Editorial Commentary: Magnetic Resonance Imaging Is Generally Superior to Ultrasound for Evaluation of Rotator Cuff Pathology: If Unrecognized Subscapularis Pathology Is Suspected After Magnetic Resonance Imaging, Ultrasound Can Then Be Performed.

Abstract

The advantages of using ultrasound over magnetic resonance imaging (MRI) in the diagnosis of rotator cuff pathology include patient and technical factors. Patient factors include the lack of claustrophobia or positioning constraints. Technical considerations include dynamic and real-time assessment, absence of contraindications due to implants, decreased cost, and portability. However, the limitations of ultrasound include operator dependency and skill, limited availability of experienced ultrasonographers, decreased sensitivity for other shoulder pathology, and possible less sensitivity for some types of rotator cuff pathology. In my practice, MRI, when indicated, is still the test of choice, as it is readily available, more versatile in diagnosing a wide range of shoulder pathologies, and not dependent on the availability of a skilled ultrasound operator. Should there still be concern for an unrecognized partial subscapularis tendon injury after MRI, ultrasound can then be performed.