Preliminary Diagnosis: Rotator Cuff Tears

I. What imaging technique is first-line for this diagnosis?

MR imaging without contrast

II. Describe the advantages and disadvantages of this technique for diagnosing rotator cuff tears.

Advantages

  • Able to localize, classify and measure the rotator cuff tear area, assess status of tendons edges and muscle bellies, and evaluate the presence of secondary findings associated with impingement as acromial spurs, hooked acromion, or acromioclavicular arthritis.

  • High diagnostic accuracy in evaluating full-thickness or partial-thickness tears of the rotator cuff.

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  • Non-invasive.

  • Does not require use of ionizing radiation.

Disadvantages

  • Expensive.

  • Time consuming.

  • Requires patient cooperation to limit motion artifact.

III. What are the contraindications for the first-line imaging technique?

Contraindicated in patients with non-MR compatible foreign bodies or metallic hardware.

IV. What alternative imaging techniques are available?

  • Ultrasound

  • MR arthrography

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing rotator cuff tears.

Ultrasound
Advantages

  • As accurate as MR imaging for full-thickness tears and partial-thickness tears.

  • Cost-effective imaging method.

  • May be performed more quickly than MR imaging

  • Requires less patient cooperation than MR imaging

Disadvantages

  • Less accurate for assessment of the secondary findings associated with rotator cuff tears.

  • Operator dependent technique.

  • Gives less anatomic detail as compared to MR imaging.

MR arthrography
Advantages

  • More accurate than MRI and ultrasound in diagnosing rotator cuff tears.

Disadvantages

  • Invasive procedure that exposes the patient to potential risks and discomfort.

  • Should be performed only when the MRI and ultrasound are not definitive.

VI. What are the contraindications for the alternative imaging techniques?

Ultrasound

None

MR arthrography

  • Contraindicated in patients with non-MR compatible foreign bodies or metallic hardware.

  • Should not be performed where there is suspected infection of the skin or soft tissue close to the needle path.

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