Objective: To provide more information about various types of rheumatoid involvement of the painful shoulder by ultrasonography (US).
Methods: US examinations were performed in 44 patients (88 shoulders) with rheumatoid arthritis (RA). The technique of shoulder ultrasonography was standardized in studies of 30 healthy volunteers (60 shoulders) without shoulder complaints. US findings were compared with clinical, laboratory and radiographic data to find any relationship.
Results: Sonography could reveal inflammatory conditions at early stages of RA when no radiographic changes were seen. The most common US finding was subacromial-subdeltoid bursitis in 61 shoulders (69%) of 35 patients. Synovitis in the glenohumeral joint was seen in 51 shoulders (58%) of 32 patients, biceps tendinitis in 50 shoulders (57%) of 29 patients and changes in the supraspinatus tendon in 29 shoulders (33%) of 20 patients. There were multiple rheumatoid symptoms in 61 shoulders (69%), one condition resulted in changes in 17 shoulders (19%) and no visible US findings in 10 shoulders (11%). Clinical findings were rather unspecific. Flexion, abduction and outward rotation were often restricted in shoulder symptoms, whereas inward rotation was rarely limited. Shoulder swelling indicated subacromial-subdeltoid bursitis.
Conclusion: Ultrasonography is a very useful method for rheumatologists and orthopedists to see inside joints. It can provide remarkable help for local injection therapy and for planning surgery because of its suitability for evaluation of the extent of rheumatoid disease.