title: Classification of rotator cuff tendinopathy using high definition ultrasound.
abstract: BACKGROUND
  ultrasound is a valid cost effective tool in screening for rotator cuff pathology with high levels of accuracy in detecting full-thickness tears. To date there is no rotator cuff tendinopathy classification using ultrasound. The aims of this study are to define a valid high-definition ultrasound rotator cuff tendinopathy classification, which has discriminate validity between groups based upon anatomical principles.
  
  
  METHODS
  464 women, aged 65-87, from an established general population cohort underwent bilateral shoulder ultrasound and musculoskeletal assessment. Sonographer accuracy was established in a separate study by comparing ultrasound findings to the gold standard intra-operative findings.
  
  
  RESULTS
  there were 510 normal tendons, 217 abnormal tendons, 77 partial tears, and 124 full-thickness tears. There was no statistical difference in age or the proportion with pain between the abnormal enthesis and partial tear groups, however both groups were statistically older (p<0.001) and had a greater proportion with pain (p<0.001 & p=0.050) than normal tendons. The full-thickness tears were statistically older than normal tendons (p<0.001), but not abnormal/partially torn tendons. The proportion with pain was significantly greater than both groups (p<0.001 & p=0.006). Symptomatic shoulders had a larger median tear size than asymptomatic shoulders (p=0.006). Using tear size as a predictor of pain likelihood, optimum sensitivity and specificity occurred when dividing tears into groups up to 2.5cm and >2.5cm, which corresponds with anatomical descriptions of the width of the supraspinatus tendon.
  
  
  CONCLUSIONS
  the classification system is as follows: Normal Tendons; Abnormal enthesis/Partial-thickness tear; Single tendon full-thickness tears (0-2.5cm); Multi-tendon full-thickness tears (>2.5cm).
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Biomedical Research Unit, Botnar Research Centre, University of Oxford, UK.
authors.forename: Hannah
authors.initials: H
authors.lastname: Hinsley
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Biomedical Research Unit, Botnar Research Centre, University of Oxford, UK.
authors.forename: Alex
authors.initials: A
authors.lastname: Nicholls
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Biomedical Research Unit, Botnar Research Centre, University of Oxford, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Daines
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Biomedical Research Unit, Botnar Research Centre, University of Oxford, UK.
authors.forename: Gemma
authors.initials: G
authors.lastname: Wallace
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Biomedical Research Unit, Botnar Research Centre, University of Oxford, UK.
authors.forename: Nigel
authors.initials: N
authors.lastname: Arden
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Biomedical Research Unit, Botnar Research Centre, University of Oxford, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Carr
keywords: classification; high-definition ultrasound; rotator cuff