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Weimer AM, Weimer JM, Berthold S, Stein S, Müller L, Buggenhagen H, Balser G, Stankov K, Sgroi M, Schmidmaier G, Kloeckner R, Schamberger C. Shoulder and Knee Arthroscopy Access Point: Prospective Comparison of Sonographic and Palpatory Detection - Which Method is Better for Novices? Ultrasound Int Open 2024; 10:a22710098. [PMID: 38812890 PMCID: PMC11135419 DOI: 10.1055/a-2271-0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/03/2024] [Indexed: 05/31/2024] Open
Abstract
Purpose Arthroscopy is one of the most common interventions in orthopedics. Hence it is important to train users early in order to ensure the safest possible identification of access portals (AP). This prospective study aimed to compare a palpatory (PalpMethod) with a sonographic (SonoMethod) method for AP location in the shoulder and knee joints. Materials and Methods The study included trainee doctors (n=68) attending workshops (lasting approx. 90 minutes). In these workshops a teaching video initially demonstrated the PalpMethod and SonoMethod of AP identification. An experienced operator first marked the access portals on the test subject with a UV pen (determined ideal point [DIP]). Adhesive film was then affixed to the puncture regions. Subsequently participants marked on shoulders and knees first the point determined by palpation, then the point determined by sonography. Analysis involved DIP visualization with a UV lamp and employed a coordinate system around the central DIP. In addition, participants completed an evaluation before and after the workshop. Results The analysis included 324 measurements (n=163 shoulders and n= 161 knees). The majority of participants had not previously attended any courses on manual examination (87.9%) or musculoskeletal ultrasound (93.9%). Overall, the markings participants made on the shoulder using the SonoMethod were significantly closer to the DIP than those made by the PalpMethod (Palp 18.8mm ± 14.5mm vs. Sono 11.2mm ± 7.2mm; p<0.001). On the knee, however, the markings made by the PalpMethod were significantly closer to the DIP overall (Palp 8.0mm ± 3.2mm vs. Sono 12.8mm ± 5.2mm; p<0.001). Conclusion The results show that the SonoMethod produces more accurate markings on the shoulder, while the PalpMethod is superior for the knee.
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Affiliation(s)
- Andreas Michael Weimer
- Clinic for Trauma and Reconstructive Surgery, University
Hospital Heidelberg, Heidelberg, Germany
| | - Johannes M. Weimer
- Rudolf-Frey Teaching Department, University Medical
Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Svenja Berthold
- Department for Orthopaedics and Trauma Surgery,
University Medical Centre Mannheim, Mannheim, Germany
| | - Stephan Stein
- Clinic for Trauma and Reconstructive Surgery, University
Hospital Heidelberg, Heidelberg, Germany
| | - Lukas Müller
- Department of Diagnostic and Interventional Radiology,
University Medical Center of the Johannes Gutenberg University Mainz, Mainz,
Germany
| | - Holger Buggenhagen
- Rudolf-Frey Teaching Department, University Medical
Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Gerd Balser
- Rudolf-Frey Teaching Department, University Medical
Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Kay Stankov
- Corporate Finance, Technical University of Darmstadt,
Darmstadt, Germany
| | - Mirco Sgroi
- Department of Orthopaedic Surgery, Ulm University
Medical Center, Ulm, Germany
| | - Gerhard Schmidmaier
- Clinic for Trauma and Reconstructive Surgery, University
Hospital Heidelberg, Heidelberg, Germany
| | - Roman Kloeckner
- Institute of Interventional Radiology, University
Medical Center Schleswig Holstein Campus Lübeck, Lübeck, Germany
| | - Christian Schamberger
- Clinic for Trauma and Reconstructive Surgery, University
Hospital Heidelberg, Heidelberg, Germany
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Chai JW, Lee JH, Kim DH, Park J, Oh SH, Shin SM. Effect of Patient's Positioning on the Grade of Tendinosis and Visible Range of Infraspinatus Tendon on Ultrasound. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:627-637. [PMID: 37325003 PMCID: PMC10265234 DOI: 10.3348/jksr.2022.0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/16/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
Purpose To investigate the effect of patient positioning on tendinosis grade, visible range, and infraspinatus tendon (IST) thickness, and to determine the feasibility of internal rotation (IR) position to assess IST on ultrasound (US). Materials and Methods This study included 52 shoulders of 48 subjects who were evaluated for IST in three different positions: neutral position (N), IR, and position with the ipsilateral hand on the contralateral shoulder (HC). Two radiologists retrospectively graded IST tendinosis from grade 0 to grade 3 and the visible range from grade 1 to grade 4. The thickness of the IST was measured by another radiologist with a short-axis view. A generalized estimating equation was used for statistical analysis. Results The tendinosis grades were higher in the HC position than in the IR position, with a cumulative odds ratio of 2.087 (0.004, 95% confidence interval [CI]: 1.268-3.433). The tendinosis grades in the HC position (p = 0.370) and IR position (p = 0.146) were not significantly different from those in the N position. The overall difference in IST thickness was significant (p < 0.001), but the visible range (p = 0.530) was not significantly different according to position. Conclusion Patient positioning significantly affected the grade of tendinosis and thickness but not the visible range of the IST. The IR position is a feasible position for assessing the IST on US.
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Vopat ML, Peebles LA, McBride T, Cirone I, Rider D, Provencher CMT. Accuracy and Reliability of Imaging Modalities for the Diagnosis and Quantification of Hill-Sachs Lesions: A Systematic Review. Arthroscopy 2021; 37:391-401. [PMID: 32798670 DOI: 10.1016/j.arthro.2020.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/24/2020] [Accepted: 08/11/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine the reliability and accuracy of different imaging modalities in assessing Hill-Sachs lesions within the setting of anterior shoulder instability. METHODS A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines using the PubMed, Scopus, Embase, and Cochrane Library databases. The inclusion criteria were clinical trials or cadaveric studies that assessed the accuracy of humeral head bone loss imaging or reliability and English-language articles. The exclusion criteria were animal studies; imaging studies without measures of accuracy, reliability, or clinical predictive power; studies of shoulder injuries without humeral head bone loss; editorials; abstracts; reviews; case reports; and surveys. The search terms included "imaging" OR "radiographic" OR "CT" OR "MRI" AND "Hill-Sachs" OR "humeral head bone loss." Assessment of the methodologic quality of the included studies was performed using the original Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. RESULTS Forty studies (2,560 shoulders) met the inclusion criteria and were assessed. For diagnosing the presence of Hill-Sachs lesions, computed tomography (CT) arthrography had the highest reported accuracy (median, 91%; range, 66%-100%). For the same assessment, CT arthrography also had the greatest reported sensitivity (median, 94%; range, 50%-100%). For the quantification of Hill-Sachs lesion parameters, reported intraobserver reliabilities were highest for 3-dimensional (3D) CT (intraclass correlation coefficient [ICC] range, 0.916-0.999), followed by 2-dimensional CT (ICC range, 0.858-0.861) and magnetic resonance imaging (MRI) (ICC range, 0.28-0.97). For the same quantification parameters, interobserver reliabilities were also reported for 3D CT (ICC range, 0.772-0.996), 2-dimensional CT (ICC range, 0.721-0.879), and MRI (κ range, 0.444-0.700). Intraobserver reliabilities for determining glenoid tracking were only reported for 3D CT (κ range, 0.730-1.00; ICC range, 0.803-0.901) and MRI (ICC range, 0.770-0.790). CONCLUSIONS This study shows that the current literature supports a variety of different imaging modalities that provide clinically acceptable accuracy in diagnosing and quantifying Hill-Sachs lesions, as well as determining whether they will cause persistent anterior shoulder instability. Furthermore, this systematic review justifies that further research is needed to help develop a treatment algorithm on the proper imaging modalities needed to help treat patients with anterior shoulder instability that is both reliable and financially acceptable. LEVEL OF EVIDENCE Level IV, systematic review of Level I through IV studies.
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Affiliation(s)
- Matthew L Vopat
- University of Kansas School of Medicine-Wichita, Wichita, Kansas, U.S.A
| | - Liam A Peebles
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Trevor McBride
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania, U.S.A
| | - Isaak Cirone
- Colorado State University, Fort Collins, Colorado, U.S.A
| | - Danielle Rider
- Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Capt Matthew T Provencher
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; The Steadman Clinic, Vail, Colorado, U.S.A..
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Ultrasound Evaluation of Anterior Acromioclavicular Relationship in the Horizontal Plane on 40 Healthy Subjects. A New Possibility for Differential Diagnosis of Acromioclavicular Disjunctions Rockwood Stage 3 and 4? A Pilot Study. Clin J Sport Med 2020; 30:e219-e224. [PMID: 30312184 DOI: 10.1097/jsm.0000000000000675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the repeatability and reproducibility of an ultrasound examination of the acromioclavicular joint (ACJ) performed by an orthopaedic surgeon to analyze anterior ACJ relationship in the horizontal plane. DESIGN Prospective observational study on healthy subjects. SETTING The study was conducted in 2017 in a university department of orthopaedic surgery and traumatology. LEVEL OF EVIDENCE III. PATIENTS (OR PARTICIPANTS) Forty consecutive volunteers aged 18 to 40 years were involved. INTERVENTIONS (OR ASSESSMENT OF RISK FACTORS OR INDEPENDENT VARIABLES):: The ultrasound examination was performed by 2 orthopaedic surgeons with a SonoSite M-Turbo portable ultrasound machine (Fujifilm, Japan). Distance measurement between the anterior edge of the clavicle (AECL) and the anterior edge of the acromion (AEAC) was done on the right side, then on the left one and repeated by the same examiner. MAIN OUTCOME MEASURES The intra- and interexaminer reproducibility of measurements was analyzed as primary outcome. Concordance of distance measurements between the right and left sides on the same subject was evaluated, as well as the "typical morphology" of the ACJ in the horizontal plane. RESULTS The intra- and interexaminer reproducibility for AECL-AEAC distance measurements was, respectively, 0.95 (0.93-0.97) and 0.87 (0.84-0.90). The correlation between the right and left sides was significant (P < 0.001), with a reproducibility of 0.86 (0.83-0.89). Twenty-seven (67.5%) volunteers were considered to have a "perfect alignment" of the AECL and AEAC. CONCLUSIONS This study confirms that it is possible to evaluate with good reproducibility the anterior AC relationship in the horizontal plane and that both sides are similar on the same subject.
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Krill MK, Rosas S, Kwon K, Dakkak A, Nwachukwu BU, McCormick F. A concise evidence-based physical examination for diagnosis of acromioclavicular joint pathology: a systematic review. PHYSICIAN SPORTSMED 2018; 46:98-104. [PMID: 29210329 PMCID: PMC6396285 DOI: 10.1080/00913847.2018.1413920] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 12/04/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The clinical examination of the shoulder joint is an undervalued diagnostic tool for evaluating acromioclavicular (AC) joint pathology. Applying evidence-based clinical tests enables providers to make an accurate diagnosis and minimize costly imaging procedures and potential delays in care. The purpose of this study was to create a decision tree analysis enabling simple and accurate diagnosis of AC joint pathology. METHODS A systematic review of the Medline, Ovid and Cochrane Review databases was performed to identify level one and two diagnostic studies evaluating clinical tests for AC joint pathology. Individual test characteristics were combined in series and in parallel to improve sensitivities and specificities. A secondary analysis utilized subjective pre-test probabilities to create a clinical decision tree algorithm with post-test probabilities. RESULTS The optimal special test combination to screen and confirm AC joint pathology combined Paxinos sign and O'Brien's Test, with a specificity of 95.8% when performed in series; whereas, Paxinos sign and Hawkins-Kennedy Test demonstrated a sensitivity of 93.7% when performed in parallel. Paxinos sign and O'Brien's Test demonstrated the greatest positive likelihood ratio (2.71); whereas, Paxinos sign and Hawkins-Kennedy Test reported the lowest negative likelihood ratio (0.35). CONCLUSION No combination of special tests performed in series or in parallel creates more than a small impact on post-test probabilities to screen or confirm AC joint pathology. Paxinos sign and O'Brien's Test is the only special test combination that has a small and sometimes important impact when used both in series and in parallel. Physical examination testing is not beneficial for diagnosis of AC joint pathology when pretest probability is unequivocal. In these instances, it is of benefit to proceed with procedural tests to evaluate AC joint pathology. Ultrasound-guided corticosteroid injections are diagnostic and therapeutic. An ultrasound-guided AC joint corticosteroid injection may be an appropriate new standard for treatment and surgical decision-making. LEVEL OF EVIDENCE II - Systematic Review.
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Affiliation(s)
- Michael K Krill
- a Florida Atlantic University Charles E. Schmidt College of Medicine , Boca Raton , FL , USA
- b Jameson Crane Sports Medicine Institute , The Ohio State University Wexner Medical Center , Columbus , OH , USA
| | - Samuel Rosas
- c Baptist Health, Department of Orthopedic Surgery , Wake Forest University , Winston-Salem , NC , USA
| | - KiHyun Kwon
- d Florida International University Herbert Wertheim College of Medicine , Miami , FL , USA
| | - Andrew Dakkak
- a Florida Atlantic University Charles E. Schmidt College of Medicine , Boca Raton , FL , USA
| | - Benedict U Nwachukwu
- e Department of Orthopedic Surgery , Hospital for Special Surgery , New York , NY , USA
| | - Frank McCormick
- f Department of Orthopedics , Harvard Medical School, Beth Israel Deaconess Medical Center , Boston , MA , USA
- g Department of Sports Medicine , Harvard Medical School, Beth Israel Deaconess Medical Center , Boston , MA , USA
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Rosas S, Krill MK, Amoo-Achampong K, Kwon K, Nwachukwu BU, McCormick F. A practical, evidence-based, comprehensive (PEC) physical examination for diagnosing pathology of the long head of the biceps. J Shoulder Elbow Surg 2017; 26:1484-1492. [PMID: 28479256 PMCID: PMC6427911 DOI: 10.1016/j.jse.2017.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 03/01/2017] [Accepted: 03/02/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Clinical examination of the shoulder joint has gained attention as clinicians aim to use an evidence-based examination of the biceps tendon, with the desire for a proper diagnosis while minimizing costly imaging procedures. The purpose of this study is to create a decision tree analysis that enables the development of a clinical algorithm for diagnosing long head of biceps (LHB) pathology. METHODS A literature review of Level I and II diagnostic studies was conducted to extract characteristics of clinical tests for LHB pathology through a systematic review of PubMed, Medline, Ovid, and Cochrane Review databases. Tests were combined in series and parallel to determine sensitivities and specificities, and positive and negative likelihood ratios were determined for each combination using a subjective pretest probability. The "gold standard" for diagnosis in all included studies was arthroscopy or arthrotomy. RESULTS The optimal testing modality was use of the uppercut test combined with the tenderness to palpation of the biceps tendon test. This combination achieved a sensitivity of 88.4% when performed in parallel and a specificity of 93.8% when performed in series. These tests used in combination optimize post-test probability accuracy greater than any single individual test. CONCLUSION Performing the uppercut test and biceps groove tenderness to palpation test together has the highest sensitivity and specificity of known physical examinations maneuvers to aid in the diagnosis of LHB pathology compared with diagnostic arthroscopy (practical, evidence-based, comprehensive examination). A decision tree analysis aides in the practical, evidence-based, comprehensive examination diagnostic accuracy post-testing based on the ordinal scale pretest probability.
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Affiliation(s)
- Samuel Rosas
- Department of Orthopedic Surgery, Baptist Health, Wake Forest University, Winston-Salem, NC, USA
| | - Michael K. Krill
- Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA,Jameson Crane Sports Medicine Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - KiHyun Kwon
- Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA
| | | | - Frank McCormick
- Department of Orthopedics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA,Department of Sports Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA,Reprint requests: Frank McCormick, MD, 330 Brookline Ave., Boston, MA02215, USA.
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