Background: The present study aims to add to the body of evidence delineating the learning curve for a shoulder surgeon to become proficient in focussed ultrasound for the detection of full-thickness rotator cuff tears, as well as to describe a learning method for this skill. Methods: Consecutive patients who were scheduled to undergo an arthroscopy for rotator cuff disease were scanned immediately before surgery by a senior shoulder surgeon with limited previous experience of shoulder ultrasound. The presence or absence of a full-thickness rotator cuff tear on scan was compared with intra-operative findings as the gold standard. Results: Two hundred and ten shoulders were scanned over three equal learning periods. Comparing predictive values from the first to the third training period, sensitivity improved from 0.86 to 0.95, specificity from 0.92 to 0.98, negative predictive value from 0.94 to 0.98, and positive predictive value from 0.82 to 0.95. Conclusions: The high predictive values obtained in the present study for surgeon-led detection of cuff tears using ultrasound are comparable with those quoted for musculoskeletal radiologists in the literature. The present study adds evidence that a shoulder surgeon can achieve accelerated learning of this skill and offers some potentially time-saving and patient-friendly alternatives to existing guidelines.

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Background: The purpose of the present study was to validate the Functional Shoulder Score (FSS), a new patientreported outcome score specifically designed to evaluate patients with rotator cuff disorders. Methods: One hundred and nineteen patients were assessed using two shoulder scoring systems [the FSS and the Constant-Murley Score (CMS)] at 3 weeks pre-and 6 months post-arthroscopic rotator cuff surgery. The reliability, validity, responsiveness and interpretability of the FSS were evaluated. Results: Reliability analysis (test-retest) showed an intraclass correlation coefficient value of 0.96 [95% confidence interval (CI) ¼ 0.92 to 0.98]. Internal consistency analysis revealed a Cronbach's alpha coefficient of 0.93. The Pearson correlation coefficient FSS-CMS was 0.782 pre-operatively and 0.737 postoperatively (p < 0.0005). There was a statistically significant increase in FSS scores postoperatively, an effect size of 3.06 and standardized response mean of 2.80. The value for minimal detectable change was AE8.38 scale points (based on a 90% CI) and the minimal clinically important difference for improvement was 24.7 AE 5.4 points. Conclusions: The FSS is a patient-reported outcome measure that can easily be incorporated into clinical practice, providing a quick, reliable, valid and practical measure for rotator cuff problems. The questionnaire is highly sensitive to clinical change.

INTRODUCTION:We propose a new radiographic classification of greater tuberosity changes seen in patients with atraumatic rotator cuff dysfunction. The aim of this study is to determine the predictive values and accuracy of this classification for the detection of rotator cuff tears using arthroscopic findings as the gold standard. STUDY DESIGN & METHODS:This was a retrospective study of 91 consecutive patients (47 male, 44 female; mean age 57 year old) who underwent shoulder arthroscopy for a clinical diagnosis of rotator cuff dysfunction. The presence and size of a rotator cuff tear for each patient had been documented at the time of surgery. The radiographs were anonymised and randomised for interpretation by 2 experienced shoulder surgeons and of 2 orthopaedic residents newly-educated on the use of the classification. The predicative values of the new classification for the diagnosis of rotator cuff tear were calculated. Inter-rater agreement values were obtained using the Fliess' kappa method. Statistical significance was set at p < 0.05. RESULTS: Comparative statistics showed that Stage 0 or 1 were associated with the absence of a cuff tear. Stage 2 and 3 were strongly predictive of a rotator cuff tear. The mean predicative values of the new classification stage 2 and 3 for the detection of a rotator cuff tear were: sensitivity 93%, specificity 83%, positive predictive value 87%, and negative predictive value 92%. The accuracy of the experienced observer group was significantly higher than the inexperienced group (97% v 83%, p-value <0.01) and therefore the overall group accuracy was 89%. Inter-rater agreement for stages 1, 2 and 3 changes was substantial overall (Kappa value of 0.63) and almost perfect between the experienced assessors (Kappa=0.95) CONCLUSIONS: The new classification is a useful adjunct for the diagnosis of rotator cuff tears where adequate radiographs are available. It may be used as a screening test in a large number of patients with shoulder pain and select stage 2 and 3 patients for further rotator cuff imaging to assist preoperative planning.