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The importance of ultrasonographic evaluation in the differentional diagnosis of the shoulder

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Obuchowicz R., Kita S. B.

Medical Rehabilitation

2008

vol. 12(2)

15-23

Because its superficially located soft tissue structures are readily accessible, the shoulder joint constitutes an appropriate area for ultrasonographic examination. Technical progress in the field of ultrasonography and the continuously increasing experience of the examiners has markedly increased the diagnostic usefulness of this imaging modality. Ultrasonographic evaluation has advantages over other imaging modalities, with its possibility of dynamic examination, which provides an opportunity for a much more accurate evaluation of joint structures while in motion. As a diagnostic method, ultrasonography is also preferred by patients. The most common cause of pain associated both with degenerative process-induced changes and the posttraumatic shoulder syndrome is supraspinatus muscle tendon tear – ultrasonography enables the identification of various types of injury of this component and other rotator cuff components. Dynamic evaluation increases diagnostic accuracy in the evaluation of the causes of subacromial impingement including instability of the humeral joint and instability of the acromioclavicular joint, the pathology of which has recently been ascertained as being among the most important causes of shoulder pain. Other pathologic conditions related to extra-skeletal calcifications within the soft tissue structures of the shoulder joint as well as degenerative protrusions from the acromioclavicular joint are readily visualised by means of ultrasonography. Ultrasonographic evaluation is also a recognised method in the assessment of the superficially located tendon of the long head of biceps brachii muscle and it has been proven as a very accurate method in the assessment of both chronic and acute biceps tendinitis. It is also considered to be one of the best imaging methods used for the detection of the presence of fluid in the gliding spaces and the joint cavity of the shoulder. Depending on the experience of the sonographer, ultrasound evaluation should be considered the imaging study of choice for the detection of pathological changes in soft tissues of the shoulder and be used as a valuable tool for the assessment of different functional pathological states.

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1 Medical Rehabilitation

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1 Obuchowicz R.

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The importance of ultrasonographic evaluation in the differentional diagnosis of the shoulder