Board Certified Consultants in Musculoskeletal Diagnostic Ultrasound
2232 Santa Monica Blvd. Suite 101, Santa Monica, California 90404 | (310) 456-6182 | facsimile (310) 456-9092 | |
Kevin K. Drake, M.D. | Alex Kaliakin, D.C.

Santa Monica Physical Medicine
Adam Silver D.O.
2232 Santa Monica Blvd #101
Santa Monica, CA 90404
Referring Physician: Dr Pain

Patient (first, middle, last)Back Pain
Date of ScanSeptember 19, 2017
Consulting DateSeptember 19, 2017
Number of submitted images23 images submitted
Additional Patient informationRight shoulder

Dear Doctor(s):

Attached herewith-kindly find an evaluation of the 23 scans submitted by your offices for review. For your convenience, we have placed our diagnostic impressions at the beginning of this report.

Diagnostic Impression

  1. There is sonographic evidence of local tissue reaction of tendinosis of the supraspinatus tendon as it covers the head of the humerus. No tears are visualized on the presented images. Right side


    The images are of adequate diagnostic quality with identification of all echogenic structures made. The findings are consistent with the diagnoses indicated below. Other than the scans commented on, the balance of the sonographic scans are unremarkable.


    System used:

    Presented images were by an electronic linear scanning ultrasound diagnostic unit. Ultrasonographic image projections appear to have been extracted by an appropriate transducer at full resolution zoom. Scans taken are of regions noted at each study.

    Report documentation:

    A total of 23 images have been scanned and digitized on a high-speed processing computer. The diagnostically significant image has been C weighted through computer software for maximum visualization. There has been no alteration to the physical or diagnostic characteristic features of that selected image(s).


    The patient, Back Pain, has demonstrated a diagnosis as noted above. For your information the sonographic significance of these findings are as follows:

    1. The Shoulder
      Incomplete and complete tears of the rotator cuff are the end point of the disease spectrum called impingement. Unfortunately, there are no clinical tests that will differentiate impingement from rotator cuff tear. According to Van Holsbeeck the duration of symptoms may influence the clinical diagnosis, depending on the patient's history. The majority of patients will experience 10 to 15 years of chronic shoulder pain before impingement progresses to rotator cuff tear.

      Treatment for the initial stages of impingement differs considerably from the treatment for rotator cuff tears. Edema of the cuff is managed with conservative measures for as long as possible. This usually consists of avoidance of painful elevation of the arm, oral anti-inflammatory medication, and injections of anti-inflammatory drugs beneath the acromion. Surgery is considered only when the pain persists for more than 18 months, despite conservative treatment.

      Surgery is then limited to resection of capsular structures and, in some patients, extended by an anterior acromioplasty. Rotator cuff tear is treated differently. Surgery is indicated in all complete tears. It is important to perform repair early before the defect becomes too big and then irreparable. (cf Van Holsbeek, et. al. Musculoskeletal Ultrasound, Mosby Year Book 1991 And, Middleton WD., Status of Rotator Cuff Sonography Radiology, 1989 173:307-309)

A careful review of the 23 submitted images strongly suggest that a follow-up study should be performed in 4-6 weeks to contrast and compare progress during the treatment phase of the case.

The above findings suggest the patient is a candidate for conservative therapeutic procedures, including passive and active physical therapy and rehabilitation, interventional physical medicine, and/or Chiropractic, as directed by the patients treating physician.

Please note that these diagnoses indicated above should be correlated to your clinical findings. Should you have any questions regarding this report submission please contact this office. We will respond to your inquiry promptly.

Thank you for allowing us to participate in the care of your patient, Back Pain.

The American Board of Radiology
American College of Radiology

Registered Chiropractic Musculoskeletal Ultrasonologist
American Institute of Chiropractic
Musculoskeletal Diagnostic Ultrasound

The patient's history was taken from a presented medical record and a report and analysis was performed. This report is for a consultation only and is not to be construed either directly or by implication as a report on a complete evaluation for medical or chiropractic problems. As the treating group, the medical or chiropractic offices may perform medical or chiropractic procedures to treat the patient's complaint or injury. Only those symptoms that we believe have been reported or involved in the injury or alleged injury have been sonographically evaluated and commented upon. (Report certification id: 1505850128-)