Status of rotator cuff sonography

The weight of current evidence, including the current report by Soble et al, suggests that sonography can play a valuable role in evaluating patients for rotator cuff tears. However, recent reports including the current article by Brandt et al indicate that sonography is not infallible and that it may not be easily integrated into some radiology practices. The examination is technically difficult and is not easily mastered, even by well-qualified, experienced sonographers. However, this does not mean that it should be abandoned. Newer, higher-resolution transducers will likely make the examination easier and more accurate and may shed further light onto the described sonographic criteria for rotator cuff tears. On the basis of the two current articles as well as previous work, it is evident that nonvisualization and focal thinning are extremely reliable signs of rotator cuff tear that require no confirmatory tests. Discontinuity is a sign that must be interpreted on an individual basis. In some cases, it may require confirmatory tests. Echogenic foci should be interpreted with extreme caution since they can result from many factors other than rotator cuff tears.