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Ultrasound or MRI for shoulder injury?

Q: I was in Israel with a tour group when I fell and hurt my arm. The surgeon who saw me ordered ultrasound pictures of my shoulder instead of an MRI. When I got back to the U.S., my orthopedic surgeon here requested MRIs. Should they have done MRIs in the first place?

A: Ultrasound and MRIs are both used to diagnose shoulder problems involving the rotator cuff tendons. Some surgeons prefer one over the other as they have different advantages. In the case of ultrasound, it is a quick and easy, noninvasive approach. Both shoulders can be done with little added time or cost.

The transducer used in taking ultrasound pictures can be used to help compress or move tissue when necessary. Usually a fully torn tendon retracts (pulls away from the bone where it was attached).

The ultrasound technician uses the transducer to separate out the torn edges from the healthy tendon. This gives the surgeon a better view of the size of the tear and extent of the damage -- important information when planning surgery.

Follow-up ultrasound images will give an idea of any changes that have occurred since the initial injury. MRIs may offer some additional information. Both can be valuable in planning treatment, especially if surgery is being considered.

Reference: Ori Safran, MD, et al. Natural History of Nonoperatively Treated Symptomatic Rotator Cuff Tears in Patients 60 Years Old or Younger. In The American Journal of Sports Medicine. April 2011. Vol. 39. No. 4. Pp. 710-714.

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