Assessment of a painful non-traumatic shoulder by radiography paired to ultrasound: a series of 222 cases

Context and objective. Chronic shoulder pain is a common reason for outdoor parients in rheumatology. Magnetic Resonance Imaging (MRI), which is its main diagnosis tool, is not accessible for the majority of Congolese patients. The objective was to describe diseases that lead to non-traumatic shoulder pain (NTSP) using the radiography-ultrasound pair and to assess the performance of X-ray compared to that of ultrasound. Methods. This is a cases series of 222 patients for whom an X-ray and an ultrasound were carried out for an NTSP at the Gombe imaging center in Kinshasa and at the Intercommunal Hospital of Fécamp in France, during the period from January 2015 to October 2016. The variables of interest were demographic, clinical, radiographic and ultrasound data. Results. Two hundred and twenty-two patients were included in the study, including 113 women (50.9%) and 109 men (49.1 %). The mean age of the patients was 55.7 ± 14.3 years. A normal shoulder was observed in 122 patients (55 %) on the radiography versus 48 (21.6 %) on the ultrasound. Tendinopathies, calcifications and acromio-clavicular arthropathy were the most common forms of NTSP. The X-ray was more informative than ultrasound for the diagnosis of capsulitis and subacromial conflict. In all other cases it was less effective than ultrasound. The sensitivity and negative predictive value of X-ray were lower than that of ultrasounds. Conclusion. The coupling of X-ray with ultrasound helps to diagnose a greater number of entities than if we considered each examination in isolation. Ultrasound presented a better diagnosticu performance than standard radiography.