Imaging

 

The best modality for imaging the supraspinatus tendon (a soft tissue) varies according to the specific tendon disorder – Tendonitis (inflammation) Vs tendinosis (micro-tears) Vs partial or full thickness tear Vs rupture.

The options include: 

 

(a) MRI – Magnetic Resonance Imaging

MRI machines are used commonly to assess internal changes in a joint and produce the best quality images for soft tissue injuries, especially tendons. This device involves the use of a large magnetic field, does not use ionising radiation and is non-invasive; however, it is expensive. This device is considered to be the 'gold standard' for imaging tendons although ultrasonography may be an alternative option if time and/or cost are limiting factors.

 

 (b) Diagnostic Ultrasound

Good quality images of tendon, muscle and soft tissues. This imaging device can show haematoma formation (bleeding into the tissues) resulting from tendon tears and early calcification.

Ultrasound is most effective for distinguishing supraspinatus tears from other tendinopathies. Thus it is most clinically useful when attempting to either exclude or diagnose a suspected partial or full thickness tear or complete rupture. 

Research studies have shown that the accuracy of ultrasound in diagnosing tears depends on the size of the lesion. There is good specificity (91%) and sensitivity (97%) for complete tears.

 

For further information on reaserch findings see:

 

Brasseur, J., Lucidarme, O., Tardieu, M., Tordeur, M., Montalvan, B., Parier, J., LeGoux, P., Gires, A., & Grenier, P. (2004). Ultrasonographic rotator cuff changes in veteran tennis players: the effect of hand dominance and comparison with clinical findings. J.Eur.Radiology, 14: 857-864

Itoi, E., Minagawa, H., Yamamoto, N., Seki, N., & Abe, H. (2006). Are pain location and physical examinations useful in locating a tear sit of the rotator cuff? American J.Sports Medicine, 34(2):256-264.

 

Ultrasound of  a normal supraspinatus tendon

Complete tear of supraspinatus tendon 

(c) Plain X-ray 

Produce poor quality images of tendons but show bone detail well. This modality can detail the presence of any calcifications within the tendon and/or degenerative changes. Additionally, it can reveal structural abnormalities of the shoulder joint that may have lead to the tendon being impinged and the subsequent development of the tendinopathy.

 

Note: There is limited evidence based practice comparing the effectiveness of each imaging technique for the supraspinatus tendon as an individual structure. The decision as to whether imaging is required for a diagnosis and what is the best option to use will depend on your physiotherapists initial clinical findings.

 

Plain X-ray film of the right shoulder joint. Note the gap between the acromion and head of humerus - this is the subacromial space. 

Diagnosis is complicated and so you may find that your treating practitioner will provide treatment first and then assess your level of improvement in the next session. This will allow for confirmation that initial suspicions were correct and that the treatment is working, thus removing the need for expensive imaging. The expectation that you have to undergo imaging immediately for a diagnosis is not always warranted.