Such symptoms may be caused by tendinitis, impingement, or recurrent rotator cuff tear. Differentiation among these diseases is important in instituting the proper therapy. Similarly, MR imaging is more difficult to interpret after surgery. Because surgery may distort sonographic landmarks, sonography in the postoperative patient is more difficult than in the preoperative patient. It is important, therefore, to understand the surgical procedures used in acromioplasty and cuff repair to be able to understand the altered anatomy and make the correct diagnosis.
Acromial configuration plays an important role in the impingement syndrome.
The spectrum of acromial configurations is shown. In acromioplasty, the anterior-inferior aspect of the acromion is surgically removed. Sonographically, this appears as disruption of the normal rounded, smooth acromial contour. After surgery, the acromion appears pointed. Because the inferior aspect of the acromion is removed, a larger portion of the supraspinatus may be visualized.