title: Biceps sheath fluid on shoulder ultrasound as a predictor of rotator cuff tear: analysis of a consecutive cohort.
abstract: BACKGROUND
  Ultrasound provides evaluation of rotator cuff disease with accuracy comparable to that of magnetic resonance imaging. Fluid in the sheath of the long head of the biceps tendon (LHB), identified on ultrasound scan, has been associated with disease of the rotator cuff, LHB, and glenohumeral joint. Prior literature has compared ultrasound findings only with arthrography, and results have been conflicting. Arthroscopy remains the reference standard in assessing accuracy of imaging modalities. We present the first study investigating the significance of fluid in the LHB on ultrasound in predicting subsequent rotator cuff disease identified on arthroscopy.
  
  
  METHODS
  Records were reviewed of 175 patients undergoing ultrasound and subsequent arthroscopy under 1 shoulder surgeon. Experienced musculoskeletal radiologists and sonographers performed ultrasound. Ultrasound examination and operating records were collected and analyzed. Data were analyzed using descriptive statistics, correlation, and logistic regression modeling.
  
  
  RESULTS
  Highly significant correlation (P < .001; ρ = 0.354) was found between fluid in the LHB sheath and rotator cuff tears on arthroscopy. Statistically significant but weak correlation (P < .05; rho = 0.187) was found between fluid in the LHB sheath and both biceps tendon disease and glenohumeral joint disease. Fluid around the LHB was shown to increase the likelihood of having rotator cuff tear (odds ratio, 2.641; 95% confidence interval, 1.229-5.674) and biceps tendon disease (odds ratio, 2.698; 95% confidence interval, 1.216-5.987).
  
  
  CONCLUSIONS
  This is the first report identifying significant correlation between fluid in the LHB sheath identified on ultrasound and subsequent rotator cuff disease identified at arthroscopy. We recommend routine reporting of fluid in the LHB sheath as it is likely to improve the accuracy of detecting rotator cuff and biceps tendon diseases.
authors.affiliation: Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, UK. Electronic address: bhanusch@doctors.org.uk.
authors.forename: Birgit C
authors.initials: BC
authors.lastname: Hanusch
authors.affiliation: Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, UK.
authors.forename: Navnit
authors.initials: N
authors.lastname: Makaram
authors.affiliation: Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, UK.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Utrillas-Compaired
authors.affiliation: Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, UK.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Lawson-Smith
authors.affiliation: Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, UK.
authors.forename: Amar
authors.initials: A
authors.lastname: Rangan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging* / Q000473:pathology; D011237:Predictive Value of Tests; D000070636:Rotator Cuff Injuries / Q000000981:diagnostic imaging* / Q000473:pathology; D012785:Shoulder Joint / Q000000981:diagnostic imaging* / Q000473:pathology; D014463:Ultrasonography; D055815:Young Adult
keywords: Long head of biceps; biceps sheath fluid; rotator cuff tear; shoulder arthroscopy; shoulder pain; ultrasound