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Open Access Research article

Ultrasound-diagnosed disorders in shoulder patients in daily general practice: a retrospective observational study

Ramon PG Ottenheijm1*, Inge GM van’t Klooster1, Laurens MM Starmans1, Kurt Vanderdood2, Rob A de Bie3, Geert-Jan Dinant1 and Jochen WL Cals1

Author Affiliations

1 Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, Maastricht, MD 6200, The Netherlands

2 Department of Radiology, Orbis Medical Centre, Dr. H. van der Hoffplein 1, Sittard-Geleen, BG 6162, The Netherlands

3 Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, Maastricht, MD 6200, The Netherlands

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BMC Family Practice 2014, 15:115  doi:10.1186/1471-2296-15-115

Published: 10 June 2014

Abstract

Background

Ultrasound imaging (US) is considered an accurate and widely available method to diagnose subacromial disorders. Yet, the frequency of the specific US-diagnosed shoulder disorders of patients with shoulder pain referred from general practice is unknown. We set out to determine the frequency of specific US-diagnosed shoulder disorders in daily practice in these patients and to investigate if the disorders detected differ between specific subgroups based on age and duration of pain.

Methods

A predefined selection of 240 ultrasound reports of patients with shoulder pain (20 reports for each month in 2011) from a general hospital (Orbis Medical Centre Sittard-Geleen, The Netherlands) were descriptively analysed. Inclusion criteria were: (i) referral from general practice, (ii) age ≥18 years, and (iii) unilateral shoulder examination. Subgroups were created for age (<65 years and ≥65 years) and duration of pain (acute or subacute (<12 weeks) and chronic (≥12 weeks)). The occurrence of each specific disorder is expressed as absolute and relative frequencies.

Results

With 29%, calcific tendonitis was the most frequently diagnosed disorder, followed by subacromial-subdeltoid bursitis (12%), tendinopathy (11%), partial-thickness tears (11%), full-thickness tears (8%) and AC-osteoarthritis (0.4%). For 40% of patients, no disorders were found on US. Significantly more full thickness-tears were found in the ≥65 years group. ‘No disorders’ was reported significantly more often in the <65 years group. The supraspinatus tendon was the most frequently affected tendon (72%).

Conclusions

Calcific tendonitis is the most common US-diagnosed disorder affecting patients in general practice, followed by subacromial-subdeltoid bursitis, tendinopathy, partial- and full-thickness tears and AC-osteoarthritis. Full-thickness tears were diagnosed significantly more frequently in patients ≥65 years, while ‘no disorders’ was more frequently reported in patients <65 years. Our findings imply that patients can be stratified into diagnostic subgroups, allowing more tailored treatment than currently applied.

Keywords:
Shoulder; Shoulder impingement syndrome; Rotator cuff; Ultrasound; General practice