Surgeon-operated ultrasonography in a one-stop shoulder clinic

Abstract

Ultrasonography has become an essential adjunct to clinical examination when assessing patients with suspected rotator cuff pathology. [1][2][3][4][5][6] The advantages of portable shoulder ultrasonography are that the surgeon can evaluate the integrity of the rotator cuff immediately in a one-stop clinic. This allows an efficient and effective treatment plan to be initiated. Shoulder ultrasonography is non-invasive, has virtually no side effects and allows the rotator cuff to be visualised dynamically during rotation and elevation of the shoulder. It is cost effective and time efficient and allows patients to see their own pathology, leading to better understanding of the disease process and a constructive discussion on the merits of treatment.It has shown previously that a surgeon using portable ultrasonography in a one-stop clinic can accurately demonstrate whether there is a full thickness tear of the rotator cuff with a sensitivity of 96.2% and a specificity of 95.4%. 1 This is as accurate as any series performed by a sonographically trained radiologist. This study set out to determine if there is any benefit in time efficiency and cost effectiveness from a one-stop clinic. MethodsPatients attending the same shoulder clinic between November 2007 and July 2008 were allocated to one of two clinicians with a specialist interest in the shoulder. This process occurred as part of the standard outpatient allocation but did not involve patient pre-selection by either clinician. The clinicians had worked adjacent to each other in the same clinic for over eight years. As part of his standard initial assessment, one clinician performed his own ultrasonography examination of the shoulder in a one-stop clinic. Patients at this clinic formed Group A. The second clinician made a clinical diagnosis based on objective clinical findings and referred patients for departmental ultrasonography were appropriate. These patients formed Group B.

Do subacromial ultrasonography findings predict efficacy of intra-bursal injection? Prospective study in 39 patients

“…Seagger et al [31] described a one-stop strategy for managing shoulder pain, in which patients were evaluated by a surgeon, underwent diagnostic ultrasonography, and received a therapeutic injection if appropriate during the same clinic visit. Ultrasonography was performed by the surgeon using a portable machine.…”

American College of Rheumatology report on reasonable use of musculoskeletal ultrasonography in rheumatology clinical practice

“…However, these studies have demonstrated that ultrasound‐guided knee injections can save money over palpation‐guided injections by prolonging time to reinjection (150). Others demonstrated cost savings of MSUS over MRI through reduced utilization, reduced time to diagnosis (22), and reduced number of visits to treat the condition (23, 231). Nevertheless, cost consideration is necessary to guide use and mitigate societal risks through overutilization and consumption of health care resources.…”

Pre-operative departmental ultrasound of the rotator cuff: sensitivity and specificity in a regional specialist orthopaedic centre

“…Recently, there have been reports of ultrasound scans being performed immediately in the shoulder clinic, obviating the need for a separate scan appointment [6][7][8][9]. These 'one stop' scans have been performed by both sonographers and appropriately trained surgeons.…”

“…In our unit, 'one stop' or 'office-based' scanning is not yet widely available [6][7][8][9]. Patients are usually filtered through to the shoulder clinic by a musculoskeletal assessment team (MATS) who take all referrals from the local general practitioners.…”