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Table 1 Imaging diagnostic criteria

From: A prospective study of shoulder pain in primary care: Prevalence of imaged pathology and response to guided diagnostic blocks

Pathology

Imaging Diagnostic Criteria

X-Ray

 

Acromioclavicular joint

 

   arthropathy/degenerative change

joint space narrowing, subchondral sclerosis, subchondral cystic change or marginal osteophytes.

   osteolysis

bony resorption or increased lucency in distal clavicle.

Glenohumeral joint

 

   arthropathy/degenerative change

joint space narrowing, subchondral sclerosis, subchondral cystic change or marginal osteophytes.

   other

loose bodies, joint calcifications.

Calcification of rotator cuff components

 

   supraspinatus

calcific deposits adjacent to the greater tuberosity on AP-external rotation x-ray view.

   infraspinatus

calcific deposits adjacent to the greater tuberosity on AP-internal rotation x-ray view.

   subscapularis

calcific deposits in the anterior shoulder region on axial x-ray view.

Ultrasound a

 

ACJ pathology

Capsular hypertrophy, cortical irregularity or osteophytes, capsular bulge, joint space narrowing or widening.

Glenohumeral joint effusion

more than 2 mm between posterior glenoid labrum and posterior capsule.

Rotator cuff

 

   normal

normal contour, normal echogenicity.

   calcification

focal increase in echogenicity with or without shadowing.

   tendinosis

tendon thickening or decreased echogenicity.

   tear

 

   intrasubstance

hypoechoic change not extending to articular or bursal surface.

   partial thickness

SSp and ISp: hypoechoic change extending to either the articular or bursal surface. Subscapularis: partial fibre discontinuity.

   full thickness

SSp and ISp: hypoechoic region extends from bursal to articular surface. Subscapularis: complete fibre discontinuity.

Subacromial bursa

 

   bursitis

hypoechoic fluid or effusion present and >1 mm thick.

   bursal thickening

≥2 mm measured from deep margin of deltoid to superficial margin of supraspinatus.

   "bunching"

Fluid distension of the SAB or 'buckling' of the rotator cuff during abduction

MR arthrogram a

 

Acromioclavicular joint

 

   arthropathy/degenerative changes

capsular hypertrophy with or without joint space narrowing, subchondral cystic change, bone marrow oedema or osteophytes

   osteolysis

bony resorption or bone marrow oedema in the distal clavicle

Rotator cuff

 

   normal

normal contour, normal signal

   tendinosis

tendon thickening or mild increase in T2 signal

   intrasubstance tear

linear increase in T2 signal which does not extend to the articular or bursal surface.

   partial thickness tear

linear increase in T2 signal extending to the (bursal or articular) margins.

   full thickness tear

fluid signal intensity or contrast extending from the bursal to the articular side lesion of the rotator cuff. Contrast seen in the SAB.

Subacromial bursitis

increased T2 signal within the SAB

Glenohumeral joint

 

   rotator interval pathology

thickening, signal change or tear involving the biceps pulley, superior glenohumeral or coracohumeral ligament, or synovitis in the rotator interval.

   arthropathy/degenerative change

chondral loss, subchondral sclerosis, cystic changes, bone marrow oedema or osteophytes

   labral tear

contrast extending into- or undermining the glenoid labrum, not conforming to normal variant anatomy.

  1. Abbreviations: AP, antero-posterior view; ACJ, acromioclavicular joint; SSp, supraspinatus; ISp, infraspinatus; SAB, subacromial bursa;
  2. adefinitions based upon accepted diagnostic criteria [33, 35]