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EARLY
EXPERIENCES OF PHYSIOTHERAPISTS USING SHOULDER ULTRASOUND IN THE
DETECTION OF
ROTATOR CUFF TEARS G.Lumsden,
R.Fallows,
M.Fletcher*, N.Price, S.Sutherland, R.M.Dodenhoff The
* INTRODUCTION 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. METHODS 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.
RESULTS 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%. CONCLUSION 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. BESS
2005, For further information on shoulder ultrasound go to |
