Venu 2002.

Clinical features and settings	Inclusion criteria: Participants with clinical supraspinatus impingement syndrome and failure of clinical improvements with conservative treatment within one year of onset of symptoms Exclusion criteria: Not reported Duration of symptoms: Probably more than one year Previous treatments: Shoulder physiotherapy and sub‐acromial steroid injections Care setting: Not reported
Participants	Place of study: Eastbourne, UK Period of study: June 1997 to June 1999 Number of participants eligible: 276 participants Number of participants enrolled IT and RS: ‐ US and arthroscopy: 41 participants Data available for analyses: ‐ US and arthroscopy: 41 participants Age: mean 54 years (range 34 to 79 years) Male/Female: 24/17 Dominant arm: Not reported Nature of onset: Not reported
Study design	Primary objective: To determine the accuracy of ultrasound compared with arthroscopy in the evaluation of the symptomatic supraspinatus tendon and to identify whether ultrasound diagnosis was helpful in pre‐operative planning Study design: Prospective, consecutive, accuracy cohort study Language: English
Target condition and reference standard(s)	Target conditions: Presence of normal tendon, tendinopathy, partial thickness tear, full thickness tear, and rotator cuff rupture Reference standard(s): Shoulder arthroscopy ‐ Description of technique: Not reported ‐ Criteria for a positive result: Not reported
Index and comparator tests	Index test(s): US ‐ Description of technique: Scanner: 5 to 10 MHz using a linear array transducer Technique: Longitudinal and transverse views of the supraspinatus Patient position: Patient probably seated with the shoulder internally rotated to visualise the supraspinatus tendon ‐ Criteria for a positive result: Tendinopathy: thickened and often decreased echogenicity Partial thickness tears: a hypo‐or hyperechoic tendon defect not involving the full thickness of the tendon Full thickness tears: a hypo or hyperechoic tendon defect involving the full thickness of the tendon Rupture: the tendon was absent with often only the retracted proximal tendon visualised ‐ Time from symptoms to index test: More than 1 year ‐ Time from index test to reference standard (mean): 6 months
Follow‐up	Adverse events due to index test(s): Not reported Adverse events due to reference standard test(s): Not reported
Notes	The study reported five categories to classify the tendon (normal tendon, tendinopathy, partial thickness tear, full thickness tear, and rotator cuff rupture) In our analyses we classified the categories ‘normal’ and ‘tendinopathy’ as normal tendon; and ‘full’ and ‘rupture’ as full thickness tear No two‐by‐two table of the ITs and RS was given but it was possible to back‐calculate this from the reported summary data
Table of Methodological Quality
Item	Authors' judgement	Description
Representative spectrum? All tests	Unclear	Population was patients with suspected of having any rotator cuff tears The study was prospective and recruitment was reported as consecutive The care setting was not specified
Acceptable reference standard? All tests	Yes	The reference standard was arthroscopy and the target conditions were presence of normal tendon, tendinopathy, partial thickness tear, full thickness tear, and rotator cuff rupture
Acceptable delay between tests? All tests	No	The average interval between reference standard and index test was 6 months
Partial verification avoided? All tests	No	Not all the patients who received the index test underwent a reference standard to verify their true disease status Of the 276 eligible participants only 41 (15%) received the reference standard
Differential verification avoided? All tests	No	The result of the index test influenced the choice of the reference standard
Incorporation avoided? All tests	Yes	The index test did not form part of the reference standard
Index test results blinded? All tests	Yes	The study was prospective and the results of the index tests were interpreted before the reference standard
Reference standard results blinded? All tests	No	The surgeon knew the US diagnosis prior to surgery
Relevant clinical information? All tests	Yes	Clinical data and plain radiographs were available at the time of performing the US examination
Uninterpretable results reported? All tests	No	The results of 235 (85%) patients were not reported
Withdrawals explained? All tests	No	Some of the eligible patients who entered the study did not complete it and these patients were not accounted for
Learning curve / training reported of index test? All tests	Yes	The interpreters of index tests were two radiologists specialised in shoulder US
Learning curve / training reported of reference standard? All tests	Unclear	Insufficient information was given to permit judgement
Index test criteria for a positive test result reported? All tests	Yes	The study reported the definition of a positive index test result