Diagnostic Accuracy of Ultrasound Compared to MRI for Rotator Cuff TearsUltrasound shows high accuracy for detecting full-thickness rotator cuff tears

medRxiv Published September 15, 2026 Study authors: Kassam, K.; Ghosh, S.; Wichuk, S.; Qian, T.; Knight, J.; Gallant, C.; McDonald, S.; Jaremko, J. L.; … DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Ultrasound is highly accurate for full-thickness tears but less reliable than MRI for identifying partial-thickness tears.

This meta-analysis evaluated the diagnostic performance of ultrasound (US) compared to MRI for identifying supraspinatus tendon tears. Analyzing data from 1,452 patients, the study aimed to determine the reliability of ultrasound in clinical settings for both full-thickness and partial-thickness tears.

Findings indicate that ultrasound is highly effective for detecting full-thickness tears, achieving a sensitivity of 88.5% and a specificity of 95.2%. The overall accuracy for full-thickness tears was reported at 93.4%, suggesting that ultrasound is a robust tool for ruling out major structural damage.

In contrast, ultrasound performance for partial-thickness tears was less consistent, with a sensitivity of 71.5% and an accuracy of 79.2%. While ultrasound remains a practical first-line modality, MRI remains the preferred standard for evaluating equivocal partial-thickness tears and complex associated pathology.

Clinical application suggests that ultrasound can effectively screen for full-thickness tears in a rapid manner. However, clinicians should consider MRI when precise localization of partial-thickness tears or comprehensive preoperative planning is required.

If you have a shoulder injury, getting a clear diagnosis is the first step toward healing. Doctors often look for rotator cuff tears, which are tears in the tendons that help move your arm. This study looked at how well ultrasound works compared to other methods to find these specific injuries.

Researchers analyzed data from over 1,400 patients to see how well ultrasound identifies different types of tears. The results showed that ultrasound is very reliable for finding full-thickness tears, with an accuracy rate of 93.4 percent. It also showed high sensitivity, meaning it is very good at correctly identifying those specific injuries when they are present.

However, the technology is more challenging when it comes to partial-thickness tears, which are smaller tears. While ultrasound is a great first step to rule out major, full-thickness tears, doctors may still use MRI scans to get a clearer picture of smaller tears or other nearby issues. Because the skill of the person using the ultrasound can vary, it is best used as a practical first step in the diagnostic process.

What this means for you:

Ultrasound is highly accurate at finding full-thickness rotator cuff tears and can be a great first step for diagnosis.

Common questions

How accurate is ultrasound for rotator cuff tears?

Ultrasound is very accurate for finding full-thickness tears, with a reported accuracy of 93.4 percent. It also shows high sensitivity for these specific injuries. However, it is more challenging to use ultrasound to accurately identify partial-thickness tears, which have a lower accuracy rate of 79.2 percent.

Can ultrasound be used instead of an MRI?

Ultrasound can serve as a practical first-line tool to rule out full-thickness tears. However, an MRI is still useful and complementary when a doctor needs to see partial-thickness tears, check for other nearby issues, or perform a detailed assessment before surgery.

What are the limitations of using ultrasound for this diagnosis?

The accuracy of an ultrasound can depend on the expertise of the person performing the scan. Additionally, the quality of the studies reviewed varied, and only one study specifically looked at a handheld ultrasound system.

Study Details

Study typeMeta analysis

Sample sizen = 1,452

EvidenceLevel 1

PublishedSep 2026

View Original Abstract ↓

Objective: Rotator cuff tears involving the supraspinatus tendon are a common cause of shoulder pain. Ultrasound (US) is accessible, dynamic, and lower cost than MRI, but diagnostic performance may vary by tear severity, operator expertise. This systematic review and meta-analysis compared the US with MRI for supraspinatus tear detection. Methods: MEDLINE, Embase, Scopus, and CINAHL Plus were searched for studies published from January 2015 to June 2026. Study quality was assessed using QUADAS-2. Diagnostic outcomes included sensitivity, specificity, accuracy, PPV, NPV. Meta-analyses were performed separately for any, partial-thickness, and full-thickness tears when complete 2 x 2 data were available. Results: 23 studies comprising 1,452 participants were included. US demonstrated stronger and more consistent performance for full-thickness than partial-thickness tears. Mean sensitivity, specificity, and accuracy were 88.5%, 95.2%, and 93.4%, respectively, for full-thickness tears, compared with 71.5%, 91.5%, and 79.2% for partial-thickness tears. HSROC analysis showed pooled sensitivity and specificity of 96% and 76% for any tear, 94% and 80% for partial-thickness tears, and 96% and 98% for full-thickness tears. Agreement measures also generally favored full-thickness tears. Operator expertise, study quality varied, and only one study evaluated a handheld ultrasound system. Conclusion: Ultrasound demonstrates strong diagnostic performance for supraspinatus tears, particularly full-thickness tears, while partial-thickness tears remain more challenging. Given the high observed sensitivity, well-performed US may serve as a practical first-line modality to rule out full-thickness tears, with MRI remaining complementary for equivocal partial-thickness tears, associated pathology, and preoperative assessment.

Diagnostic Accuracy of Ultrasound Compared to MRI for Rotator Cuff TearsUltrasound shows high accuracy for detecting full-thickness rotator cuff tears

Common questions

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Diagnostic Accuracy of Ultrasound Compared to MRI for Rotator Cuff TearsUltrasound shows high accuracy for detecting full-thickness rotator cuff tears

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