial rotation in the adducted position, the rotator cuff tear group had significantly smaller acromiohumeral distance than the control group at each point between −20° and 40° of glenohumeral external rotation (P < 0.05 at each measured angle).InterpretationThe minimum measured acromiohumeral distance was 0.9 mm in the rotator cuff tear shoulders and 2.1 mm in the healthy shoulders at 90° of scapular plane abduction. The findings are of clinical relevance because quantitative evaluation of the dynamic acromiohumeral distances in rotator cuff tear and healthy shoulders might provide important insight into subacromial impingement.     

High‐Frequency Sonographic Measurements of True and False Vocal Cords

Objective. The purpose of this study was to prospectively identify the normal sonographic values of human true and false vocal cords. Methods. In total, 229 healthy volunteers were divided into 8 groups according to their age and sex. High‐frequency sonography was used to measure the length, width, and thickness of both true and false vocal cords. Measurements were compared between groups, and correlations with age were analyzed. Forty of the 229 volunteers also participated in reliability and reproducibility studies. Results. The sonographic measurements had good reproducibility, with intraclass correlation coefficient ranges of 0.736 to 0.903 for interobserver reliability and 0.723 to 0.943 for intraobserver reliability. Measurements for the 3 parameters of both true and false vocal cords in male adults were greater than those in female adults (P < .001). The length, width, and thickness of true and false vocal cords in participants younger than 18 years were obviously correlated with age (r = 0.835–0.957; P < .001), but no significant correlation was found in the adult groups. The rates of visualization in male groups were significantly lower than those in female groups (P < .001) and gradually decreased with increasing age. Conclusions. Both true and false vocal cords can be shown by high‐frequency sonography, which can quantitatively measure both true and false vocal cords with good reliability and reproducibility.     

Sonographic differences in the appearance of acute and chronic full‐thickness rotator cuff tears.

This study was undertaken to identify differences in the sonographic appearance of acute and chronic full‐thickness rotator cuff tears. The ultrasonograms of 24 patients with an acute rotator cuff tear and 20 with a chronic tear were reviewed for tear size (width), location, and the presence and distribution of fluid. Among these 24 patients, 75% with a midsubstance tear location had an acute tear; 64% of patients with joint or bursal fluid had an acute tear; 80% of patients with a nonvisualized rotator cuff due to a massive tear had a chronic tear; and 73% of patients with no sonographic evidence of bursal or joint fluid had a chronic tear. In conclusion, a midsubstance location and the presence of joint or bursal fluid were more commonly associated with an acute tear. A nonvisualized cuff and the absence of joint and bursal fluid were more commonly observed with a chronic tear.     

Association of shoulder sonographic findings with subsequent surgical treatment for rotator cuff injury.

OBJECTIVE: To identify any clinical and radiologic findings of rotator cuff injury that predict whether patients will undergo shoulder surgery. METHODS: We retrospectively studied all shoulder sonograms obtained at a single institution over 12 months. Possible predictors of surgical treatment were documented, including patient age and sex, duration and types of symptoms, and the location and severity of tendon damage on sonography. One hundred twenty-eight patients underwent shoulder sonography; 34 patients eventually underwent shoulder surgery. Multivariate logistic regression was performed to identify clinical and sonographic factors associated with the use of surgical therapy. RESULTS: The only statistically significant predictor of surgical intervention was the finding of full-thickness tears (with or without tendon retraction) on sonography (P = .03). Patients with full-thickness tears were 4.3 times more likely to undergo surgery than those with no tears (odds ratio, 4.3). CONCLUSIONS: The sonographic diagnosis of full-thickness rotator cuff tears is the only finding statistically associated with the use of surgical treatment. No single clinical variable was consistently associated with subsequent surgery. Partial-thickness tears on sonography also do not show any statistical association with the eventual use of surgery for rotator cuff symptoms.     

Sonography of the Coracoid Process Region

Sonography is widely known as an accurate imaging tool for assessment of the rotator cuff of the shoulder, the long head of the biceps tendon, and joint disorders, but it is rarely performed to evaluate the coracoid process and the adjacent soft tissues. Nevertheless, sonography can show anatomic details of this region and be used to assess several pathologic conditions. The aims of this pictorial essay are to briefly review the anatomy of the coracoid process region, describe examination technique and normal sonographic appearances, and present the sonographic findings of the main disorders affecting this region.     

Is there a role for sonography in the diagnosis of tears of the knee menisci?

PURPOSE: The aim of this study was to investigate the usefulness of sonography in diagnosing tears of the knee menisci. METHODS: In this retrospective study, we reviewed the sonographic examinations of the knees of 321 patients diagnosed with a torn meniscus on the basis of clinical findings. Of the 321 knees imaged, 216 were also examined using MRI or CT. Arthroscopic meniscectomy was performed on 126 knees. RESULTS: MRI or CT did not confirm 48% (71 cases) of the positive sonographic diagnoses (ie, false positives) and 72% (50 cases) of the negative sonographic diagnoses (ie, false negatives). Thus, the sonographic diagnosis was correct in 95 cases (44%) and incorrect in 121 cases (56%), yielding low rates of sensitivity (60%) and specificity (21%). Among the 126 cases in which arthroscopic meniscectomy was performed, arthroscopy confirmed 100% of the MRI or CT diagnoses of meniscal tears. CONCLUSIONS: Our results indicate that sonography is not accurate enough to be used as the only imaging modality for diagnosing tears of the knee menisci.     

Comparison of acromiohumeral distance in symptomatic and asymptomatic patient shoulders and those of healthy controls

BackgroundThe reduction of the subacromial space has traditionally been linked to rotator cuff pathology. The contribution of this narrowing, both in the development and maintenance of rotator cuff tendinopathy, is still under debate. The objective of the present study was compare the acromiohumeral distance at 0 and 60 degrees of active shoulder abduction in scapular plane, static position, in both symptomatic and contralateral shoulders, between participants with unilateral rotator cuff related shoulder pain, and in asymptomatic participants.MethodThis was a cross-sectional observational study. Seventy-six participants with chronic shoulder pain were assessed. Forty participants without shoulder pain were also recruited to compare the acromiohumeral distance with symptomatic participants. The acromiohumeral distance was measured at 0 and 60 degrees of active shoulder abduction in all the groups by ultrasound imaging. Mean differences between symptomatic versus contralateral shoulders, and versus healthy controls, were calculated.FindingsThere were no statistical significant differences (p > .05) in the acromiohumeral distance at 0 degrees of shoulder elevation between the groups. However, significant differences were found at 60° between symptomatic and contralateral shoulder groups (0,51 mm; 95% CI: −0.90 to −0.12).InterpretationsDifferences in shoulder pain perception at 0° are not attributable to acromiohumeral distance differences. However, treatments focused on increasing AHD at 60° could be prescribed, as a significantly reduced AHD was found in symptomatic shoulders when compared with contralateral shoulders. Further research is needed to determine, not only static differences in AHD, but also dynamic differences.     

Two‐ and three‐dimensional prenatal sonographic diagnosis of prune‐belly syndrome

We report the prenatal diagnosis of 6 cases of Prune‐belly syndrome in the 2^nd trimester. The sonographic diagnosis was based on the findings of oligohydramnios, renal anomalies, and a lower abdominal cystic mass representing the abnormal dilatation of the bladder on conventional 2‐dimensional sonographic examination. We discuss the role of Doppler imaging and 3‐dimensional sonography as complementary methods to conventional sonography. Four of our 6 cases were confirmed with associated defects. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2010