Ultrasound Imaging for Tailored Treatment of Patients With Acute Shoulder Pain

Abstract

PURPOSE:The objective of this study was to assess the frequencies of ultrasound findings in patients with acute rotator cuff disorders in family medicine. METHODS:In a prospective observational study, 129 patients aged 18 to 65 years with acute shoulder pain in whom the family physician suspected rotator cuff disease underwent ultrasound imaging. RESULTS:Rotator cuff disease was present in 81% of the patients, and 50% of them had multiple disorders. Calcific tendonitis was the most frequently diagnosed specific disorder. An age of 40 years or older was most strongly related to rotator cuff disease. CONCLUSIONS:Ultrasound imaging enables family physicians to rationalize treatment in nearly all patients who are aged 40 years and older with acute shoulder pain. INTRODUCTIONA lthough most patients with acute shoulder pain are cared for in family medicine, 1 physical examinations used to evaluate the extensive spectrum of rotator cuff disease are often inadequate.2 As a result, recommended treatment for all patients in family medicine consists of stepwise treatment regardless of the specific underlying cause. 3,4The disadvantage of this management approach is that it may lead to unnecessary interventions and a delay in specific treatment, with subsequent prolonged recovery. Ultrasound imaging of the shoulder has become an accepted diagnostic modality for evaluating rotator cuff disorders, 5 which potentially allows for more tailored treatment based on diagnostic subgroups. Against this background, it seemed useful to prospectively determine the frequencies of the disorders from the spectrum of rotator cuff disease in patients with shoulder pain in a family medicine setting. The objectives of this study were to assess prospectively the frequencies of specific findings as diagnosed using ultrasound imaging in patients with acute shoulder pain, and to identify possible predictors of shoulder pain. METHODSThe present study was part of the Maastricht Ultrasound Shoulder Pain Trial (MUST) study, a randomized controlled trial among patients in family medicine with acute shoulder pain. The design of the MUST study has been presented in detail elsewhere. 6 We included 129 patients with acute shoulder pain in whom the family physician suspected rotator cuff disease. Patients were eligible if they (1) had shoulder pain upon abduction with painful arc, (2) had symptoms having lasted for fewer than 3 months, (3) had no other episodes of shoulder pain in the previous 12 months, (4) were aged between 18 and 65 years.All ultrasound examinations were obtained in real time using a Phillips IU22 (Phillips Medical Systems) with a 5-12 MHz broadband linear-array transducer (Phillips L12-5). All examinations were performed by experienced musculoskeletal radiologists at the Orbis Medical Centre, The Netherlands, using a protocol-based scanning approach. Standardized ultrasound diagnostic criteria for pathology were used. 6 Ultrasound findings were prospectively evaluated for abnormalities of the rotator cuff, the long head of the...

Ultrasound imaging to tailor the treatment of acute shoulder pain: a randomised controlled trial in general practice

“…21 26 53 If GPs still consider ultrasound imaging, it might be used preferentially in patients aged 40 years or older, as over 90% of shoulder pain patients in this age group have a subacromial disorder, compared to a much lower prevalence in younger age groups. 25 In patients with persistent pain, ultrasound imaging may yield a more specific diagnosis, provide a rationale for further treatment and inform patients about the prognosis of their disorder. For daily practice, it is important that ultrasound findings are considered in the clinical context, as asymptomatic findings may be detected.…”

“…[22][23][24] Moreover, the full spectrum of subacromial disorders is observed in patients with shoulder pain presenting in general practice. [25][26][27] For each of these disorders, evidence-based treatments are available. 3 28 29 This implies that stratification of patients into diagnostic subgroups potentially allows for more tailored treatment than currently applied.…”

Role of Ultrasound in the Detection of Rotator-Cuff Syndrome: An Observational Study

“…The rotator cuff is a natural reduction of the muscle-tendon unit in old adults [7]. Many of the patients with pain in the shoulder are treated under medicine by orthopedic surgeons [8,9] because 30–70% of painful shoulders patients are related cases of rotator cuff disorders [7]. Physical tests like the external rotation lag test and positive painful arc test [10] are utilized to assess the rotator-cuff syndrome but usually insufficient to predict the morphology and size of rotator-cuff [2,11].…”

Does the outcome of diagnostic ultrasound influence the treatment modalities and recovery in patients with shoulder pain in physiotherapy practice? Results from a prospective cohort study

“…A retrospective observational study under 240 patients who were referred by GPs to make a DUS, concluded that in most cases there was a calcific tendonitis (29%), a tendinopathy in 11% of cases and a full-thickness tear in 8% (Ottenheijm et al, 2010). A prospective study where patients with acute shoulder pain were referred to a radiologist for DUS also showed calcific tendonitis to be the most frequently observed pathology (50.4%) followed by tendinopathy (28.7%) and full thickness tears (3.1%) (Ottenheijm et al, 2015). A systematic review with secondary care studies, showed that tendinopathy (30-39%) and full thickness tears (24-70%) were the most observed disorders (Ottenheijm et al, 2010).…”