Clinical application of multi-parameter ultrasonic assessment for grading rotator cuff injuries: development and validation of a novel scoring system.

BACKGROUND: Rotator cuff injuries, a leading cause of shoulder pain and dysfunction, present significant diagnostic challenges. While MRI is the diagnostic gold standard, ultrasonography (US) offers a cost-effective alternative but lacks standardization. This study addresses this gap by developing and validating a novel multiparameter ultrasonic scoring system to increase the diagnostic accuracy and clinical applicability of shoulder ultrasonography for rotator cuff pathology.

METHODS: A retrospective diagnostic accuracy study of 252 patients with suspected rotator cuff injury was analyzed. Independent predictors identified through multivariable logistic regression included tear width, tendon swelling, synovial effusion, and vascular score, which were integrated into a weighted composite scoring system. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis.

RESULTS: The scoring system demonstrated excellent discriminative ability, with an area under the ROC curve (AUC) of 0.92. An optimal diagnostic threshold of > 4 points yielded a sensitivity of 82.2% and a specificity of 94.0%. This system enabled risk stratification into three tiers. Multivariate analysis confirmed tear width, degree of tendon swelling, synovial effusion, and vascular score as key diagnostic indicators.

CONCLUSION: This ultrasonic scoring system introduces a standardized, quantitative approach to rotator cuff diagnostics, designed to reduce interobserver variability and enhance diagnostic reliability. By stratifying patients into risk categories, it facilitates personalized treatment planning. However, as this represents the initial development and internal validation phase, further prospective and external validation studies are warranted to confirm its broader applicability.