Diagnostic accuracy of high-resolution ultrasonography for detection of rotator cuff tear with respect to magnetic resonance imaging

Background: Rotator cuff tears are a common cause of shoulder pain; although magnetic resonance imaging (MRI) is the diagnostic gold standard, this study evaluated high-resolution ultrasonography as a cost-effective, non-invasive alternative for detecting rotator cuff tears. Methods: A prospective cross-sectional study was conducted at the Department of Radiodiagnosis, Al-Ameen Medical College, Bijapur, from 2023 to 2025. Sixty-five patients aged 18–49 years with suspected rotator cuff injury underwent high-resolution ultrasonography (HRUS) followed by MRI. Findings from both modalities were compared for tendon pathology, including complete and partial tears, tendinosis, and normal appearances. Results: High-resolution ultrasonography detected partial-thickness rotator cuff tears in 20 patients (20/65, 30.8%) and complete tears in 17 patients (17/65, 26.2%), whereas MRI identified partial tears in 23 patients (23/65, 35.4%) and complete tears in 22 patients (22/65, 33.8%). The supraspinatus tendon was the most commonly involved tendon, affected in 28 patients (28/65, 43.1%). For complete supraspinatus tears, ultrasonography demonstrated high diagnostic performance, with a sensitivity of 83.1%, specificity of 97.4%, positive predictive value of 99.4%, negative predictive value of 96.7%, and a Kappa value of 0.90, indicating almost perfect agreement with MRI. However, ultrasonography showed reduced sensitivity and lower agreement for partial-thickness tears and for infraspinatus tendon involvement. Conclusion: High-resolution USG is a reliable first-line modality for detecting complete rotator cuff tears, particularly of the supraspinatus and subscapularis tendons; however, MRI remains essential for evaluating partial and posterior tendon tears when USG findings are inconclusive.