Initial Experience of Office-based, Orthopaedic Surgeon Operated Ultrasonography of the Shoulder

Abstract

OBJECTIVES: We present our initial experience of orthopaedic surgeon operated ultrasound examination as an extension of physical examination of the shoulder in our out-patient setting. MATERIALS AND METHODS: We retrieved information of all cases that underwent shoulder ultrasound examination in our out-patient clinic from June 2019 to Mar 2020. We reviewed the demography of the patients, their presenting symptoms and shoulder ultrasonographic findings. We also reviewed medical literature pertaining to accuracy of ultrasound detection of rotator cuff pathology, short learning curve for orthopaedic surgeons who are interested in acquiring proficiency in the use of ultrasound for shoulder examination, and increased accuracy of ultrasound guided therapeutic injections. RESULTS: We identified 90 patients who underwent out-patient clinic-based shoulder ultrasound examination. There were almost equally divided between males and females. Average age was 57 years. Pain was the most common chief complaint. We identified 12 different ultrasonographic pathologies in isolation or in combination. We describe the ultrasound findings in these pathologies. Most common ultrasonographic pathologies were subacromial-subdeltoid (SASD) bursitis and supraspinatus tendinitis or combination of both. Fifty-four ultrasound-guided therapeutic injections were performed. In our literature review we found overwhelming evidence for high accuracy for detection of rotator cuff pathology by orthopaedic surgeons, comparable to radiologists. There is also evidence of a shorter learning curve for orthopaedic surgeons interested in shoulder problems and for increased accuracy of therapeutic injections using ultrasound guide. CONCLUSION: We would like to encourage more orthopaedic surgeons to take up shoulder ultrasonography as part of their routine examination of shoulder problems and also consider integrating shoulder ultrasound training to the residency and fellowship training programs. The benefits to the patients include savings in time and money and also more accurate therapeutic injections when needed.