Q.What are some of the other diagnostic tools that are used? How good are they to confirm diagnosis?

A.Impingement Syndrome is commonly diagnosed by clinical findings, subjective history in addition to diagnostic findings seen through MRI, Ultrasound and MR arthrography.

Jesus et al in their meta analysis compared MRI , Ultrasound and MR arthrography for rotator cuff tears. They found that MR arthrography was the most sensitive and specific of the three. However they also found MRI and Ultrasound to be comparable in both specificity and sensitivity. (1)

Shahabpour et al in their meta- analysis found that, for the shoulder impingement syndrome and rotator cuff tears, MRI and US have a comparable accuracy for detection of full-thickness rotator cuff tears. MRA and US might be more accurate for the detection of partial-thickness tears than MRI. Given the large difference in cost of MR and US, ultrasound may be the most cost-effective diagnostic method for identification of full-thickness tears in a specialist hospital setting.(2)

Bottom Line

•  MRI , MR arthrography and Ultrasound are commonly used diagnostic tools and their effectiveness is comparable.
• MR arthrography is the most sensitive.
• Ultrasound is the most cost-effective.

References

1. de Jesus JO, Parker L, Frangos AJ, Nazarian LN. Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: a meta-analysis. AJR Am J Roentgenol. 2009 Jun;192(6):1701-7. PubMed PMID: 19457838. 
2. Shahabpour M, Kichouh M, Laridon E, Gielen JL, De Mey J. The effectiveness of diagnostic imaging methods for the assessment of soft tissue and articular disorders of the shoulder and elbow. Eur J Radiol. 2008 Feb;65(2):194-200. Review. PubMed PMID: 18312783