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Sonography of the Rotator Cuff: Analysis of Interobserver Variability

William D. Middleton1, Sharlene A. Teefey1 and Ken Yamaguchi2

1 Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd., St. Louis, MO 63110.
2 Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO 63110.



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  		Fig. 1A. —47-year-old man with left shoulder pain. Arthroscopy performed after sonographic examination showed partial-thickness tear of supraspinatus tendon. Long-axis sonographic view of left supraspinatus insertion obtained from observer 1 shows hypoechoic region (cursors) that was interpreted as deep surface partial-thickness tear.

 


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  		Fig. 1B. —47-year-old man with left shoulder pain. Arthroscopy performed after sonographic examination showed partial-thickness tear of supraspinatus tendon. Similar long-axis sonographic view of left supraspinatus insertion obtained from observer 2 shows hypoechoic region similar to that shown in A that was interpreted as normal anisotropy.

 


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  		Fig. 2A. —75-year-old man with left shoulder pain. Surgery was not performed on this patient. Short-axis sonographic view of left supraspinatus and infraspinatus insertions obtained from observer 1 shows rotator cuff defect (cursors) that was interpreted as full-thickness tear of supraspinatus and infraspinatus tendons.

 


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  		Fig. 2B. —75-year-old man with left shoulder pain. Surgery was not performed on this patient. Similar short-axis sonographic view of left supraspinatus and infraspinatus insertions obtained from observer 2 shows rotator cuff defect (cursors) that was also interpreted as a full-thickness tear of supraspinatus and infraspinatus tendons.

 


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  		Fig. 3A. —65-year-old woman with left shoulder pain. Arthroscopy performed after sonographic examination showed partial-thickness tear of supraspinatus tendon. Long-axis view of left supraspinatus insertion obtained from observer 1 shows hypoechoic defect (cursors) that was interpreted as partial-thickness tear.

 


View larger version (100K):

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  		Fig. 3B. —65-year-old woman with left shoulder pain. Arthroscopy performed after sonographic examination showed partial-thickness tear of supraspinatus tendon. Similar long-axis sonographic view of left supraspinatus insertion obtained from observer 2 shows similar hypoechoic defect (cursors) that was also interpreted as partial-thickness tear.

 

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