Shoulder Impingement Clinical Trial
Official title:
Role of Ultrasound in Shoulder Impingement
- To evaluate the role of dynamic ultrasound in evaluation patient with clinically
suspected shoulder joint impingement.
- To assess the added value of dynamic ultrasonography to the static examination of
patients with clinically suspected impingement.
Shoulder impingement syndromes and degenerative rotator cuff (RC) disease represent the main
causes of shoulder pain . Impingement is classified into four types, depending on the site of
soft-tissue entrapment: sub acromial, sub coracoid, poster superior inner and anterosuperior
inner impingement. The sub acromial impingement syndrome is by far the most common in
practice. . The clinical symptoms of sub acromial impingement include nocturnal pain and
progressive, limited range of motion. At clinical examination, there is a painful area at
80-120° elevation, which is worsened during downward movements Osteophytes, or an abnormal
shape of the acromion, sub acromial spurs, and the acromioclavicular joint, are common causes
of compression at the rotator cuff and the overlying subacromial-subdeltoid bursa .
Ultrasonography (US) is a commonly performed examination for shoulder impingement,
recommended by experts as the first-choice technique to evaluate various shoulder diseases.
Shoulder impingement is the most common and well-recognized indication for dynamic US in the
shoulder.
Dynamic evaluation can be done by shoulder abduction or flexion with the probe placed at the
end of the acromion in the coronal plane or in the sagittal plane. The two important points
to be checked for shoulder impingement are the humeral head depression and tendon/bursal
impingement . Because humeral head depression is essential to make enough space for the
rotator cuff to slide beneath the acromion, the center of the humeral head normally moves
inferiorly in the latter half of the cycle during shoulder abduction. When the humeral head
does not move inferiorly or abnormally moves superiorly, the space for the rotator cuffs and
the subacromial-subdeltoid bursa decreases and subacromial impingement can occur .
Magnetic resonance imaging (MRI) is currently considered the reference standard for imaging
of shoulder disorders. The strength of MRI lies in its ability to assess sonographically
inaccessible areas such as labrum, deep parts of various ligaments, capsule, and areas
obscured by bone . MRI is the imaging study of choice for classifying tendon retraction and
assessing the shoulder musculature. Its main disadvantage is being a static evaluation of the
shoulder joint . There are several advantages of Ultrasonography over MRI. Ultrasonography
has the benefit of being a dynamic form of imaging as compared to the static MRI.
Ultrasonography is portable, quick, and a more cost-effective method. It is also better
tolerated by the patient and allows interaction with the patient, who can point at the
symptomatic area, thus optimizing the diagnostic yield.
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