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Abstract: Pediatric acquired and congenital conditions leading to shoulder pain and dysfunction are common. Objective, quantitative musculoskeletal imaging-based measures of shoulder health in children lag recent developments in adults. We review promising applications of quantitative imaging that tend to be available for common pediatric shoulder pathologies, especially brachial plexus birth palsy and recurrent shoulder instability, and imaging-related considerations of musculoskeletal growth and development of the shoulder. We highlight the status of quantitative imaging practices for the pediatric shoulder and highlight gaps where better care may be provided with advances in imaging technique and/or technology., Competing Interests: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To explore patient experiences of rotator cuff-related shoulder pain, and their views on the role and value of diagnostic shoulder imaging., Materials and Methods: Semi-structured interviews were conducted with 20 patients with shoulder pain exploring the impact and management of their shoulder condition, reasons for and experiences of diagnostic imaging, and feelings about and responses to diagnostic imaging findings. Framework analysis was used to analyse the dataset., Results: Five themes were identified [1]: Lived experience and beliefs about pain and movement [2]; Contextualisation of imaging findings by health professionals is more important than the imaging report [3]; Factors influencing whether and when to have imaging [4]; Imaging can identify the actual problem and guide treatment; and [5] Treatment responses and treatment decision making., Conclusion: Patients commonly believe imaging is needed to formulate a diagnosis. There was minimal concern about potential indirect harms that could arise (e.g., inappropriate diagnosis leading to unnecessary treatments). The context of the diagnostic imaging reports (i.e., what needed to be done) was perceived as more important than the exact meaning of the imaging findings. Patients felt that the diagnostic imaging confirmed their existing biomedical beliefs, and these beliefs were not challenged by their healthcare professionals.

Aims: Rotator cuff related shoulder pain (RCRSP) is a prevalent cause of musculoskeletal pain. Patients presenting with this condition often undergo diagnostic imaging. However, many patients appear to have difficulty recalling the nature of their diagnosis. This may impact their rehabilitation outcomes. The aim of this study was to explore peoples' recall of their structural features relating to RCRSP by comparing their recalled description of their condition with the contents of their imaging reports as reported in an online questionnaire. In doing so, we aim to explore the potential emphasis they place on structural features related to their condition., Methods: This study was a content analysis embedded within a larger survey study published previously. Data containing patients' recall of their diagnosis was used from the study, and analysed using content analysis to quantify content in terms of codes and categories. The aims of frequency, completeness and accuracy of recall were then explored., Results: The analysis identified eight categories of terminology either recalled by patients or reported in imaging reports. The most frequent categories in reports were tendinopathy (71%) and joint (67%), but only 17% and 36% of participant responses contained these codes, respectively. Participants' completeness of recall compared with their imaging report was 30% on average. In terms of accuracy, only 8 out of 95 participants recalled their diagnoses 100% correctly., Conclusion: This study indicates that patients have poor overall recall of their RCRSP-related structural features. We contend that participants may have been able to recall what they viewed to be the most prominent structural feature in their imaging findings. It may be important for clinicians to consider the impact of diagnostic labelling, and whether a patient's ability to recall such labelling may have an influence on their outcomes., (© 2024 The Author(s). Musculoskeletal Care published by John Wiley & Sons Ltd.)

Purpose: The shoulder pain is one of the main causes that lead the patient to medical evaluation. Today, the ultrasound (US) represents an essential tool in the orthopaedical, rheumatological and rehabilitative setting to address the musculoskeletal causes of pain. Amongst the commonest causes of shoulder complains lay the frequent subacromial chronic bursitis (SACB). In this condition, the thickening of the bursal walls and subsequent fusion of the two synovial sheets leads to the reciprocal loss of bursal walls gliding under the subacromial space and consequently pain. This condition represents a common cause of shoulder pain and may be easily addressed by musculoskeletal sonographers. The purpose of this paper will be to describe the US appearance of SACB and to evaluate the efficacy of US-guided hydrodilation in its treatment., Methods: We included patients with painful shoulder attending our outpatient clinic for shoulder complains with the diagnosis of SACB with a bursal wall > 1.5 mm. A group was treated via US-guided hydrodilation, while the control group was treated via a classical blind approach using triamcinolone acetonide. Both groups underwent the same rehabilitation program following the injections. The shoulder functionality was assessed via qDASH questionnaire at baseline, days 3, 7, 14, 30, 60, and 90. A p <0.05 was considered significant., Results: Both groups displayed a significant reduction of pain; nevertheless, in the group treated with US-hydrodilation, there was no need for re-treatment., Conclusions: The US-guided hydrodilation for SACB should be the preferred technique to detach bursal walls and improve patient symptoms, since it requires fewer invasive maneuvers., (© 2024. Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB).)

Objectives: Shoulder pain is common but current clinical classification has limited utility. We aimed to determine whether groups of ultrasound-based shoulder pathologies exist and to evaluate outcomes according to identified groups and individual pathologies., Methods: This was a prospective study of a community-based cohort with shoulder pain referred for their first ultrasound scan at a single radiology unit, with subsequent routine clinical care. Patient-reported outcomes were collected at baseline, 2 weeks and 6 months; standardized ultrasound reporting was employed. Latent class analysis (LCA) identified ultrasound pathology-based groups. Multiple linear regression analysis explored associations between baseline pathologies, subsequent treatment and Shoulder Pain and Disability Index (SPADI). Short-term response to corticosteroid injections was investigated., Results: Of 500 participants (mean age 53.6 years; 52% female), 330 completed follow-up. LCA identified four groups: bursitis with (33%) or without (27%) acromioclavicular joint degeneration, rotator cuff tear (21%) and no bursitis/tear (19%). Total SPADI was higher at baseline for cuff tears (mean 55.1 vs 49.7-51.3; overall P = 0.005), but accounting for this, groups did not differ at 6 months (43.5 vs 38.5-40.5; P = 0.379). Baseline SPADI was the only predictor of 6-month SPADI retained by penalized modelling; neither LCA-derived ultrasound groups nor individual pathologies were selected. Response to baseline injection at week 2 did not differ between groups (mean SPADI 40.1-43.8; P = 0.423)., Conclusion: Ultrasound-based classification (groups or individual pathologies) of shoulder pain did not predict medium-term outcomes using current treatments. The role of routine diagnostic ultrasound for shoulder pain needs consideration; it may be useful to establish evidence-based therapies for specific pathologies., (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology.)

Purpose: To investigate pain hypervigilance in individuals suffering from chronic neck and shoulder pain (CNSP) and its underlying brain mechanism., Methods: The evaluation of pain vigilance was conducted through the utilization of pain vigilance and awareness questionnaires. Voxel-wise regional homogeneity (ReHo) from 60 CNSP patients and 60 healthy controls (HCs) using resting-state fMRI data. Voxel-wise two-sample T-test was conducted to reveal the ReHo variations between CNSP and HC. Correlation analyses were utilized to reveal the connection between brain abnormalities and medical measurements. Furthermore, a mediation analysis was conducted to elucidate the pathway-linking changes in brain function with medical measurements., Results: Our present study revealed three main findings. Firstly, patients with CSNP demonstrated a heightened vigilance of pain in comparison to healthy adults, a common occurrence among individuals with chronic pain conditions. Secondly, we observed brain abnormalities in various brain regions in CSNP patients, and these alterations were associated with the extent of pain vigilance. Lastly, the pain hypervigilance impact on the severity of pain was found to be controlled by regional neural activity in the anterior cingulate cortex (ACC) in subjects with CSNP., Conclusion: Our findings suggested that long-term repetitive nociceptive input caused by chronic pain further aggravates the pain intensity by impairing the vigilance-related pain processing within the anterior cingulate cortex in CNSP patients., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: Adhesive capsulitis (AC) has traditionally been a clinical diagnosis characterized by progressive shoulder pain and decreased range of motion. Our aim is to examine the role of shoulder MRI in making the diagnosis of AC, and to identify the frequency of cases where MRI was the primary method in diagnosing AC amongst medical providers., Methods: This was an anonymized retrospective analysis. Patients with positive MRI features suggestive for AC from 2015 to 2018 were included. Pre and post MRI clinical notes were assessed in order to ascertain the clinical suspicion of AC. A total of 117 cases were included for this study., Results: Our results demonstrated the number of patients whose management were influenced by shoulder MRI. When all of the imaging parameters by MRI are taken into account by aggregate, there is a statistically significant difference (p-value < 0.01) with regards to orthopedists having their working diagnosis of AC confirmed by the MRI results as compared to the primary care physicians., Conclusion: This study supports the role of shoulder MRI in the evaluation of AC. Not only does shoulder MRI assist ordering clinicians with providing additional evidence to support a suspected diagnosis of AC, but also plays a primary role in making the diagnosis of AC in cases in which it was not initially suspected, ultimately impacting management., (Copyright © 2024. Published by Elsevier Inc.)

Background: After stroke, the effects of focused scapulo-humeral training with simultaneous assessment of the changes in shoulder subluxation, related muscle thicknesses and upper limb performance have not been studied in the literature., Objectives: This study aimed to investigate the effects of an 8-week scapulo-humeral training program in addition to conventional rehabilitation on upper extremity/trunk functions, shoulder pain, and sonographic measurements of the shoulder joint and periscapular muscles., Methods: Thirty stroke individuals were randomly separated into two groups as Group I-scapulo-humeral training (5F/10 M) and Group II - control (5F/10 M). Conventional rehabilitation program was applied to both groups, and a scapulo-humeral training exercise protocol was added for the scapulo-humeral group. All the treatments were applied for 1 hour/day, 3 days/week, 8 weeks. Clinical evaluations were made using the Fugl Meyer Assessment-Upper Extremity(FMA-UE), Action Research Arm Test(ARAT), ABILHAND, Visual Analog Scale, and Trunk Impairment Scale(TIS). Ultrasound was used to measure serratus anterior/lower trapezius muscle thicknesses, and acromion-greater tubercule/acromio-humeral distances., Results: FMA-UE, ARAT, ABILHAND and TIS scores increased in both groups, with greater increases in most parameters in the scapulo-humeral training group. Shoulder pain decreased only in the scapulo-humeral training group. Subacromial distances were decreased on the paretic side, and muscle thicknesses increased on both sides in the scapulo-humeral training group, and in the control group, only serratus anterior muscle thickness increased on the paretic side ( p  < 0.05 for all)., Conclusions: Additional scapulo-humeral exercises to conventional rehabilitation was seen to improve upper extremity/trunk performance and shoulder pain, and to increase scapula stabilizer muscle thicknesses in stroke individuals with mild-moderate upper extremity disability.

Background: Dysfunctional gliding of deep fascia and muscle layers forms the basis of myofascial pain and dysfunction, which can cause chronic shoulder pain. Ultrasound shear strain imaging may offer a non-invasive tool to quantitatively evaluate the extent of muscular dysfunctional gliding and its correlation with pain. This case study is the first to use ultrasound shear strain imaging to report the shear strain between the pectoralis major and minor muscles in shoulders with and without chronic pain., Case Presentation: The shear strain between the pectoralis major and minor muscles during shoulder rotation in a volunteer with chronic shoulder pain was measured with ultrasound shear strain imaging. The results show that the mean ± standard deviation shear strain was 0.40 ± 0.09 on the affected side, compared to 1.09 ± 0.18 on the unaffected side (p<0.05). The results suggest that myofascial dysfunction may cause the muscles to adhere together thereby reducing shear strain on the affected side., Conclusion: Our findings elucidate a potential pathophysiology of myofascial dysfunction in chronic shoulder pain and reveal the potential utility of ultrasound imaging to provide a useful biomarker for shear strain evaluation between the pectoralis major and minor muscles., (© 2024. The Author(s).)

Background: Recent scientific work shows that the most common injuries in CrossFit© occur in the shoulder joint. This paper aims to provide a review of shoulder pathologies in a young CrossFit © cohort via MRI and clinical examination., Methods: A survey was conducted in 13 CrossFit "boxes" in Germany, in which athletes with recurrent shoulder pain could report for a clinical examination and MRI diagnostic. Fifty-one CrossFit athletes with chronic shoulder pain agreed to participate in the study and were then examined physically and by MRI., Results: Fifty-one active CrossFit athletes aged 21-45 years (mean 33.7 years, 35 male and 16 female) were recruited. The most frequently detected pathologies were partial lesions of the supraspinatus tendon (N.=25; 49%) and labral lesions (N.=11; 21.6%). The findings also identified partial lesions of the subscapularis tendon (N.=9; 17.6%), pulley lesions (N.=9; 17.6%), and partial lesions of the infraspinatus muscle (N.=2; 3.9%)., Conclusions: These data demonstrate the need for a specific focus on particular shoulder injuries in CrossFit. Knowledge about the type of shoulder pathologies caused by CrossFit training allows for training-specific adaptations with regard to prevention, as well as a more targeted, sport-specific therapy. This study is the first in the literature to present on structural changes in the shoulders of active CrossFit athletes.

Background: Increase in supraspinatus tendon thickness (STT) resulting from swimming practice has been observed in those with a history of shoulder pain. The magnitude of change in STT after a swimming session and its rate of recovery may be an indicator of future shoulder pain incidence., Hypothesis: The supraspinatus tendons that demonstrate a greater increase in thickness as a result of swimming practice will have an increased likelihood of future shoulder pain in a cohort of competitive swimmers over a period of 6 months., Design: Descriptive epidemiology study., Level of Evidence: Level 2b, individual cohort studies., Methods: A cohort of 50 nationally qualified swimmers aged between 14 and 22 years, from 3 open National Swimming Programs in Victoria, Australia, were recruited for this study. Ultrasonographic measurements of swimmers' STT was obtained of both shoulders, before, immediately after, and 6 hours after a single swimming practice session. Data were recorded of any significant interfering shoulder pain at 3 and 6 months after the initial testing session., Results: Stepwise logistic regression models indicated that significant predictors of the likelihood of experiencing significant interfering pain were sex [significant at 6 months; odds ratio (OR) 4.2] and the extent of change in STT immediately (OR 2.3 and 1.3 per mm at 3 and 6 months, respectively) and 6 hours postpractice (OR 1.9 and 1.5 per mm at 3 and 6 months, respectively)., Conclusion: The current data suggest larger increases in tendon thickness after training are associated with an increased likelihood of future shoulder pain., Clinical Relevance: These data may be valuable for monitoring training load and identifying athletes who may have an increased likelihood of shoulder pain., Competing Interests: The authors report no potential conflicts of interest in the development and publication of this article.

Objectives: To assess the prevalence of shoulder injuries and ultrasound findings in elite Portuguese swimmers and their association with symptoms and personal or training-related factors., Methods: This cross-sectional study was conducted at the Portuguese Open and Youth Swimming National Championships between 27 and 30th July 2022. Each athlete entered details regarding personal and training history into a questionnaire and underwent a physical and ultrasound shoulder examination., Results: A total of 102 swimmers out of 662 Portuguese athletes were included in the study. Shoulder pain experienced during the previous season was reported by 42% of the athletes. A high prevalence of shoulder structural abnormalities was noted, specifically supraspinatus tendinosis (91%), tears (29%), and subacromial bursitis (29%). Specific training for injury prevention was associated with higher rates of infraspinatus tendinosis ( p  = 0.047), and supraspinatus tears were linked to greater swimming distances per week ( p  < 0.001) and practice ( p  < 0.001), more years of practice ( p  = 0.018), shoulder pain at the time of evaluation ( p  = 0.023), a higher number of missed competitions ( p  = 0.041), and shoulder injections ( p  = 0.009). Subacromial bursitis was associated with shoulder pain at the time of evaluation ( p  = 0.002) and during the previous season ( p  < 0.001), missed competitions ( p  < 0.001), and requirement for physical therapy ( p  = 0.006)., Conclusions: A high prevalence of shoulder morphological changes was found in surveyed swimmers and there were several associations with training load, regardless of individual characteristics of each athlete. It is essential to understand the true impact of current injury prevention programs and to develop effective measures to protect swimmers' health.

Background: Adhesive capsulitis affects the shoulder joint, causing pain and limiting motion. In clinical practice, the effectiveness of injections varies, and the factors influencing their success remain unclear. This study investigates the predictors of effective corticosteroid injections in patients with primary adhesive capsulitis., Design: This retrospective study enrolled adhesive capsulitis patients older than 35 yrs who received intra-articular corticosteroid injections. The response was determined based on patients' pain and range of motion 3 mos after the injection. Demographic data, medical comorbidities, and radiographic parameters (critical shoulder angle and acromial index) were compared between the effective and noneffective groups. Receiver operating characteristic curves and logistic regression were used to identify the predictors of injection effectiveness., Results: This study included 325 patients with primary adhesive capsulitis, who were divided into responder (189 patients, 58.2%) and nonresponder (136 patients, 41.8%) groups. The receiver operating characteristic curve revealed that the acromial index score indicated favorable discrimination for predicting a poor response to injections, whereas the critical shoulder angle score did not. Logistic regression revealed that the pain period, diabetes mellitus, and acromial index are predictors of nonresponders to injections., Conclusions: Long pain duration, the presence of diabetes mellitus, and an acromial index score greater than 0.711 were predictors of nonresponse to corticosteroid injections for primary adhesive capsulitis patients., Competing Interests: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose of the Study: In this study, we aimed to evaluate acromiohumeral distance (AHD) and supraspinatus tendon (ST) thickness measurements and their relationship with pain and function in ST pathologies., Material and Methods: The study included 111 patients and 25 healthy controls (HC). Patients were divided into 3 groups according to their diagnosis: non-tear tendinopathy (NTT), partial thickness tear (PTT), and full thickness tear (FTT). The AHD and ST thickness of the participants were measured with ultrasound. The pain and functional status of the patients were evaluated with the Numeric Rating Scale (NRS), The QuickDASH shortened version of the DASH Outcome Measure - Disabilities of the Arm Shoulder and Hand (QDASH), and Simple Shoulder Test (SST)., Results: The AHD value was significantly higher in the NTT group (p=0.000). The AHD value was significantly lower in the FTT group (p=0.000). ST thickness value was significantly lower in the PTT group compared to the NTT group (p=0.000). There was a positive correlation between ST thickness and BMI (r=0.553,p<0.01). There was a negative correlation between ST thickness and SST and a positive correlation between ST thickness (r=-0.223,p<0.05) and QDASH (r=0.276,p<0.05)., Conclusions: We found that AHD and SST thicknesses significantly differed in the NTT, PTT, FTT, and HC groups. This difference may be important for diagnosis. In addition, the effect of obesity on ST thickness and the relationship between ST thickness and functional scores may be considered. Weight control may be effective at this point., Key Words: acromiohumeral distance, supraspinatus tendon thickness, ultrasound.

Shoulder pain is a common musculoskeletal pain in the general population and results in significant disability, quality of life impairment and financial burden to the health care system. This cross-sectional study was carried out among purposively selected 61 adult patients with shoulder pain and or limited range of motion in the Department of Radiology and Imaging, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from September 2018 to August 2020 to determine the usefulness of USG in detection of common shoulder abnormalities, as an initial imaging modality using MRI as reference standard. The majority of the patients 25(40.98%) were in age group of 51-60 years with mean age of 52.98±10.85 years. In the dectection of rotator cuff pathology, the overall sensitivity, specificity and accuracy of USG for any complete tear were 100.0% each, for any partial tear were 79.71%, 96.57% and 91.80%, for any rotator cuff tear were 83.33%, 96.25% and 91.80%, and for any tendinosis were 90.48%, 99.37% and 96.31% respectively. The sensitivity, specificity and accuracy of USG were 88.23%, 92.59% & 90.16% for long head of biceps tendon sheath effusion, 100.0% each for long head of biceps tendon dislocation, 71.11%, 87.50% and 75.41% for glenohumeral joint effusion, and 58.06%, 96.67% and 77.05% for bursal effusion respectively. From this study, it is concluded that high resolution USG showed high sensitivity, specificity and accuracy compared to MRI in detecting common shoulder abnormalities, and could be considered as the first line imaging modality in the evaluation of shoulder pain.

Background: Os acromiale (OA) is an uncommon pathology with a variable prevalence rate among different populations. Objectives: The aim of this study was to report the frequency of OA utilizing shoulder MRI of patients with shoulder pathology. Methods: It was a retrospective study. After obtaining our IRB approval, we gathered all shoulder and upper arm MRIs from the radiology department and evaluated them. Results: The prevalence of OA was found to be 3.32%. The mean age of the affected patients was 50.87 years (25-81). Conclusion: The rate of OA in patients presenting with shoulder pain is 3.32% in Saudi Arabia, which correlates with what has been previously reported in the literature., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Shoulder pain is a substantial medical and socioeconomic problem in most societies, affecting the ability to work or carry out leisure time activities as well as subsequently influencing physical and psychological well-being. According to a nationwide survey in Finland, 27% of the population reported shoulder pain within the last 30 days. In clinical practice, imaging findings of structural abnormalities are typically thought to explain symptoms, even though such findings are also prevalent in asymptomatic individuals, particularly with increasing age. Overall, there is a paucity of high-quality evidence on the prevalence, clinical relevance and prognosis of 'abnormal' imaging findings of the shoulder.The aim of the Finnish Imaging of Shoulder (FIMAGE) study is fourfold: to assess (1) the prevalence of shoulder symptoms and the most common anatomical variants and imaging abnormalities of the shoulder; (2) the concordance between shoulder symptoms, function and imaging abnormalities; (3) the most important determinants of symptoms, function and imaging abnormalities; and (4) the course of shoulder complaints over 5 years., Methods: The FIMAGE target population of 600 participants, aged 40-75 years, will be randomly selected from a nationally representative general population sample of 9922 individuals originally recruited for the Finnish Health 2000 Survey. On giving informed consent, the participants will be invited to a clinical visit that includes assessment of general health, shoulder symptoms, bilateral shoulder examination and imaging of both shoulders with plain radiography and MRI., Ethics and Dissemination: The study has been approved by the Institutional Review Board of the Helsinki and Uusimaa Hospital District. The findings will be published according to the Strengthening the Reporting of Observational Studies in Epidemiology criteria., Trial Registration Number: NCT05641415., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Shoulder pain is one of the most common presentations in the orthopedic clinic. Multiple factors have been found to cause shoulder pain. Radiographs and ultrasound are widely available, relatively cheap modalities in assessing shoulder pain. The aim of this study is to assess the radiographic and sonographic imaging patterns of shoulder pain., Methods: A descriptive prospective cross-sectional hospital-based study was conducted at the Department of Radiology of Tikur Anbessa Specialized Hospital among patients with shoulder pain that came for imaging from August 2021-January 2022., Result: Of the 73 patients with shoulder pain included in the study, 67% were females while 33% males. The mean age was 51.7 years. Radiographs found pathology in 53% of the cases. Acromioclavicular joint osteoarthritis, greater tuberosity degenerative changes, rotator cuff calcification were common radiographic findings. Ultrasound detected pathologies in 87% of the cases. The common pathologies were rotator cuff pathologies, biceps tendon pathologies, acromioclavicular joint degeneration, greater tuberosity degenerative changes, subacromial subdeltoid bursitis, and adhesive capsulitis. There was a significant association between greater tuberocity degenerative changes and supraspinatous pathologies with age, greater tuberocity degenerative changes with supraspinatous pathologies, acromiohumeral distance of <7mm with supraspinatous pathology., Conclusion: Radiographs and ultrasound are valuable imaging modalities for shoulder pain. Low acromiohumeral interval, greater tuberosity degenerative changes, and acromioclavicular joint osteoarthritis are associated with rotator cuff tears. Rotator cuff pathologies are the most common pathologies observed in ultrasound. We recommend ultrasound to be second step after radiograph due to its low cost and wide availability., (© 2023 Bemnet Taye Gebregirgis, et al.)

Background: Acromiohumeral distance (AHD) and supraspinatus tendon thickness (STT) measured by ultrasound (US) can be combined in the occupation ratio (OR). Inter-rater reliability on these subacromial measures depends on the US experience of raters and on the subject status, differing between asymptomatic or patients with subacromial shoulder pain (SSP)., Objective: To evaluate inter-rater reliability between two raters with different US experience (experienced examiner and novice examiner)., Methods: In total, 20 asymptomatic subjects (controls) and 21 patients with SSP were examined on one shoulder. Inter-rater reliability was evaluated with intraclass correlation coefficient (ICC)., Results: ICC for controls was good for AHD at rest and at 60° (0.76-0.77), moderate for STT and AHD at 60° with weights (0.53-0.72), while OR was poorly reliable (below 0.44). ICC for SSP was moderate for AHD at rest and at 60°, STT, OR at rest and at 60° (0.52-0.74) and poor for AHD at 60° with weights and OR at 60° with weights (0.33-0.36). Bland-Altman plots showed systematic bias., Conclusion: Inter-rater reliability varied largely from poor to good between two examiners with different US experience. Clinicians might use the US as additional tool for detecting the subacromial structures, but a structured training including also symptomatic subjects is suggested. Researchers may further investigate the OR in matched case-control studies, and an overall agreement phase is recommended before starting the inter-rater reliability phase.

Impingement, especially subacromial impingement, is one of the most frequent causes of shoulder pain. It results in soft tissue pathologies due to constriction of the subacromial space. It can lead to tendon pathologies and bursitis. In addition to the clinical examination, imaging methods such as magnetic resonance imaging (MRI), MRI arthrography, ultrasound and X‑ray examinations are helpful in making a diagnosis or evaluating the cause of pain. Conservative treatment approaches, such as rest, medication, physiotherapy, manual therapy and infiltrations should primarily be used. If the symptoms do not improve after 3-6 months of conservative treatment, surgical treatment should be considered., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Ultrasound imaging has emerged as one of the most useful tools for evaluating shoulder disorders. To date, the association between shoulder ultrasonography and a patient's work status has rarely been explored by antecedent studies., Aim: This study aimed to investigate the association between sonographically diagnosed shoulder pathologies and job discontinuation and return to work., Design: A cross-sectional study., Setting: Outpatient clinic in the university hospital., Population: Fifty-nine patients who were older than 20 years of age and had worked in a full-time job within the past three years., Methods: All participants underwent clinical evaluation using the visual analog scale (for pain), Shoulder Pain and Disability Index, Pittsburgh Sleep Quality Index, and shoulder ultrasound examination. The work-related ergonomic risks, including dealing with heavy objects, repeated use and requiring forceful motion of the affected upper extremity, were assessed. The ultrasound-identified shoulder pathologies associated with job discontinuation, that is, sick leave due to painful shoulder for more than two consecutive months, were considered as the primary outcome. In the job discontinuation subgroup, we further investigated the association between return to work and the clinical/sonographic findings., Results: Univariate analysis revealed a positive association between job discontinuation and shoulder surgery or work types requiring forceful upper-limb movements. Multivariate analysis demonstrated that job discontinuation was positively associated with supraspinatus tendon full-thickness tears (risk ratio, 8.80; 95% CI, 1.77-10.56; P=0.018). Of the patients who received shoulder surgery, 46.6% had recurrent rotator cuff tears. Return to work was likely to be related to pain scores during overhead activities and shoulder function impairment but not to sonographic findings., Conclusions: Job discontinuation is associated with shoulder surgery, work that necessitates forceful upper-extremity movements and supraspinatus tendon full-thickness tears detected by ultrasound., Clinical Rehabilitation Impact: Sonographic findings should not be used as the only standard for evaluating the patient's work capability.

Background: Corticosteroid (CS) can be injected in a blind fashion (landmark-guided) or with ultrasound (US) guidance, and this may contribute to varying clinical results. We conducted this systematic review and meta-analysis to assess the effectiveness of US-guided versus landmark CS injections in the treatment of adult patients with shoulder pain., Methods: We searched MEDLINE (via PubMed), Scopus, Web of Science, EBSCO, and Cochrane Library for randomized controlled trials (RCTs) comparing US-guided versus landmark CS injection regarding visual analogue scale (VAS), functional scores, disability scores, abduction degree, and side effects. The data were pooled as mean difference (MD), standardized mean difference (SMD), or risk ratios (RRs), with 95% confidence intervals (CIs), using R software (meta package 4.9-0) for windows. Subgroup analysis and leave-one-out analysis were conducted., Results: Eighteen RCTs, with a total of 1010 patients, were included in this meta-analysis. The pooled estimate favored the US-guided over landmark CS injection in terms of the mean change of VAS between 6 weeks and baseline (SMD = - 0.48, 95% CI [- 0.79, - 0.17]), the shoulder functional scores (SMD = 0.35, 95% CI [0.05, 0.65]) and shoulder abduction degree (MD = 8.78, 95% CI [3.11, 14.46]). Whilst no significant difference was found between the compared group regarding the overall shoulder disability scores (SMD = - 0.51, 95% CI (- 1.25, 0.22]) and side effects (RR = 0.45, 95% CI [0.15, 1.34]). None of the eligible study analyzed the cost-effectiveness of the US-guided method compared with the landmark method for CS injection., Conclusion: Our analysis showed that US-guided CS injection was effective in the treatment of various shoulder diseases. Further research on the cost-effectiveness of US-guided CS methods is needed., (© 2022. The Author(s).)

Background: Suprascapular nerve entrapment is a rare disorder that is frequently misdiagnosed as another disease. The suprascapular nerve is commonly entrapped at the following two sites: the suprascapular and spinoglenoid notches. Nerve entrapment at the spinoglenoid notch causes infraspinatus muscle weakness and atrophy. Patients present with posterior shoulder pain and weakness. Magnetic resonance imaging is used to confirm the diagnosis of a spinoglenoid cyst and nerve compression. Open or arthroscopic aspiration or decompression is indicated for patients with cysts in whom conservative treatment has failed and those with cysts associated with suprascapular nerve compression., Case Presentation: Herein, we describe the case of a 49-year-old man with suprascapular nerve entrapment caused by a large cyst, namely, a hematoma, in the superior scapular and spinoglenoid notches. Open surgical decompression of the suprascapular nerve was performed owing to an intact rotator cuff and glenoid labrum., Conclusion: Posterior shoulder pain promptly resolved without complications., (© 2023. The Author(s).)

Objectives: To evaluate the diagnostic performance of an automated reconstruction algorithm combining MR imaging acquired using compressed SENSE (CS) with deep learning (DL) in order to reconstruct denoised high-quality images from undersampled MR images in patients with shoulder pain., Methods: Prospectively, thirty-eight patients (14 women, mean age 40.0 ± 15.2 years) with shoulder pain underwent morphological MRI using a pseudo-random, density-weighted k-space scheme with an acceleration factor of 2.5 using CS only. An automated DL-based algorithm (CS DL) was used to create reconstructions of the same k-space data as used for CS reconstructions. Images were analyzed by two radiologists and assessed for pathologies, image quality, and visibility of anatomical landmarks using a 4-point Likert scale., Results: Overall agreement for the detection of pathologies between the CS DL reconstructions and CS images was substantial to almost perfect (κ 0.95 (95% confidence interval 0.82-1.00)). Image quality and the visibility of the rotator cuff, articular cartilage, and axillary recess were overall rated significantly higher for CS DL images compared to CS (p < 0.03). Contrast-to-noise ratios were significantly higher for cartilage/fluid (CS DL 198 ± 24.3, CS 130 ± 32.2, p = 0.02) and ligament/fluid (CS DL 184 ± 17.3, CS 141 ± 23.5, p = 0.03) and SNR values were significantly higher for ligaments and muscle of the CS DL reconstructions (p < 0.04)., Conclusion: Evaluation of shoulder pathologies was feasible using a DL-based algorithm for MRI reconstruction and denoising. In clinical routine, CS DL may be beneficial in particular for reducing image noise and may be useful for the detection and better discrimination of discrete pathologies. Assessment of shoulder pathologies was feasible with improved image quality as well as higher SNR using a compressed sensing deep learning-based framework for image reconstructions and denoising., Key Points: • Automated deep learning-based reconstructions showed a significant increase in signal-to-noise ratio and contrast-to-noise ratio (p < 0.04) with only a slight increase of reconstruction time of 40 s compared to CS. • All pathologies were accurately detected with no loss of diagnostic information or prolongation of the scan time. • Significant improvements of the image quality as well as the visibility of the rotator cuff, articular cartilage, and axillary recess were detected., (© 2023. The Author(s).)

Background: Steroid injection after percutaneous irrigation of calcific deposits is a common method for the treatment of rotator cuff calcific tendinitis (RCCT). However, steroids may prevent calcification resorption and cause potentially irreversible damage to tendons. Recent studies have confirmed the positive effects of ozone injection in shoulder tendinopathies, but no RCCTs have been reported. Thus, our study aims to evaluate the non-inferiority of ozone versus steroid injection., Methods: This is a prospective, randomized, parallel control and non-inferiority trial. A total of 100 patients with unilateral symptomatic RCCT will be enrolled and randomized in a 1:1 ratio to two groups: ultrasound-guided injection with ozone or corticosteroid. The primary outcome is the numeric rating scale for pain (NRS) at 1 week and 3 months following the procedure. Secondary outcomes include a multi-dimensional evaluation of shoulder disability and quality of life improvement, the degree of calcification absorption after treatment, and the number of multiple treatments., Discussion: The results of this study will provide short-term and long-term evidence for the effectiveness of ozone treatment in RCCT in relieving pain or improving shoulder function., Trial Registration: Chinese Clinical Trial Registry ChiCTR2200063469. Registered on 7 September 2022., (© 2023. The Author(s).)

Shoulder pain is a common cause of musculoskeletal presentation in primary care, where both traumatic and atraumatic pathologies can also lead to emergency department attendances. This article discusses common acute and chronic presentations of a painful shoulder, looking at the typical history of patients presenting with a painful shoulder, examination findings and the most appropriate imaging modalities to consider. Strengths and weaknesses of each imaging modality are discussed along with their role in aiding diagnosis, as well as management of the various pathologies encountered in primary and secondary care.

Purpose: To find ultrasound prognostic factors for shoulder pain., Methods: This was an observational, prospective study, comparing the evolution of ultrasound findings with clinical outcomes, in patients with shoulder pain. Data were collected in two appointments, from February 2018 to March 2021. Two-tailed non-parametric statistics were used, and p values <0.05 were considered significant., Results: A total of 79 participants were included in this study (median age 59 years, range 24-70, 61 women). A positive Doppler signal on tendons (p = 0.002) and absent tendon heterogeneity (p = 0.01) were associated with the patient's self-reported improvement. Tendon calcifications with poorly defined contours (p = 0.03) and sparse distribution (p = 0.001) were associated with VAS improvement. A reduction in the number of calcifications (p = 0.004), in the supraspinatus tendon thickness (p = 0.01), in subacromial effusions (p = 0.03), and in color Doppler grade (p = 0.02), between initial and follow-up exams, was found in patients with an improved DASH outcome., Conclusion: A positive Doppler signal on shoulder tendons can be a marker for a better prognosis in shoulder pain. Poorly defined and sparsely distributed calcifications can also indicate a better course of the disease., (© 2023 The Authors. Journal of Clinical Ultrasound published by Wiley Periodicals LLC.)

Chronic shoulder pain is an extremely common presenting complaint. Potential pain generators include the rotator cuff tendons, biceps tendon, labrum, glenohumeral articular cartilage, acromioclavicular joint, bones, suprascapular and axillary nerves, and the joint capsule/synovium. Radiographs are typically the initial imaging study obtained in patients with chronic shoulder pain. Further imaging may often be required, with modality chosen based on patient symptoms and physical examination findings, which may lead the clinician to suspect a specific pain generator. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation., (Copyright © 2023 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate the progression of rotator cuff tendon pathology across one year in manual wheelchair (MWC) users with spinal cord injury (SCI) and matched able-bodied individuals, and to explore the association between pain, age, and duration of wheelchair use with the progression of rotator cuff pathology. Design: Longitudinal cohort study, 1-year follow-up. Setting: Outpatient clinic at a tertiary medical center. Participants: Twenty-four adult MWC users with SCI (20 men) with an average age (SD) of 37(12) years and 24 age and sex-matched able-bodied individuals. Interventions: Not applicable. Main outcome measure(s): Presence of shoulder pain was collected. Magnetic resonance imaging (MRI) abnormalities of rotator cuff tendons including tendinopathy and tendon tears at baseline and 1-year follow-up visits were graded by a board-certified musculoskeletal radiologist, and three categories of tendon pathology scores including individual tendon scores, unilateral cuff scores, and bilateral cuff scores were calculated for each participant. Results: Fifty-four percent of the MWC users reported shoulder pain at both time points which was significantly higher than able-bodied cohort at baseline (17%, P = 0.012) and year 1 (21%, P = 0.021). Rotator cuff tendon pathology was detected as mainly mild tendinopathies and low-grade partial-thickness tears in both cohorts at both time points but was more common in MWC users. The results for the bilateral cuff scores indicated a significant (P < 0.008) progression of rotator cuff tendon pathology in the MWC users over one year. MRI findings did not change significantly for the able-bodied cohort across time. There was no association of pain, age, or duration of MWC use with progression of rotator cuff pathology in MWC user cohort. Conclusion: MWC users had a higher prevalence of pain than matched able-bodied cohort, but pain was minimal and not function-limiting. Bilateral cuff TOTAL scores showed pathology progression in MWC users, but MRI findings remained stable in the able-bodied cohort. MWC users were 3.4 times more likely to experience pathology progression than the able-bodied cohort.

Background: The rotator cuff is a group of muscles and tendons which support the shoulder joint. Rotator cuff disease is a frequent cause of morbidity in adulthood., Aims: The aims of his study are to determine the prevalence and patterns of rotator cuff derangement in symptomatic patients using MRI and to attempt to correlate identified patterns of disease with age and gender METHODS: Five hundred ninety-seven patients attending for MRI of the shoulder with atraumatic shoulder pain were included for study. Patients' age and gender was recorded. Record was made of the presence or absence of rotator cuff derangement and of degenerative change in the AC and glenohumeral joints. Correlation was made between age and gender., Results: There were 358 males (60%) and 239 females (40%) with a mean age of 49.4 ± 17.1 years. Subacromial bursitis was identified in 517 patients. A normal supraspinatus tendon was identified in 219 patients and supraspinatus full thickness tearing was identified in 102 patients. A normal AC joint was identified in 267 patients while degenerative AC joint changes were identified in 370 patients. A significant correlation was identified between age and rotator cuff derangement (p < .001) and between age and AC joint derangement (p < .001). No significant difference was identified between gender and patterns of cuff derangement CONCLUSION: The extent of rotator cuff and AC joint derangement increases with ageing. Impingement appears to trigger a cascade of events in sequence, from isolated subacromial bursitis through to supraspinatus tendon tearing. Patterns of rotator cuff derangement are similar in men and women., (© 2022. The Author(s).)

Background: High signal intensity (HSI) on T2-weighted or fat-suppressed magnetic resonance imaging (MRI) around the shoulder is often observed in patients who have a rotator cuff tear, and is generally recognized as an indicator of shoulder pain, especially pain at night. We hypothesized these HSI volumes are reduced after improvement of symptoms. We sought to compare HSI before and after conservative treatment, and to determine if HSI is associated with the patient's pain status over time., Methods: We enrolled 55 patients (average age 65 years) into the study. All the patients complained of pain at night (University of California, Los Angeles (UCLA) pain score ≤2, Japanese Orthopedic Association (JOA) pain score ≤10) at their initial visits and underwent conservative treatment. MRI was obtained at their initial visit and after improvement of pain when their initial UCLA pain score was ≥6 points or JOA pain score was ≥20 points. The mean time between the MRI examinations was 11.8 months (SD 7.7) (range 2.5-39). HSI was assessed at the location of the subacromial-subdeltoid bursa, glenohumeral joint, subcoracoid bursa, and sheath of the long head of the biceps tendon, and graded. Factors correlating with the improvement of MRI findings were evaluated retrospectively., Results: HSI had improved in 30 shoulders in all or some of the locations (I-group). There was no change in 25 shoulders for any location or aggravation in one or more locations (N-group). Multivariate logistic regression analysis found that the time from pain improvement until the second MRI was the only independent factor related to the improvement in HSI (p = .045)., Conclusion: Improvement of shoulder symptoms is not directly associated with MRI findings. Improvement in HSI followed symptom improvement after a delay; the changes varied for each shoulder location., Competing Interests: Declaration of competing interest None., (Copyright © 2021 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Background: Macroscopic alterations of the affected rotator cuff (RC) are undoubtedly linked to microscopic changes, but they may underestimate the actual degree of the disease. Moreover, it remains unclear whether preoperative structural RC changes may alter clinical outcomes., Methods: Supraspinatus tendon and muscle samples were collected from 47 patients undergoing RC surgery. Tendons were evaluated histologically according to the Bonar score; fatty infiltration and muscle atrophy were quantified using a software for biomedical image analysis (ImageJ) in percentage of area affected in the observed muscle section. Preoperative shoulder ROM and pain were evaluated. Radiological muscle atrophy was evaluated with the Tangent Sign and Occupation Ratio; fatty infiltration was assessed according to the Goutallier classification. Correlations between histological, radiological and clinical outcomes were assessed. Statistics were performed using the Spearman correlation coefficient. Intraobserver and interobserver agreement was calculated., Results: Histopathologic fatty infiltration (r = 0.007, p = 0.962), muscle atrophy (r = 0.003, p = 0.984) and the total Bonar score (r = 0.157, p = 0.292) were not correlated to preoperative shoulder pain. Muscle atrophy showed a significant but weak negative correlation with the preoperative movement of abduction (r = -0.344, p = 0.018). A significant but weak positive correlation was found between muscle atrophy and the total Bonar score (r = 0.352, p = 0.015). No correlation between histological and radiological evaluation was found for both fatty infiltration (r = 0.099, p = 0.510) and muscle atrophy (Tangent Sign: r = -0.223, p = 0.131; Occupation Ratio: r = -0.148, p = 0.319). Our histological evaluation showed a modal value of 3 (out of 3) for fatty infiltration and an equal modal value of 2 and 3 (out of 3) for muscle atrophy. In contrast, the modal value of the Goutallier score was 1 (out of 4) and 28 patients out of 47 showed a negative Tangent sign. At histology, intraobserver agreement ranged from 0.59 to 0.81 and interobserver agreement from 0.57 to 0.64. On the MRI intraobserver agreement ranged from 0.57 to 0.71 and interobserver agreement ranged from 0.53 to 0.65., Conclusions: Microscopic muscle atrophy appeared to negatively correlate with the movement of abduction leading to functional impairment. Shoulder pain did not show any relationship with microscopic changes. Radiological evaluation of the supraspinatus muscle alterations seemed to underestimate the degree of the same abnormalities evaluated at histology., (© 2023. The Author(s).)

Purpose: Bursitis is a common musculoskeletal cause of shoulder pain and treatment varies, thus correctly diagnosing and grading bursitis is paramount in deciding management. Our aim was to assess reliability in grading shoulder bursitis on ultrasonography among fellowship trained musculoskeletal radiologists at our institution. Methods: Retrospective study of patients diagnosed with bursitis on ultrasonography. Single-sonographic images of the subacromial-subdeltoid bursa were collected for each patient and randomized to form a test-bank of varying degrees of bursitis. Three months after the test was administered, the cases were randomized and readministered. The radiologists graded each case as: within normal limits, mild, moderate or severe. Intraobserver variability was measured using Cohen's kappa coefficient. Linear regression model was performed to assess correlation between years of experience and kappa. Results: 10 radiologists reviewed 70 cases of bursitis. Kappa values ranged from .53 to .91, indicating 'moderate' to 'almost perfect' variability amongst radiologists. A moderate positive correlation of improving variability ( r = .69) with increasing years of experience exists. Conclusion: Fellowship trained musculoskeletal radiologists were able to grade shoulder bursitis with moderate to almost perfect variability, with a positive correlation of improved variability with increasing experience. This may help clinicians choose the correct treatment more confidently in their patients with shoulder pain.

Purpose: To assess the feasibility of transarterial embolization (TAE) for recalcitrant nighttime shoulder pain in a multicentric study., Materials and Methods: This prospective, open-label, feasibility trial included 100 patients treated at 5 institutions. TAE was performed in 76 patients with adhesive capsulitis (AC) and 24 patients with symptomatic rotator cuff tears (sRCTs). The ipsilateral radial artery was punctured, and imipenem/cilastatin sodium was infused as an embolic agent. Adverse events, 10 point pain numerical rating scale (NRS), range of motion (ROM) of the shoulder joint, and quality of life (via the EuroQol-5D [EQ-5D]) were evaluated., Results: All patients exhibited neovascularity on baseline angiography, and all TAE procedures were performed successfully. No patient experienced a major adverse event. The mean nighttime pain NRS scores at baseline and 1, 3, and 6 months after TAE were 6.4 ± 2.2, 3.4 ± 2.6, 2.3 ± 2.5, and 1.6 ± 2.2, respectively (for all, P < .001). The mean ROM of anterior elevation at baseline and 1, 3, and 6 months after TAE were 97° ± 29°, 119° ± 28°, 135° ± 27°, and 151° ± 17°, respectively (for all, P < .001). The mean EQ-5D scores at baseline and 1, 3, and 6 months after TAE were 0.63 ± 0.17, 0.73 ± 0.16, 0.80 ± 0.17, and 0.84 ± 0.17, respectively (for all, P < .001). There was no significant difference in the clinical success rate between the AC and sRCT groups., Conclusions: TAE for nighttime shoulder pain caused by AC and sRCTs was feasible with sufficient safety and efficacy., (Copyright © 2022 SIR. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Competing interests: None declared.

Background: Ultrasound imaging is shown to be superior to other imaging tools for the evaluation of shoulder disorders in a primary care settings. In addition to its diagnostic utility, ultrasound diathermy is useful as a deep heat modality for the management of shoulder pain., Objective and Study Design: In this study, we analyzed the bibliometric data of publications that have focused on ultrasound imaging/therapy for shoulder-related pain syndrome., Methods: We searched the Web of Science (WoS) database for articles published between January 1, 1976, and June 24, 2022. The CiteSpace Version 6.1R2 software was used to analyze publication output, authoritative journals/countries/institutions/authors, keywords, references, and citations., Results: We analyzed 1185 articles in this study and observed a significant trend of an increase in publications per year (beta coefficient 1.8165, R2 = 0.7519, P < 0.001). The maximum number of relevant citations was identified in 2009, and these declined in subsequent years. The Journal of Ultrasound in Medicine, the United States of America, and the League of European Research Universities were identified as the journal, country, and institution with the highest number of publications, respectively. Keyword analysis revealed that "ultrasonography" showed the strongest citation bursts, followed by "arthroscopic findings" and "painful shoulders.", Limitations: We only analyzed publications indexed in the WoS because most indicators required for bibliometric analysis can be efficiently extracted from its website., Conclusion: This study highlights a significant trend of an increase in the number of publications focused on ultrasound imaging for shoulder-related pain syndrome. Ultrasound was shown to be a highly popular imaging modality among health care practitioners for the evaluation of shoulder disorders. Randomized controlled trials and state-of-the-art reviews are warranted to boost the citation count and conclusively establish the role of ultrasound applications in patients with shoulder pain syndrome.

Objective: To describe the number, specifics and co-occurrence of shoulder pathologies detected by MRI in manual wheelchair users with spinal cord injury and to evaluate the association between shoulder pathologies and presence of shoulder pain., Design: Cross-sectional observation study., Setting: Community., Participants: Fifty-one wheelchair-dependent persons with spinal cord injury (44 males, 7 females, median age 50 years (IQR 14), median time since injury 24 years (IQR 16)) were allocated to pain or no-pain group based on the Wheelchair User Shoulder Pain Index., Interventions: Not applicable., Outcome Measures: All persons underwent shoulder MRI. Pathologies were scored blinded by two experienced radiologists. Participant characteristics, number and severity of shoulder pathologies were analyzed descriptively. Logistic regression was performed to evaluate the association between MRI findings and shoulder pain., Results: The median number of co-occurring MRI findings per person ranged from 0 to 19 (out of 31 possible findings). The cluster of MRI findings occurring most often together were tendon tears of supraspinatus (present in 84%), subscapularis (69%) and biceps (67%) and osteoarthritis of acromioclavicular joint (80%). When correcting for age and time since injury, the logistic regression showed no statistically significant correlation between the individual pathologies and shoulder pain., Conclusion: MRI findings of shoulder pathology are very frequent in persons with and without shoulder pain. Therefore, when diagnosing the cause of shoulder pain and planning interventions, health care professionals should keep this finding in mind and MRI should not be interpreted without careful consideration of clinical history and functional testing.

Background: Subacromial impingement syndrome (SAIS) is a common cause of shoulder pain. The effects of physiotherapy modalities including low-level laser (LLL) and high power laser (HPL) on the SAIS have mostly been evaluated by the subjective outcome variables accompanied with the controversial findings and none of them has compared a combination of these two modalities, yet., Objectives: The present study was conducted to evaluate the effects of low-level laser (LLL) and high power laser (HPL) combined with kinesiology taping (KT), on the pain, function, and musculoskeletal ultrasound (MSKUS) parameters in the SAIS., Methods: Thirty patients with SAIS were randomly divided into the LLL-KT, HPL-KT, and sham-KT groups, respectively. Patients received seven treatment sessions. Visual analogue scale (VAS), shoulder pain and disability index (SPADI), MSKUS parameters were measured before and 48 hours after the treatment cessation., Results: Pain intensity significantly reduced in the LLL-KT (-2.43 (0.97)), HPL-KT (-3.43 (1.99)), and sham-KT (-2.43 (1.62)) ( P < .01). All the SPADI subscales are significantly reduced in all the groups ( P < .05), except for the pain in the sham-KT ( P = .06). Significant improvements were only observed in the diameters of biceps ( P < .05), supraspinatus tendon thickness in short and long axes ( P < .05), occupation ratio ( P = .004), and echogenicity ( P = .03) in the HPL-KT. Although the acromiohumoral distance (AHD) significantly increased in all the groups including the sham-KT ( P < .01), supraspinatus tendon thickness significantly decreased ( P < .05), and echogenicity increased ( P = .003) just in the HPL-KT., Conclusions: Kinesiology taping method alone is an effective intervention. Nevertheless, adding the analgesic and anti-inflammatory effects of both LLL and HPL to KT seems to result in better improvement of the pain, function, and MSKUS parameters in the SAIS. Findings of this study suggested that the HPL is more beneficial than the LLL or KT alone for management of the patients with SAIS.

Rationale and Objectives: Knowing the natural history of fatty degeneration of rotator cuff muscles is important for estimating the risk and rate of progression to cuff tear arthropathy (CTA). The purpose of this study was to investigate the changes in rotator cuff muscle fatty degeneration over time quantitatively in patients treated conservatively for shoulder pain., Materials and Methods: Thirty patients with a baseline and follow-up shoulder MRI, including a 2-point Dixon sequence, which were performed at least 1 year apart, were included. We classified patients into 3 groups: "full-thickness tear" (n = 7), "partial-thickness tear" (n = 13), and "no-tear" (n = 10) groups. The fat fraction in the supra- and infraspinatus muscles, and the rate of change in the fat fraction (ΔF fr ) were calculated using the formula "fat fraction of follow-up MRI/fat fraction of initial MRI." We investigated the difference in ΔF fr among the 3 groups and the degree of progression to CTA., Results: Statistically significant differences in ΔF fr within the supraspinatus and infraspinatus muscles were found among full-thickness, partial-thickness, and no-tear groups (2.54 vs 1.02 vs 0.75, p < 0.001 and 1.96 vs 1.07 vs 0.73, p = 0.021, respectively). Overall, 71.4% of the full-thickness tear group showed progression of CTA, and 28.6% of the full-thickness tear group needed reverse shoulder arthroplasty within an average follow-up period of 34 months., Conclusions: MR quantification, together with the knowledge of change in fatty degeneration over time, may be useful for the management of patients with shoulder pain., (Copyright © 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Background: Musculoskeletal pain is common in hemodialysis (HD) patients and may be related to articular or periarticular amyloid deposition. The shoulder is one of the most common afflicted joints, but not all causes of shoulder pain are detectable on radiography, and magnetic resonance imaging (MRI) is not always available. The aim of this study was to evaluate the validity of musculoskeletal ultrasound (MSUS) to properly detect shoulder disorders in HD patients by identifying US abnormalities in the shoulder and comparing them to those identified on MRI, with MRI serving as the gold standard test., Methods: This cross-sectional observational study was conducted on 28 HD patients (16 males and 12 females, mean age 46.89) with either unilateral or bilateral shoulder pain. Demographic data and clinical characteristics were recruited. All patients were subjected to clinical assessment, MSUS and MRI of both shoulders., Results: US abnormalities were prevalent in almost all patients. Supraspinatus tendinopathy was the most common abnormality in symptomatic shoulders (92.1%), followed by subacromial-subdeltoid (SASD) bursitis (65.8%), humoral erosions (57.9%), and acromioclavicular joint (ACJ) osteoarthritis (52.6%). MSUS shows high sensitivity and specificity when compared to MRI in all the studied shoulder pathologies except glenohumeral joint (GHJ) effusion (sensitivity, 33.3%) and infraspinatus tendinopathy (sensitivity, 58.3%). The percentage of agreement between MSUS and MRI in detecting biceps tenosynovitis was 82.14% (kappa, 0.64), subscapularis tendinopathy 83.93% (kappa, 0.654), supraspinatus tendinopathy 91.07% (kappa, 0.617), infraspinatus tendinopathy 82.14% (kappa, 0.470), SASD bursitis 80.36% (kappa, 0.569), humeral head erosions 82.14% (kappa, 0.635), GHJ effusion 82.14% (kappa, 0.352), and ACJ osteoarthritis 76.79% (kappa, 0.539)., Conclusions: Shoulder problems are common in HD patients, even in people who do not have obvious shoulder complaints. MSUS is a valuable imaging technique that assists in the diagnosis of HD patients who report shoulder pain., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2022 Samar Tharwat et al.)

In the pertinent literature, standardized sonographic protocols have been widely described to evaluate the different compartments of the shoulder. However, the subcoracoid space is a complex anatomical region-usually not included/described in basic ultrasound approaches. Accordingly, starting from its anatomy, we describe a two-phase dynamic ultrasound protocol to scan the subcoracoid space. This way, we aim to optimize the diagnosis and management of patients with anterior shoulder pain and subcoracoid effusion., (© 2021 American Institute of Ultrasound in Medicine.)

Objective: To describe MRI changes of the coracoclavicular bursa in patients presenting with shoulder pain and examine whether there is an association with coracoclavicular distance measurements., Methods: Retrospective analysis of 198 shoulder 3T MRI scans for patients with shoulder pain was performed. Two musculoskeletal trained radiologists read all MRI scans. Inter-reader and intra-reader agreements for the bursal changes were assessed using the Kappa coefficient. The coracoclavicular distance was stratified into three intervals: < 5 mm, 5-10 mm, and > 10 mm. Statistical analysis for the coracoclavicular bursal changes and coracoclavicular distance was conducted using Fisher's exact test., Results: Coracoclavicular bursal changes were detected in 9% (n = 18/198) of patients. There was a statistically significant association between coracoclavicular distance (< 5 mm) and the presence of coracoclavicular bursal changes (p-value = 0.011). All patients (100%, n = 18/18) with coracoclavicular bursal fluid presented with shoulder pain with 44.5% of the patients (n = 8/18) describing anterior shoulder pain. A statistically significant association was detected between coracoclavicular bursal changes and anterior shoulder pain (p-value = 0.0011). Kappa coefficient for the bursal changes inter-reader agreement was moderate (0.67) and the intra-reader agreement was almost perfect (0.91)., Conclusion: Coracoclavicular bursal changes were detected in 9% of shoulder MRI scans and were associated with reduced coracoclavicular distance (< 5 mm) suggesting an underlying mechanical disorder such as a friction or an impingement process. Documenting coracoclavicular bursal changes in the MRI report could help address patients' concerns and guide further management particularly in the context of shoulder pain and coracoclavicular distance of less than 5 mm., (© 2022. Crown.)

Objectives: The aim of this study is to determine the prevalence of abnormal anatomical change present on MRI in elite swimmers' shoulders compared to age-matched controls., Design: Descriptive epidemiological study., Methods: Sixty (aged 16-36 years) elite Australian swimmers and 22 healthy active, age and gender matched controls (aged 16-34 years). All participants completed a demographic, and training load and shoulder pain questionnaire and underwent shoulder MRI. Tests for differences in the population proportion was used for comparison between swimmers dominant and non-dominant shoulders and those of the controls., Results: Subscapularis and supraspinatus tendinopathy was the most common tendon abnormality identified in swimming participants, being reported in at least one shoulder in 48/60 (73 %) and 46/60 (70 %) swimmers, respectively. There was no significant difference between dominant and non-dominant shoulders for either tendinopathy, however, grade 3 tendinopathy was significantly more prevalent in subscapularis than in supraspinatus (P < 0.01). Compared with controls, significantly more abnormalities were reported in swimmers' shoulders in both subscapularis and supraspinatus tendons along with the labrum and acromioclavicular joint. Pathology was not a predictor of current pain., Conclusions: This data confirms that tendon abnormality is the most common finding in elite swimmers' shoulders. Furthermore, that subscapularis tendinopathy is not only as common as supraspinatus but has a greater prevalence of grade 3 tendinopathy. With significant varied abnormalities including tendinopathy being so common in both symptomatic and asymptomatic shoulders of swimming athletes', clinicians should consider imaging findings alongside patient history, symptom presentation and clinical examination in determining their relevance in the presenting condition., (Copyright © 2022 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Objectives: The aim of this study was to analyze whether differences in the coracohumeral distance (CHD) exist between the symptomatic and the asymptomatic shoulder in patients with subacromial pain syndrome and compare with the shoulder of control participants., Methods: This was a cross-sectional, observational study. A sample comprising 62 participants with subacromial pain syndrome was recruited from 3 different primary care centers. The CHD was determined from standardized ultrasonography measures performed on both shoulders at 0° and 60° of shoulder abduction, whereas the dominant arm was measured for the control participants., Results: Statistically significant differences in CHD at 0° and 60° were found between the symptomatic and control shoulders (P = .011/P = .002) and between the contralateral asymptomatic shoulder and controls (P = .026/P = .007)., Conclusion: We found differences in CHD at 0° and 60° of shoulder elevation between both the affected and the nonaffected shoulders when compared with healthy shoulders. These results suggest that CHD may be a contributing factor in chronic shoulder pain., (Copyright © 2022. Published by Elsevier Inc.)

Objective: To introduce cooled radiofrequency nerve ablation (C-RFA) as an alternative to managing symptomatically moderate to severe glenohumeral osteoarthritis (OA) in patients who have failed other conservative treatments and who are not surgical candidates or refuse surgery., Material and Methods: This prospective pilot study includes a total of 12 patients experiencing chronic shoulder pain from moderate to severe glenohumeral OA. Patients underwent anesthetic blocks of the axillary, lateral pectoral, and suprascapular nerves to determine candidacy for C-RFA treatment. Adequate response after anesthetic block was over 50% immediate pain relief. Once patients were deemed candidates, they underwent C-RFA of the three nerves 2-3 weeks later. Treatment response was evaluated using the clinically validated American Shoulder and Elbow Surgeons (ASES) score and visual analog scale (VAS) to assess pain, stiffness, and functional activities of daily living. Follow-up outcome scores were collected up to 6 months after C-RFA procedure., Results: Twelve patients underwent C-RFA procedure for shoulder OA. VAS scores significantly improved from 8.8 ± 0.6 to 2.2 ± 0.4 6 months after the C-RFA treatment (p < 0.001). Patient's ASES score results significantly improved in total ASES from 17.2 ± 6.6 to 65.7 ± 5.9 (p < 0.0005). No major complications arose. No patients received re-treatment or underwent shoulder arthroplasty., Conclusion: Image-guided axillary, lateral pectoral, and suprascapular nerve C-RFA has minimal complications and is a promising alternative to treat chronic shoulder pain and stiffness from glenohumeral arthritis., (© 2022. ISS.)