Impact of Shoulder Sonography on Clinical Decision Making

OBJECTIVES: To assess the impact of musculoskeletal shoulder sonography (US) on clinical decision making. METHODS: This Health Insurance Portability and Accountability Act-compliant retrospective study received Institutional Review Board approval with a waiver of informed consent. Consecutive musculoskeletal shoulder US examinations ordered over a 12-month period were retrospectively reviewed. The medical records of each patient were analyzed, recording immediate pre- and post-US treatment plans. Treatment plans were categorized as follows: 1, no further treatment; 2, conservative management/physical therapy; 3, therapeutic injection; 4, surgical intervention; 5, change in diagnosis; and 6, need additional imaging. Data were analyzed by nonparametric statistical methods. RESULTS: A total of 935 patient examinations met inclusion criteria. Of 935 patients, 591 (63.2%) had a post-US treatment plan that differed from pre-US treatment, showing a statistically significant impact on patient treatment (P < .001). In 744 of the 935 examinations (79.6%), the treating physician initially prescribed conservative therapy as a treatment plan; 423 of those 744 patients (56.9%) were subsequently prescribed a more invasive form of treatment. Of the remaining 191 of 935 patients (20.4%) initially treated with invasive treatment, 101 (52.9%) received a change in the treatment plan after the US examinations, with 46 patients (24.1%) relegated to noninvasive treatment. Sonography also played a role in surgical planning, with 25 studies (2.7%) specifically performed to evaluate rotator cuff integrity when deciding between conventional and reverse shoulder arthroplasty. CONCLUSIONS: Musculoskeletal shoulder US has a substantial impact on clinical decision making and patient treatment.