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Ultrasound compared with magnetic resonance imaging for the diagnosis of rotator cuff tears: a critically appraised topic.

Failure of rotator cuff tendons because of wear and tear is the most common clinical problem of the shoulder, with more than 4.5 million physician visits per year in the United States. 1 Although failure can result from acute trauma, it more commonly arises from age-related attrition of the tendons. Rotator cuff injury increases with age, with two-thirds of asymptomatic persons over 70 years showing tendon tears by ultrasound imaging. Rotator cuff injury is more common inobesepersons,andlocalsteroidinjectionsandnicotineuse have been implicated in impairing tendon healing. 1 Both magnetic resonance imaging (MRI) and ultrasound (US) have evolved to become the mainstay in evaluation of the rotator cuff for tears or injury. 2 These techniques have essentially obviated the need for conventional shoulder arthrography. Technical improvements, coupled with a better understanding of rotator cuff anatomy and pathology, have resulted in maturation of these 2 modalities. However, diagnostic difficulty can arise because of technical limitations, artifacts, operator experience, and interpretative pitfalls. MRI, which is more universally accepted, may be limited in evaluating partial tears, whereas US is more challenging to perform, especially for beginners. 2 This article describes the use of evidence-based practice (EBP) techniques as a means of deciding the appropriateness of MRI or US in diagnosing rotator cuff tears.