The Use of Diagnostic Ultrasound for the Assessment of Rotator Cuff Tendinopathy: A Systematic Review.

BACKGROUND

Rotator cuff tendinopathy (RCT) is a common clinical diagnosis of pain and dysfunction in the shoulder. In conjunction with clinical tests, diagnostic ultrasound (US) is beneficial in the diagnosis of RCT through its ability to visualise tendon structural change. However, there is currently no standardised method to assess RCT with US.

AIMS/PURPOSE: The primary aim of this systematic review was to identify the common US parameters used to diagnose RCT with US. The secondary aim was to determine whether a nominal or ordinal scale should be used to diagnose RCT with US.

METHODS

A systematic review was conducted in July 2024 according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Studies were selected based on the following inclusion criteria: adults with RCT diagnosed with US, defined classification criteria for symptomatic tendinopathy, the US parameter used to measure structural change was reported with a grading scale (nominal or ordinal) and retrievable in full English text. Primary diagnosis of previous shoulder operations, partial or full-thickness tears, were excluded. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal tools by two independent reviewers.

RESULTS

A total of 1286 records were identified; eight studies met the inclusion criteria. The quality of the studies ranged from poor (12%) to good (88%). The most common US parameters were echogenicity (88%, n = 7), thickness (88%, n = 7), vascularity (50%, n = 4) and calcification (25%, n = 2). A nominal grading scale was most commonly utilised when assessing echogenicity (86%, n = 6 of 7), thickness (71%, n = 5 of 7) and calcification (100%, n = 2 of 2), while an ordinal scale was utilised in 100% of studies assessing vascularisation. Additionally, it was noted positioning and operator experience varied between studies.

CONCLUSION

This systematic review demonstrates the heterogeneity between methods used to diagnose RCT through US. Future studies should develop a standardised method to assess echogenicity, thickness, vascularisation and calcification in RCT, potentially using an ordinal scale to align with tendinopathy research in the lower limb.