Diagnostic Accuracy of Ultrasonography in the Evaluation of Rotator Cuff Disorders in Patients With Shoulder Pain at Mayo Hospital Lahore

Abstract

Background: Rotator cuff disorders are among the leading causes of chronic shoulder pain and functional limitation in middle-aged and elderly populations. Accurate imaging evaluation is essential for early diagnosis and management; however, the routine use of magnetic resonance imaging may be limited by cost and accessibility. Musculoskeletal ultrasonography has emerged as a practical first-line imaging modality for the assessment of rotator cuff pathology because of its accessibility, dynamic capability, and diagnostic efficiency. Objective: To evaluate the diagnostic accuracy of ultrasonography in detecting rotator cuff disorders among patients presenting with shoulder pain and to identify clinical and imaging-related predictors associated with poor clinical outcomes. Methods: A cross-sectional observational diagnostic study was conducted at Mayo Hospital Lahore involving 146 patients with clinically suspected rotator cuff disorders. Demographic characteristics, clinical variables, ultrasonographic findings, and reference imaging results were recorded using standardized protocols. Diagnostic performance indices including sensitivity, specificity, and overall accuracy were calculated. Logistic regression analysis was performed to identify predictors of poor clinical outcome. Results: The mean age of participants was 51.2 ± 8.6 years, and 58.2% were aged ≥50 years. Ultrasonography demonstrated a sensitivity of 92.9%, specificity of 64.7%, and overall diagnostic accuracy of 86.3% for rotator cuff abnormalities. Concordance between ultrasound and reference imaging was observed in 86.3% of patients. Full-thickness tears (OR: 3.12; p=0.007), sarcopenia (OR: 2.78; p=0.014), fatty infiltration (OR: 2.46; p=0.025), prolonged symptom duration (OR: 2.21; p=0.044), and high baseline pain scores (OR: 2.63; p=0.016) were significantly associated with poor clinical outcomes. Conclusion: Ultrasonography demonstrated high diagnostic sensitivity and substantial clinical utility in the evaluation of rotator cuff disorders. Structural tendon damage, muscular degeneration, and prolonged symptom duration were significant predictors of adverse outcomes, supporting the integration of ultrasound-based assessment into routine orthopedic practice.