American Medical Society for Sports Medicine

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Released March 29, 2022

Consider evaluating rotator cuff tears with ultrasound before ordering an MRI.

Rotator cuff tears are one of the most common causes of shoulder pain. Determining rotator cuff integrity is pivotal in deciding between surgical and non-surgical management. The combination of clinical history, physical examination, and imaging studies is needed to confirm the diagnosis. Given its comparable diagnostic accuracy, low cost and convenience, high-frequency ultrasound may be considered prior to MRI, based on clinical determination via medical history, physical examination and review of relevant imaging, for the evaluation of rotator cuff tears. Furthermore, the cost of MRI and some contraindications, like the presence of metal-mounted devices, could make ultrasound a better, more accessible option in certain clinical scenarios. A clinician skilled in diagnostic ultrasound could decide not to obtain an MRI for a rotator cuff tear if the diagnosis is clear after obtaining a good medical history, completing an adequate physical exam and performing a good quality diagnostic ultrasound.

Ultrasound of the rotator cuff should be done by an experienced provider at a center with appropriate diagnostic ultrasound equipment.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Medical Society for Sports Medicine (AMSSM) has identified this list of clinical recommendations for the Choosing Wisely® campaign. The goal was to identify common topics in the practice of sports medicine that, supported by a review of the literature, would lead to significant health benefits and a reduction of common procedures that can be unnecessary or cause harm. For each item, evidence was reviewed from peer-reviewed literature and several sports medicine consensus statements. The list was initially generated and drafted by AMSSM’s Quality Measures Subcommittee. It was then edited and approved by AMSSM’s Practice and Policy Committee and the Board of Directors.

The American Medical Society for Sports Medicine’s disclosure and conflict of interest policy can be found at


Roy JS, Braën C, Leblond J, Desmeules F, Dionne CE, MacDermid JC, Bureau NJ, Frémont P. Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterisation of rotator cuff disorders: a systematic review and meta-analysis. Br J Sports Med. 2015 Oct; 49(20):1316-28.

Okoroha KR, Fidai MS, Tramer JS, Davis KD, Kolowich PA. Diagnostic accuracy of ultrasound for rotator cuff tears. Ultrasonography. 2019 Jul; 38(3):215-220.

Liang W, Wu H, Dong F, Tian H, Xu J. Diagnostic performance of ultrasound for rotator cuff tears: a systematic review and meta-analysis. Med Ultrason. 2020 May 11; 22(2):197-202.