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Bildgebende Verfahren bei Rotatorenmanschettendefekten der Schulter

Imaging in evaluating rotator cuff tears

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Zusammenfassung

Vor der Indikation zur bildgebenden Diagnostik steht die klinisch begründete Verdachtsdiagnose. Die Basis der bildgebenden Diagnostik bei Rotatorenmanschettendefekten bilden die konventionelle Röntgendiagnostik und die Sonographie. Für spezielle Fragestellungen bietet sich die Kernspintomographie an. Sehnentotaldefekte können sowohl im MRT als auch mit der Sonographie mit großer Sicherheit erkannt werden. Die Diagnostik von Partialdefekten der Manschette ist weiterhin verbesserungswürdig. Die Sicherheit des nativen MRT in der Diagnostik von Partialdefekten kann sowohl durch die indirekte als auch die direkte MR-Arthrographie deutlich gesteigert werden. Nur die Sonographie bietet bislang die Möglichkeit, im Echtzeitverfahren am bewegten Gelenk zu untersuchen. Mit der dynamischen Muskelsonographie sind zusätzliche Möglichkeiten gegeben, die Funktionsfähigkeit der Muskulatur zu erfassen. Der Einsatz der MRT als Screeningmethode sollte unterbleiben, da mit ihrer Hilfe keine therapeutisch relevanten Informationen gewonnen werden.

Abstract

Diagnostic imaging in a patient with shoulder pain should be used only after a comprehensive clinical evaluation of the shoulder. X-ray and ultrasonography are the basic diagnostic tools; computed tomography and magnetic resonance imaging (MRI) should be used only with certain indications. Ultrasonography and MRI have comparable accuracy for identifying and measuring full-thickness rotator cuff tears, but the accuracy for identifying partial-thickness still needs to be improved. MR arthrography has significantly improved sensitivity and specificity for partial-thickness tears of the cuff. Only ultrasound provides a real-time examination tool during shoulder movements. Moreover, dynamic ultrasonography can assess the contraction patterns of the supraspinatus and infraspinatus muscles, which may improve decision making in the treatment of shoulder diseases. In depicting fatty atrophy of the supraspinatus and infraspinatus muscles, MRI remains the reference standard. MRI should not be used as a diagnostic screening tool in patients with chronic shoulder pain because it does not appear to significantly affect treatment or outcome.

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  1. Orthopädische Abteilung Klinik Fleetinsel Hamburg, Admiralitätstraße 3, 20249, Hamburg, Deutschland

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