title: Doppler sonographic findings in the long bicipital tendon sheath in patients with rheumatoid arthritis as compared with patients with degenerative diseases of the shoulder.
abstract: OBJECTIVE
  To compare power Doppler sonography (PDS) findings inside the bicipital tendon sheath in patients with rheumatoid arthritis (RA) and degenerative disorders of the shoulder, in order to evaluate the diagnostic value of PDS in distinguishing between inflammatory and noninflammatory shoulder pain.
  
  
  METHODS
  The glenohumeral joints of 41 consecutive patients with shoulder pain were examined by ultrasound. Using ventral transverse and longitudinal scanning, the vascularity near and/or inside the bicipital tendon sheath was visualized by PDS. One fully trained and experienced examiner performed the sonography. Representative images were digitally stored and were read, under blinded conditions, by 2 independent investigators, who categorized the Doppler signals as being either inside or outside the tendon sheath.
  
  
  RESULTS
  Biceps tendon sheath effusion, represented by the typical hypoechoic rim, was found in 95.8% of the RA patients (23 of 24) and in 58.8% of the patients with degenerative disorders (10 of 17). PDS signals were localized to inside the tendon sheath in 22 of the RA patients (91.7%) and in none of the patients with degenerative disorders. Although no PDS signal was found inside the tendon sheath in patients with degenerative disorders, in 9 of these patients (52.9%), signals could be localized to the environment of the tendon sheath.
  
  
  CONCLUSIONS
  PDS demonstrates vascularity in the long bicipital tendon sheath of patients with RA, but not in those with degenerative shoulder disorders.
authors.affiliation: Department of Rheumatology, Kerckhoff Clinic and Foundation, University of Giessen, Ludwigstrasse. 37-39, 61231 Bad Nauheim, Germany. Johannes.strunk@kerckhoff.med.uni-giessen.de
authors.forename: Johannes
authors.initials: J
authors.lastname: Strunk
authors.forename: Uwe
authors.initials: U
authors.lastname: Lange
authors.forename: Bernhard
authors.initials: B
authors.lastname: Kürten
authors.forename: Klaus Louis
authors.initials: KL
authors.lastname: Schmidt
authors.forename: Gunther
authors.initials: G
authors.lastname: Neeck
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000473:pathology; D002061:Bursa, Synovial / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017006:Rotator Cuff / Q000000981:diagnostic imaging / Q000473:pathology; D012785:Shoulder Joint / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology; D020069:Shoulder Pain / Q000000981:diagnostic imaging* / Q000473:pathology; D013710:Tendons / Q000000981:diagnostic imaging*; D018608:Ultrasonography, Doppler