Are Shoulder Surgeons Any Good at Ultrasound ?
Authors: M Jeyam, L Funk, J Harris
References: Presented at SECEC 2006, Athens
Introduction: High resolution ultrasound has gained increasing popularity as an aid in the diagnosis of rotator cuff pathology. With the advent of portable machines, ultrasound has become accessible to clinicians.
Aim: This study was conducted to evaluate the accuracy & reliability of ultrasound in diagnosing rotator cuff tears by a shoulder surgeon and comparing their ability to that of a musculoskeletal radiologist.
Methods: 64 patients undergoing shoulder arthroscopy for rotator cuff pathology underwent pre-operative ultrasonography (US). 35 in the shoulder surgeon group and 29 in the musculoskeletal radiologist's group. All patients were of similar demographics and pathology. The surgeon used a 10MHz portable linear array transducer and the radiologist used a 9-12MHz linear array probe on a static machine. Arthroscopic diagnosis was the reference standard to which ultrasound findings were compared.
Results: The sensitivity of ultrasound in detecting full thickness tears was similar for both the surgeon (92%) and the radiologist (94%). The radiologist had 100% sensitivity in diagnosing partial thickness tears, compared to 85.7% for the surgeon. The specificity for the surgeon was 94% and 62.5% for the radiologist.
Discussion: Our study shows that the surgeons are capable of diagnosing rotator cuff tears with the use of high-resolution ultrasound in the out-patient setting. The low specificity of ultrasound by the radiologist in this study could be attributed to the higher resolution machine detecting intra-substance tears that are not seen at shoulder arthroscopy.
Conclusion: Office ultrasound, by a trained clinician, is a powerful diagnostic tool in diagnosing rotator cuff tears and can be used effectively in running one-stop shoulder clinics.