The objective of this study was to determine if point-of-care sonography of the shoulder would change diagnosis or management in patients presenting to a sports medicine clinic with shoulder pain. We performed an observational, nonrandomized, nonblinded study of provider behavior when evaluating patients presenting to a sports medicine clinic with shoulder pain. The provider completed a questionnaire regarding the most likely diagnosis and management plan after he or she had performed a physical examination and radiograph(s). Following the physical examination and radiograph(s), a bedside ultrasonographic examination (BUS) was done and the provider completed a second questionnaire regarding the findings on sonography and revisions, if any, to the diagnosis and management plan. Data were collected on 42 patient encounters. BUS led to a change in diagnosis in 53% of cases. BUS led to a change in management plan in 60.4% of patients. BUS increased provider confidence in the diagnosis from 3.7 ± 0.19 (95% confidence interval [CI]) to 4.5 ± 0.21 (95% CI) on a 1 to 5 scale, with 1 being least confident and 5 being most confident. The addition of bedside sonography to the physical examination and radiographic studies of patients with undifferentiated shoulder pain resulted in a significant number of changes to the diagnosis and management plan as well as significantly increased diagnostic confidence.
Introduction: Intramuscular administration of vaccines into the deltoid muscle is the recommended route for most vaccines in adults. Ectopic injection into the subdeltoid/subacromial bursa can produce an inflammatory bursitis that is associated with significant long-term morbidity.
Case Report: We describe a novel approach to treatment of this condition: ultrasound-guided administration of dexamethasone by the emergency physician within six hours of vaccine administration. This approach resulted in complete and durable long-term resolution of symptoms with no functional impairment.
Conclusion: This outcome is superior to that described for usual care, and the approach is well-suited to emergency physicians.
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