All participants were seated during the examination, which was conducted by a physiatrist with 12 years of musculoskeletal US experience using a linear probe of 5–18 MHz (HI VISION Ascendus, Hitachi). The transducer was placed at the level of the coracoid process to evaluate the long head of the biceps tendon inside the bicipital groove. A pathological biceps peritendinous effusion was defined when the thickness of the anechoic fluid exceeded 1 mm. Biceps tendon tear was confirmed if the tendon was invisible or split. The shoulder was then externally rotated to expose the subscapularis tendon. The supraspinatus tendon was investigated in the Middleton position (Lee et al., 2016 (link)) with the hand placed over the ipsilateral iliac crest. The transducer was finally moved to the posterior shoulder in the horizontal plane slightly distal to the scapular spine for visualization of the infraspinatus tendon. The presence of visible gaps or a total absence of tendon tissue in the subacromial space served as the criteria for diagnosing rotator cuff tendon tears. Because the supraspinatus tendon has a large size, its lesions were classified as either full-thickness or partial-thickness tears. A full-thickness tear was indicated by an intra-tendinous gap extending through the entire thickness of the supraspinatus tendon. A partial-thickness tear was indicated by noticeable intra-tendinous cleavage(s) without the involvement of the entire thickness of the tendon. All scanning procedures were performed in accordance with the EURO-MUSCULUS/USPRM basic scanning protocol for the shoulder (Ozcakar et al., 2015 (link)).
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