An independent learning method for orthopaedic surgeons performing shoulder ultrasound to identify full-thickness tears of the rotator cuff.

BACKGROUND There is an evolving interest in shoulder ultrasound performed by orthopaedic surgeons as part of routine clinical assessment of the rotator cuff in a so-called one-stop clinic. This study investigated the accuracy of ultrasound assessment of rotator cuff integrity performed by orthopaedic surgeons without prior experience of ultrasound who were following our proposed learning protocol. METHODS We studied four surgeons without previous experience with shoulder ultrasound and monitored their ability to evaluate rotator cuff integrity using ultrasound compared with findings at arthroscopy. The surgeons attended a formal training course and were taught a protocol to identify and size full-thickness tears of the rotator cuff. The surgeons performed preoperative scans on the day that patients underwent shoulder arthroscopy. This allowed the surgeons to receive same-day feedback with comparison of arthroscopic images and ultrasound images. RESULTS One hundred and fifty-nine shoulders were scanned by the surgeons in the study. In the initial training period, surgeons who performed >100 scans demonstrated a sensitivity of 94% and a specificity of 88% (a positive predictive value of 79% and a negative predictive value of 97%) for the identification of a full-thickness tear and agreed with intraoperative sizing of the defect in 84% of the scans. In the later training period, the predictive values showed a sensitivity of 90% and a specificity of 97% (a positive predictive value of 95% and a negative predictive value of 94%) for the identification of a full-thickness tear and agreement with intraoperative sizing for 95% of the scans. CONCLUSIONS The predictive values obtained in this study for the evaluation of rotator cuff integrity were comparable with published results from experienced radiologists. This study demonstrates the capacity of our proposed learning protocol to train surgeons without previous ultrasound experience to reliably evaluate rotator cuff integrity using ultrasound within fifty to 100 scans.

[1]  Y. Endo.  Accuracy of Diagnostic Ultrasound in Patients With Suspected Subacromial Disorders: A Systematic Review and Meta-Analysis , 2011 .

[2]  Andrea J. Frangos,et al.  Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: a meta-analysis. , 2009, AJR. American journal of roentgenology.

[3]  G. Allen.  Shoulder ultrasound imaging-integrating anatomy, biomechanics and disease processes. , 2008, European journal of radiology.

[4]  P. Papadopoulos,et al.  Ultrasonography of symptomatic rotator cuff tears compared with MR imaging and surgery. , 2008, European journal of radiology.

[5]  A. Al-shawi,et al.  The detection of full thickness rotator cuff tears using ultrasound. , 2008, The Journal of bone and joint surgery. British volume.

[6]  C A Richards,et al.  Diagnosis and relation to general health of shoulder disorders presenting to primary care. , 2005, Rheumatology.

[7]  D. Ziegler.  The use of in-office, orthopaedist-performed ultrasound of the shoulder to evaluate and manage rotator cuff disorders. , 2004, Journal of shoulder and elbow surgery.

[8]  K. Yamaguchi,et al.  Detection and quantification of rotator cuff tears. Comparison of ultrasonographic, magnetic resonance imaging, and arthroscopic findings in seventy-one consecutive cases. , 2004, The Journal of bone and joint surgery. American volume.

[9]  G. Murrell,et al.  A comparison of clinical estimation, ultrasonography, magnetic resonance imaging, and arthroscopy in determining the size of rotator cuff tears. , 2002, Journal of shoulder and elbow surgery.

[10]  K. Yamaguchi,et al.  Ultrasonography of the Rotator Cuff: A Comparison of Ultrasonographic and Arthroscopic Findings in One Hundred Consecutive Cases* , 2000, The Journal of bone and joint surgery. American volume.

[11]  A. Hedtmann,et al.  [Ultrasonography of the shoulder in subacromial syndromes with disorders and injuries of the rotator cuff]. , 1995, Der Orthopade.

[12]  R. King,et al.  Shoulder pain in a community-based rheumatology clinic. , 1995, British journal of rheumatology.

[13]  C. Morgan,et al.  Evaluation of ultrasonography as a diagnostic technique in the assessment of rotator cuff tendon tears , 1992, The American journal of sports medicine.

[14]  M. Chard,et al.  Shoulder disorders in the elderly: a community survey. , 1991, Arthritis and rheumatism.

[15]  F A Matsen,et al.  Sonographic evaluation of the rotator cuff. , 1988, Radiologic clinics of North America.

[16]  F A Matsen,et al.  US evaluation of the rotator cuff. , 1985, Radiology.

[17]  L. Bolvig.  Appendix 12 - Minimum Training Requirements For The Practice Of Medical Ultrasound In Europe , 2008, Ultraschall in der Medizin.

[18]  L. Funk,et al.  Are shoulder surgeons any good at diagnosing rotator cuff tears using ultrasound?: A comparative analysis of surgeon vs radiologist , 2008, International journal of shoulder surgery.

[19]  W. Seitz,et al.  Sonography of the shoulder in patients with tears of the rotator cuff: accuracy and value for selecting surgical options. , 1993, AJR. American journal of roentgenology.