title: Intense focused ultrasound stimulation of the rotator cuff: evaluation of the source of pain in rotator cuff tears and tendinopathy.
abstract: The objective of this preliminary study was to evaluate the ability of individual 0.1-s long pulses of intense focused ultrasound (iFU) emitted with a carrier frequency of 2 MHz to evoke diagnostic sensations when applied to patients whose shoulders have rotator cuff tears or tendinopathy. Patients were adults with painful shoulders and clinical and imaging findings consistent with rotator cuff disease. iFU stimulation of the shoulder was performed using B-mode ultrasound coupled with a focused ultrasound transducer that allowed image-guided delivery of precisely localized pulses of energy to different anatomic areas around the rotator cuff. The main outcome measure was iFU spatial average-temporal average intensity (I_SATA), and location required to elicit sensation. In control patients, iFU produced no sensation throughout the range of stimulation intensities (≤2000 W/cm(2) I_SATA). In patients with rotator cuff disease, iFU was able to induce sensation in the tendons of the rotator cuff, the subacromial bursa, and the subchondral bone in patients with chronic shoulder pain and rotator cuff disease, with an average ± standard deviation intensity equaling 680 ± 281 W/cm(2) I_SATA. This result suggests a primary role for these tissues in the pathogenesis of shoulder pain related to rotator cuff tendinopathy.
authors.affiliation: Division of Rehabilitation Medicine, Weill Cornell Medical College, New York, New York, USA; Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA. Electronic address: alg9109@med.cornell.edu.
authors.forename: Alfred C
authors.initials: AC
authors.lastname: Gellhorn
authors.affiliation: Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
authors.forename: Cody
authors.initials: C
authors.lastname: Gillenwater
authors.affiliation: Department of Neurological Surgery, University of Washington, Seattle, Washington, USA; Division of Engineering and Mathematics, University of Washington, Bothell, Washington, USA.
authors.forename: Pierre D
authors.initials: PD
authors.lastname: Mourad
mesh_terms: D004307:Dose-Response Relationship, Radiation; D004568:Electrodiagnosis / Q000379:methods; D005260:Female; D019220:High-Energy Shock Waves; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods*; D011829:Radiation Dosage; D015203:Reproducibility of Results; D017006:Rotator Cuff / Q000000981:diagnostic imaging; D000070636:Rotator Cuff Injuries; D012680:Sensitivity and Specificity; D020069:Shoulder Pain / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D013010:Sonication / Q000379:methods*; D052256:Tendinopathy / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging; D013708:Tendon Injuries / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging; D014463:Ultrasonography
keywords: Pain measurement; Rotator cuff; Shoulder impingement syndrome; Tendinopathy; Ultrasonography