Authors: G.Lumsden, R.Fallows, M.Fletcher*, N.Price, S.Sutherland, R.M.Dodenhoff

References: BESS 2005, Cambridge

Increasingly physiotherapists are working in an extended role in upper limb clinics or as first contact practitioners for shoulder conditions. One may argue that physiotherapists are in the ideal position to carry out a narrow range of application of ultrasound. The aim of this study was to evaluate the diagnostic capabilities of two physiotherapists in the diagnosis of rotator cuff tears after using ultrasound for six months.

Two physiotherapists underwent a 3 day formal training course in musculoskeletal ultrasound and 3 days of individual tuition in musculoskeletal ultrasound relating to the shoulder. This was supplemented by closely working alongside an upper limb surgeon with immediate feedback comparing US findings to findings at arthroscopy and MRI. A prospective audit was done on 20 patients within 3 weeks prior to shoulder arthroscopy and 10 patients within 2 months prior to MRI investigation. The cuff was assessed using a portable 5-10 MHz linear array transducer. Standard  US criteria were used and graded as intact, partial or complete tear. Results were independently analysed.

Arthroscopy/MRI revealed 13 intact, 6 partial and 11 complete tears. For complete tears the sensitivity and specificity were 73% and 79% for therapist A and 64% and 79% for therapist B. Positive and negative predictive values were 67% and 83% for A and 64% and 79% for B. Accuracy values were 77% and 73% respectively. Both therapists only detected 2 out of 6 partial tears (sensitivity 33%, specificity 71%). For the prediction of any tear, combined scores were, sensitivity 91%, specificity 62%, positive predictive value 76%, negative predictive value 84% and accuracy 78%.

Physiotherapists can demonstrate a good level of accuracy at detecting full thickness rotator cuff tears within the first year of using ultrasound. One would expect this to improve further with ongoing training and experience.

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