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Full-Thickness and Partial-Thickness Supraspinatus Tendon Tears: Value of US Signs in Diagnosis¹

¹ From the Department of Radiology, University of Michigan Medical Center, Taubman Center, Room 2910-G, 1500 E Medical Center Dr, Ann Arbor, MI 48109-0326 (J.A.J.); Advanced Radiology Services, Spectrum Health, Grand Rapids, Mich (S.L.); Department of Radiology, University of Pittsburgh Medical Center, Pa (A.P.); and Departments of Radiology (M.T.v.H., J.G.C.) and Orthopaedic Surgery (P.K.), Henry Ford Hospital, Detroit, Mich. From the 1999 RSNA scientific assembly. Received April 12, 2002; revision requested June 21; final revision received April 25, 2003; accepted May 20. Address correspondence to J.A.J. (e-mail: jjacobsn@umich.edu).

View larger version (136K): [in a new window]   Figure 1a. Full-thickness supraspinatus tendon tear. (a) Longitudinal and (b) transverse US images of the supraspinatus tendon show nonvisualization of the distal supraspinatus tendon and dipping of the deltoid muscle (D) into the tendon gap. The hypoechoic area (straight arrows) immediately superficial to the humeral head could represent tapering of the torn distal supraspinatus tendon, complex fluid, and synovial tissue. Note cortical irregularity (curved arrow) of the greater tuberosity and preservation of the infraspinatus tendon (IS).

View larger version (140K): [in a new window]   Figure 1b. Full-thickness supraspinatus tendon tear. (a) Longitudinal and (b) transverse US images of the supraspinatus tendon show nonvisualization of the distal supraspinatus tendon and dipping of the deltoid muscle (D) into the tendon gap. The hypoechoic area (straight arrows) immediately superficial to the humeral head could represent tapering of the torn distal supraspinatus tendon, complex fluid, and synovial tissue. Note cortical irregularity (curved arrow) of the greater tuberosity and preservation of the infraspinatus tendon (IS).

View larger version (134K): [in a new window]   Figure 2a. Full-thickness supraspinatus tendon tear. (a) Longitudinal and (b) transverse US images of the supraspinatus tendon show abnormal anechoic disruption of the supraspinatus tendon (straight arrows), which extends from the articular to the bursal surface. Note cortical irregularity (curved arrow) of the greater tuberosity and the cartilage interface sign (arrowhead). (c) Longitudinal US image over greater tuberosity (GT) shows supraspinatus tendon (S) and anechoic fluid (arrow) distending the subacromial-subdeltoid bursa. D = deltoid.

View larger version (130K): [in a new window]   Figure 2b. Full-thickness supraspinatus tendon tear. (a) Longitudinal and (b) transverse US images of the supraspinatus tendon show abnormal anechoic disruption of the supraspinatus tendon (straight arrows), which extends from the articular to the bursal surface. Note cortical irregularity (curved arrow) of the greater tuberosity and the cartilage interface sign (arrowhead). (c) Longitudinal US image over greater tuberosity (GT) shows supraspinatus tendon (S) and anechoic fluid (arrow) distending the subacromial-subdeltoid bursa. D = deltoid.

View larger version (139K): [in a new window]   Figure 2c. Full-thickness supraspinatus tendon tear. (a) Longitudinal and (b) transverse US images of the supraspinatus tendon show abnormal anechoic disruption of the supraspinatus tendon (straight arrows), which extends from the articular to the bursal surface. Note cortical irregularity (curved arrow) of the greater tuberosity and the cartilage interface sign (arrowhead). (c) Longitudinal US image over greater tuberosity (GT) shows supraspinatus tendon (S) and anechoic fluid (arrow) distending the subacromial-subdeltoid bursa. D = deltoid.

View larger version (139K): [in a new window]   Figure 3a. Articular side partial-thickness supraspinatus tendon tear. (a) Longitudinal and (b) transverse US images of the supraspinatus tendon show focal, well-defined anechoic disruption (between cursors and straight arrows) at the distal articular surface of the supraspinatus tendon (S). Note cortical irregularity (curved arrow) of the greater tuberosity. D = deltoid.

View larger version (136K): [in a new window]   Figure 3b. Articular side partial-thickness supraspinatus tendon tear. (a) Longitudinal and (b) transverse US images of the supraspinatus tendon show focal, well-defined anechoic disruption (between cursors and straight arrows) at the distal articular surface of the supraspinatus tendon (S). Note cortical irregularity (curved arrow) of the greater tuberosity. D = deltoid.

View larger version (122K): [in a new window]   Figure 4a. Bursal side partial-thickness supraspinatus tendon tear. US images (a) longitudinal and (b) transverse to the supraspinatus tendon show focal, well-defined anechoic disruption (between cursors and straight arrows) of the distal bursal surface of the supraspinatus tendon. The tendon abnormality extends to the greater tuberosity but does not extend to the articular surface (arrowheads). Note cortical irregularity (curved arrow) of the greater tuberosity.

View larger version (125K): [in a new window]   Figure 4b. Bursal side partial-thickness supraspinatus tendon tear. US images (a) longitudinal and (b) transverse to the supraspinatus tendon show focal, well-defined anechoic disruption (between cursors and straight arrows) of the distal bursal surface of the supraspinatus tendon. The tendon abnormality extends to the greater tuberosity but does not extend to the articular surface (arrowheads). Note cortical irregularity (curved arrow) of the greater tuberosity.

View larger version (135K): [in a new window]   Figure 5a. No tendon tear. US images (a) longitudinal and (b) transverse to the supraspinatus tendon show ill-defined heterogeneous hypoechogenicity (straight arrows), which could represent tendinosis or intrasubstance tear. The anterior aspect of the supraspinatus tendon is of normal thickness (arrowheads) but appears relatively thin due to the thickened area (curved arrow). Note absence of cortical irregularity of the greater tuberosity. B = long head of biceps brachii tendon.

View larger version (128K): [in a new window]   Figure 5b. No tendon tear. US images (a) longitudinal and (b) transverse to the supraspinatus tendon show ill-defined heterogeneous hypoechogenicity (straight arrows), which could represent tendinosis or intrasubstance tear. The anterior aspect of the supraspinatus tendon is of normal thickness (arrowheads) but appears relatively thin due to the thickened area (curved arrow). Note absence of cortical irregularity of the greater tuberosity. B = long head of biceps brachii tendon.

View larger version (139K): [in a new window]   Figure 6a. No tendon tear. US images (a) longitudinal and (b) transverse to the supraspinatus tendon show diffuse, heterogeneous, and ill-defined hypoechogenicity (arrows), which could represent tendinosis or intrasubstance tear. Note absence of cortical irregularity of the greater tuberosity (arrowheads).

View larger version (149K): [in a new window]   Figure 6b. No tendon tear. US images (a) longitudinal and (b) transverse to the supraspinatus tendon show diffuse, heterogeneous, and ill-defined hypoechogenicity (arrows), which could represent tendinosis or intrasubstance tear. Note absence of cortical irregularity of the greater tuberosity (arrowheads).

View larger version (180K): [in a new window]   Figure 7. Normal supraspinatus tendon. US image longitudinal to the supraspinatus tendon (S) shows normal hyperechoic fibrillar echotexture (straight arrows). Note artifactual hypoechogenicity (anisotropy) (curved arrow) where the tendon fibers are oblique to the ultrasound beam. D = deltoid, GT = greater tuberosity.

View larger version (41K): [in a new window]   Figure 8. Percent occurrence of each primary US sign for each arthroscopic result. FTT = full-thickness supraspinatus tendon tear, PTT-bursal = bursal side partial-thickness tear, PTT-articular = articular side partial-thickness tear.

View larger version (31K): [in a new window]   Figure 9. Percent occurrence of each secondary US sign for each arthroscopic result. FTT = full-thickness supraspinatus tendon tear, PTT-bursal = bursal side partial-thickness tear, PTT-articular = articular side partial-thickness tear.