Tuesday, December 3 | 8:50 a.m.-9:00 a.m. | VSMK31-02 | Room E451B
Unsuccessful visualization of a patient's rotator cable with ultrasound indicates that the tear area of a rotator cuff injury is large, according to researchers from the University of Montreal.In this Tuesday morning session, Dr. Nathalie Bureau will present findings from a study that investigated the relationship between visualization of the rotator cable on ultrasound and functional outcome, tear size, and muscle fatty atrophy in patients with full-thickness rotator cuff tears.
For the study, 52 patients with full-thickness rotator cuff tears and 20 comparison patients with no symptoms were examined with ultrasound by a musculoskeletal radiologist. The radiologist measured the length and width of each tear in the frontal and sagittal planes and calculated the tear area.
Ultrasound imaged the rotator cable in 75% of the asymptomatic group but in only 25% of patients with rotator cuff tears. In addition, ultrasound's inability to visualize the rotator cable in patients with tears correlated with a larger tear area.
When comparing those with a visible rotator cable to those without, the team also found a significant difference in the severity of muscle fatty replacement of the supraspinatus and the infraspinatus muscles, as well as in the severity of supraspinatus muscle atrophy.
Nonvisualization of the rotator cable on ultrasound correlates with larger rotator cuff tears and higher grades of supraspinatus and infraspinatus muscle fatty replacement, as well as supraspinatus muscle atrophy, Bureau's group concluded. The study's findings may help orthopedic surgeons choose the best treatment for their patients.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
