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RELIABILITY OF SHOULDER ULTRASOUND TO DETECT ROTATOR CUFF TEARS WHEN PERFORMED BY THE SURGEON IN THE PLACE OF FIRST CONTACT

Authors: A.K.Al-Shawi, T.D.Bunker

References: Presented at BESS 2005 Cambridge

Abstract
Ultrasound imaging has become an essential adjunct to clinical examination when assessing a patient with suspected rotator cuff pathology. With the new high-resolution portable machines it has become feasible for the shoulder surgeon to perform the scans himself in the clinic and save a great deal of time. This study was conducted to examine the accuracy of the ultrasound scans performed by a single surgeon over a period of four years. The ultrasound findings were uniformly documented and collected prospectively. Out of a total of 276 scanned patients we selected 143 who ultimately received an operation and we compared the surgical findings with the ultrasound reports. The intra-operative findings included 77 full thickness supraspinatus tears, 24 partial thickness tears and 42 normal cuffs. Two small full thickness tears were missed on ultrasound and reported as normal / partially torn and one partial thickness tear was thought to be a full thickness tear. This presents a 98.6% sensitivity and 99.3% specificity for full thickness tears. Three partial thickness tears were reported normal on ultrasound and eight normal cuffs were thought to have partial thickness tears. This presents a 97.9% sensitivity and 94.4% specificity for partial thickness tears. The size estimation of full thickness tears was more accurate for large/massive tears (96%) than moderate (82%) and small/pinhole tears (75%). The tear sizes were more often underestimated which may partly reflect disease progression during the unavoidable time lag between scan and surgery. We conclude that shoulder ultrasound performed by a sufficiently trained orthopaedic surgeon is a safe and reliable practice to identify rotator cuff tears.

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