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Forty-two individuals were symptomatic As some had bilateral pain, a total of 57 shoulders were considered symptomatic The group consisted of 11 male and 82 female mean age There was no difference in these variables between symptomatic and asymptomatic workers. The mean time of pain was 4.

Exam Series: Guide to the Shoulder Exam - CanadiEM

Semiological maneuvers usually related to abnormalities in supraspinatus tendon Neer, Hawkins, Jobe, Yocum and Appley were more frequent in symptomatic individuals, when compared with those who were asymptomatic. Comparatively, there are more altered ultrasound in symptomatic shoulders than in asymptomatic shoulders and, proportionately, more normal ultrasound in shoulders without pain.

Table 2 shows the number of positive semiological tests in individuals with and without pain, and the results of statistical comparison between them, indicating that only the tests for biceps Speed and Yergason showed no significance in relation to the pain complaint. Table 3 shows the results between pain and abnormal ultrasound of the biceps and supraspinatus tendons.

Comparison between the percentage of shoulders with and without pain, whose ultrasound presented alteration of supraspinatus and biceps tendons, showed statistically significant relevance in the symptomatic shoulders. The proportion of workers with altered ultrasound of supraspinatus tendon and painful symptoms was Abnormal ultrasound was found 17 in supraspinatus tendon, six in bicipital tendon and eight in acromioclavicular joint, one in "the acromial" and a subacromial-subdeltoid bursitis in 24 shoulders.

There were shoulders with two or more alterations. From these 24 shoulders, 14 were symptomatic and 10 asymptomatic. Therefore, the prevalence of ultrasound changes in asymptomatic shoulders was 7. Table 4 shows the results from the ultrasound abnormalities for supraspinatus tendon 17 shoulders , and the long head of the biceps tendon 6 shoulders , and their positive clinical maneuvers. In this study, we had six changes in the long head of the biceps and a subacromial-subdeltoid bursitis, all accompanying changes of supraspinatus tendon.

However, a larger sample is needed to test this maneuver. There was no statistical association between pain, semiological and ultrasound tests for the long head of the biceps tendon. Shoulder pain is a frequent clinical symptom that presents imaging and semiologic difficulties for final diagnosis. Controversy surrounds about the relationship between clinical complaint pain , symptomatic maneuvers, and the findings of anatomical changes in ultrasound. All subjects participated voluntarily in this study. The characteristic of our population, with a narrower age range, reduces the possibility of having older individuals who are more susceptible to present degenerative changes in shoulders.

Shoulder pain is a very common condition. There was no difference between age, work and sex between individuals with and without pain. There are different causes of shoulder pain, including injuries involving the rotator cuff, biceps tendon, subacromial-subdeltoid bursa and acromioclavicular joint. There were six partial ruptures, which occurred in individuals older than the average age of our sample Although all tendons were investigated, no significant change was found in infraspinatus, teres minor and subscapular.

There is no clear guideline for the diagnosis of shoulder pain.

In a near past, it was thought to be caused by repetitive strain injuries, but today, the concept of impingement is the unification of a spectrum of disorders. There is strong evidence that a more intense pain and older age years are both associated with worse outcomes in the work population. However, this result may be indicative of any rotator cuff injury, such as tendinitis and a partial or complete rupture, and also bursitis. However, in this study, statistical data showed that the association between pain and clinical maneuvers of SE tendon was significant, and the same association for bicipital tendon was negative.

The ultrasound is an operator-dependent examination, which requires extensive learning and training. It plays an important role in the diagnosis and in the decision about therapeutic strategy.

Shoulder pain

However, there are technical limitations, as the difficulties to measure the size of tendon ruptures, to analyze subacromial structures; different results among different operators, and in consecutive evaluations performed by the same operator; induction of results; altered results in asymptomatic individuals; anisotropic effect caused by inadequate inclination of the transducer, among others. Success depends on operator experience, and diagnosis should be done in real time and not from image.

In this study it was used a transducer of 7. It is necessary to elucidate that the higher the frequency of the transducer, the better the ultrasound picture quality, but worst the penetration of the sound beam. For the shoulder structures examined in this study, which lies deeper, the assessment should involve a range of frequencies between 7.

The results showed that painful shoulder, clinical maneuvers and ultrasonography have statistical correlation when compared to supraspinatus tendon, but a weak association when compared to biceps tendon. Therefore, the final diagnosis can not be confirmed with only two of these variables because the number of false positives is high and important. Other authors have reported low accuracy of clinical assessment, compared with intraoperative injuries in the diagnosis of shoulder periarticular conditions. Norwood et al. They concluded that the pain characteristics and rupture site was not useful, as well as the weakness of abduction against resistance.

Our results, and those of others, were expected because most patients with shoulder pain have impact syndrome and several periarticular lesions, usually involving different tendons and subacromial-subdeltoid bursa. A possible explanation for the low accuracy of clinical tests is the lack of correlation between clinical findings and anatomical abnormalities in the shoulder. This study showed that asymptomatic individuals may have ultrasound changes.

Is was observed too a high frequency of normal ultrasound examinations with painful shoulder These facts deserve consideration and care, as they have generated discussion and controversy in the occupational, welfare and judiciary settings. With regard to the work environment, the work-related musculoskeletal diseases represent a heterogeneous group of disorders with a high incidence on daily medical practice, which commonly occur in individuals who are outside the occupational setting.

Often, even these conditions do not have identifiable cause and are interpreted as idiopathic.

What causes bursitis of the shoulder?

In addiction to these facts, misinterpretation and use of tests such as ultrasonography, which often has been inappropriately used as definitive in the diagnosis of cuff lesions, are also associated. Thus, ultrasound findings separately should not be used to decide on a possible absence or return to work. Therefore, injuries of the shoulder may occur in asymptomatic individuals without trauma history. These lesions are not necessarily associated with pain. Image findings must be interpreted within the clinical context and should not be used as a sole diagnostic tool for decision.


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Professionals with shoulder pain had a statistically significant association with clinical testing for supraspinatus tendon Neer, Hawkins, Jobe, Appley and Yocum , compared to asymptomatic workers, on the other hand, this result was not observed for biceps tendon. The prevalence of ultrasonography changes in symptomatic shoulders is significantly higher than in asymptomatic shoulders. Neer, Hawkins, Yocum and Jobe tests had statistical association with ultrasonography. The prevalence of ultrasonography changes in asymptomatic workers was 7.

Topic Overview

This percentage is statistically significant. This is an important finding in the study, which shows the possibility of false-positive results with ultrasonography. Pain ; Health Technol Assess ; J Bone Joint Surg [Am] ; Clin Biomech ; Ultraschall Med ; Ann Rheum Dis 2 J Bone Joint Surg [Am] ;87 7 Eur J Radiol ;51 3 Ann Rheum Dis ; Neer CS.

Impingement Syndrome in Athletes. Am J Sports Med ; Painful Athletic Injuries of the Shoulder. Clin Orthop ; Yocum LA. Assessing the Shoulder.

How to treat Shoulder Pain

Clin Sports Med ; Cipriano JJ. In: Cipriano JJ. Surgical Treatment of Tenosynovitis. Yergason RM. Supination Sign.


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  8. J Bone Joint Surg ; Ultrasound Evaluation of the Rotator Cuff. Radiology ; Lehner B, Loew M. The clavicle articulates at one end with the sternum chest bone and with the acromion of the scapula at the other. This articulation between the acromial end of the clavicle and the acromion of the scapula forms the roof of the shoulder. The scapula is a large, flat triangular bone with three processes called the acromion, spine and coracoid process. It forms the back portion of the shoulder girdle.

    The spine which is located at the back of the scapula and the acromion can be readily palpated on a patient.