Reliability of musculoskeletal ultrasound imaging to measure calcific deposits in patients with calcified rotator cuff tendinopathy
More details
Hide details
University Institute of Physical Therapy, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan
School of Management, University of Management and Technology, Lahore, Pakistan
Rehabilitation Sciences, Faculty of Allied Health Sciences, Khyber Medical University, Islamabad, Pakistan
Submission date: 2020-09-03
Acceptance date: 2020-11-02
Publication date: 2022-09-26
Physiother Quart. 2022;30(3):34-38
This reliability study was designed to assess intra-rater and inter-rater reliability of musculoskeletal ultrasound as a diagnostic modality to measure calcific deposits in subjects with rotator cuff tendinopathy.

Overall, 15 participants (10 males, 5 females) with calcified shoulder, aged 32–55 years, were examined in the same sitting posture. Two experienced radiologists imaged calcific deposits, measured twice daily by both raters with an interval of 2 hours for within-day reliability and re-measured after 1 week for between-day reliability. Data were analysed by using intra-class and inter-class correlation coefficient.

The mean size of calcific deposits in supraspinatus tendons was 14.61 ± 1.78, 14.87 ± 1.77, and 14.88 ± 1.88 mm for the first rater and 14.89 ± 1.78, 14.98 ± 1.792, and 15.13 ± 1.84 mm for the second rater. The results reflected excellent reliability, with the intra-class correlation coefficient for within-day comparison calculated as 0.989 (0.975–0.996) for the first rater and 0.984 (0.963–0.994) for the second rater (p = 0.000). The inter-class correlation coefficient for between-rater comparison equalled 0.991 for the first measurements by the first and second raters, 0.984 for the second measurements, and 0.986 for the third measurements.

A high degree of within-day and between-day reliability was observed between the successive measurements. This shows that musculoskeletal ultrasound is a highly reliable diagnostic tool for measuring the size of calcific deposits in patients with tendinopathy.

Fatima A, Ahmed A. Effectiveness of routine physical therapy with and without eccentric loading training for the rehabilitation of rotator cuff tendinopathy. Ann King Edw Med Univ. 2017;23(4):469–473; doi: 10.21649/journal.akemu/2017/23.4.469.473.
Cocco G, Ricci V, Boccatonda A, Iannetti G, Schiavone C. Migration of calcium deposit over the biceps brachii muscle, a rare complication of calcific tendinopathy: ultrasound image and treatment. J Ultrasound. 2018;21(4):351–354; doi: 10.1007/s40477-018-0336-z.
Lee KS, Rosas HG. Musculoskeletal ultrasound: how to treat calcific tendinitis of the rotator cuff by ultrasound-guided single-needle lavage technique. AJR Am J Roentgenol. 2010;195(3):638; doi: 10.2214/AJR.10.4878.
Parker L, Nazarian LN, Carrino JA, Morrison WB, Grimaldi G, Frangos AJ, et al. Musculoskeletal imaging: Medicare use, costs, and potential for cost substitution. J Am Coll Radiol. 2008;5(3):182–188; doi: 10.1016/j.jacr.2007.07.016.
Adler RS, Finzel KC. The complementary roles of MR imaging and ultrasound of tendons. Radiol Clin North Am. 2005;43(4):771–807; doi: 10.1016/j.rcl.2005.02.011.
Luime JJ, Koes BW, Hendriksen IJM, Burdorf A, Verhagen AP, Miedema HS, et al. Prevalence and incidence of shoulder pain in the general population; a systema­tic review. Scand J Rheumatol. 2004;33(2):73–81; doi: 10.1080/03009740310004667.
Waseem I, Tanveer F, Fatima A. Can addition of low level laser therapy to conventional physical therapy be beneficial for management of pain and cervical range of motion in patients with trigger point of upper trapezius? Anaesth Pain Intensive Care. 2020;24(1):64–68; doi: 10.35975/apic.v24i1.1228.
Keener JD, Steger-May K, Stobbs G, Yamaguchi K. Asymptomatic rotator cuff tears: patient demographics and baseline shoulder function. J Shoulder Elbow Surg. 2010;19(8):1191–1198; doi: 10.1016/j.jse.2010.07.017.
Louwerens JKG, Sierevelt IN, van Hove RP, van den Bekerom MPJ, van Noort A. Prevalence of calcific deposits within the rotator cuff tendons in adults with and without subacromial pain syndrome: clinical and radiologic analysis of 1219 patients. J Shoulder Elbow Surg. 2015;24(10):1588–1593; doi: 10.1016/j.jse.2015.02.024.
Pereira BPG, Chang EY, Resnick DL, Pathria MN. Intramuscular migration of calcium hydroxyapatite crystal deposits involving the rotator cuff tendons of the shoulder: report of 11 patients. Skeletal Radiol. 2016;45(1):97–103; doi: 10.1007/s00256-015-2255-9.
Farin PU, Jaroma H. Sonographic findings of rotator cuff calcifications. J Ultrasound Med. 1995;14(1):7–14; doi: 10.7863/jum.1995.14.1.7.
Gärtner J, Simons B. Analysis of calcific deposits in calcifying tendinitis. Clin Orthop Relat Res. 1990;254:111–120; doi: 10.1097/00003086-199005000-00017.
Roy J-S, Braën C, Leblond J, Desmeules F, Dionne CE, MacDermid JC, et al. Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterisation of rotator cuff disorders: a systematic review and meta-analysis. Br J Sports Med. 2015;49(20):1316–1328; doi: 10.1136/bjsports-2014-094148.
Teyhen D. Rehabilitative Ultrasound Imaging Symposium, May 8–10, 2006, San Antonio, Texas. J Orthop Sports Phys Ther. 2006;36(8):A1–A17; doi: 10.2519/jospt.2006.0301.
Papatheodorou A, Ellinas P, Takis F, Tsanis A, Maris I, Batakis N. US of the shoulder: rotator cuff and non-rotator cuff disorders. Radiographics. 2006;26(1):e23; doi: 10.1148/rg.e23.
Martinoli C, Bianchi S, Prato N, Pugliese F, Zamorani MP, Valle M, et al. US of the shoulder: non-rotator cuff disorders. Radiographics. 2003;23(2):381–401; doi: 10.1148/rg.232025100.
Manzoor I, Bacha R, Gilani SA, Liaqat M. The role of ultrasound in shoulder impingement syndrome and rotator cuff tear. Ann Orthop Trauma Rehabil. 2019;2(1):126.
Temes WC, Clifton AT, Hilton V, Girard L, Strait N, Karduna A. Reliability and validity of thickness measurements of the supraspinatus muscle of the shoulder: an ultrasonography study. J Sport Rehabil. 2014;23(2):2013–2023; doi: 10.1123/jsr.2013-0023.
Hinsley H, Nicholls A, Daines M, Wallace G, Arden N, Carr A. Classification of rotator cuff tendinopathy using high definition ultrasound. Muscles Ligaments Tendons J. 2014;4(3):391–397; doi: 10.11138/MLTJ/2014.4.3.391.
Klauser AS, Tagliafico A, Allen GM, Boutry N, Campbell R, Court-Payen M, et al. Clinical indications for musculoskeletal ultrasound: a Delphi-based consensus paper of the European Society of Musculoskeletal Radiology. Eur Radiol. 2012;22(5):1140–1148; doi: 10.1007/s00330-011-2356-3.
Sharpe RE, Nazarian LN, Parker L, Rao VM, Levin DC. Dramatically increased musculoskeletal ultrasound utilization from 2000 to 2009, especially by podiatrists in private offices. J Am Coll Radiol. 2012;9(2):141–146; doi: 10.1016/j.jacr.2011.09.008.
Maier M, Schmidt-Ramsin J, Glaser C, Kunz A, Küchen­hoff H, Tischer T. Intra- and interobserver reliability of classification scores in calcific tendinitis using plain radiographs and CT scans. Acta Orthop Belg. 2008;74(5):590–595.
Chianca V, Di Pietto F, Zappia M, Albano D, Messina C, Sconfienza LM. Musculoskeletal ultrasound in the emergency department. Semin Musculoskelet Radiol. 2020;24(2):167–174; doi: 10.1055/s-0039-3402050.
Journals System - logo
Scroll to top