title: Interobserver variation in sonography of the painful shoulder.
abstract: OBJECTIVE
  This study was conducted as a prospective assessment of interobserver variability in the sonographic evaluation of the rotator cuff.
  
  
  METHODS
  Three musculoskeletal radiologists who had different levels of scanning experience each performed shoulder sonography on 24 consecutive patients during 1 patient visit. The diagnostic criteria full-thickness rotator cuff tear, tendon calcification, tendinosis of the supraspinatus, subacromial fluid, subacromial synovial/bursal thickening, dynamic signs of impingement, and abnormality in the long head of biceps tendon were scored, with independent observers recording the data. Statistical analysis was performed using Cohen's kappa test, with significance assessed at p values of less than 0.05.
  
  
  RESULTS
  There was good agreement (kappa >0.60, p <0.01) between the experienced operators for full-thickness rotator cuff tear, tendon calcification, dynamic signs of impingement, and abnormality of the long head of biceps tendon. There was no significant agreement between the experienced operators and the less experienced operator in several categories, including (and importantly) full-thickness rotator cuff tears (kappa=0.18-0.21).
  
  
  CONCLUSIONS
  In experienced hands sonography of the rotator cuff is a reproducible diagnostic test, but agreement is poor when there is marked disparity between the operators' experience levels. Our findings suggest a need for a more clearly defined training curriculum for sonography of the shoulder in radiology training programs.
authors.affiliation: Department of Clinical Radiology, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: O'Connor
authors.forename: James
authors.initials: J
authors.lastname: Rankine
authors.forename: W W
authors.initials: WW
authors.lastname: Gibbon
authors.forename: A
authors.initials: A
authors.lastname: Richardson
authors.forename: Faith
authors.initials: F
authors.lastname: Winter
authors.forename: John H
authors.initials: JH
authors.lastname: Miller
mesh_terms: D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009135:Muscular Diseases / Q000000981:diagnostic imaging; D015588:Observer Variation; D011446:Prospective Studies; D011871:Radiology / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D017006:Rotator Cuff / Q000000981:diagnostic imaging; D000070636:Rotator Cuff Injuries; D019534:Shoulder Impingement Syndrome / Q000000981:diagnostic imaging; D020069:Shoulder Pain / Q000000981:diagnostic imaging*; D013582:Synovial Fluid / Q000000981:diagnostic imaging; D013585:Synovitis / Q000000981:diagnostic imaging; D013717:Tenosynovitis / Q000000981:diagnostic imaging; D014463:Ultrasonography