الفهرس 
Acknowledgements
Shoulder PainOnly 14 pages are availabe for public view
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Abstract
Shoulder pain is one of the most frequent musculoskeletal complaints, and its prevalence and consequences increase with age. However, since the prevalence of a recurring condition is determined by its incidence and the number and duration of episodes, it is important to have valid incidence estimates and to conduct etiological studies on incidence measures to untangle risk factors of the occurrence of shoulder pain from those affecting the duration and number of episodes.
Examining the clinical management of shoulder pain in primary care settings, where the vast majority of patients present, is essential to improving the quality of care and to understanding the associated costs. Due to the sufficient diagnostic accuracy and clear relationship between high resolution ultrasound diagnosis and available evidence-based therapies, applying high resolution ultrasound in the management of shoulder pain in primary care can solve this problem.
There have been studies done in the past that evaluated the accuracy of either magnetic resonance imaging or high-resolution ultrasound in detection of shoulder pathologies and only few studies compared these two methods. Of course, magnetic resonance imaging is the most powerful diagnostic tool. But nowadays, high-resolution ultrasound shows accuracy in differentiation between complete- and partial-thickness tears and detection of osteoarthritic changes and there is a good agreement with magnetic resonance imaging.
In the current study a total of 63 patients with shoulder pain were enrolled. The study aimed to assess the role of high-resolution ultrasonography and magnetic resonance imaging in patients with shoulder pain and improve clinical practice. Mean age of those patients was 32.52 years with range between 18 and 55 years. Majority (95.2%) of those patients was males.
The main findings in this study were; 1) the causes of shoulder pain were supraspinatus tear (68.3%), bursitis (46%), AC arthritis (17.5%) and biceps dislocation (9.5%). Joint effusion was found in 46 (73%) patients, 2) there was a perfect degree of agreement between magnetic resonance image and high-resolution ultrasound as regard detection of bursitis and arthritis with strong degree of agreement as regard detection of effusion, supraspinatus tear and biceps dislocation and 3) high resolution ultrasound had 100% overall accuracy in detection of bursitis and arthritis with 93.6% and 96.6% overall accuracy for detection of effusion and supraspinatus tear, respectively. For detection of biceps dislocation; high resolution ultrasound had 75.7% overall accuracy.
In conclusion, high resolution ultrasound for the shoulder joint presents a high accuracy and sensitivity in diagnosis a wide spectrum of shoulder joint lesions, with a diagnostic performance value near to that of magnetic resonance image. Furthermore, it is a real time investigation that can afford comparison information of the two joints.
A wide availability, lower cost and better tolerability of ultrasonography make it a modality of first choice for evaluation of shoulder pain. magnetic resonance image can be reserved for patients with suspicious ultrasonography results. Future studies in large number of patients in multiple centers are required to confirm such findings.