Bedside ultrasonography for verification of shoulder reduction: A long way to go

Abstract

PurposeShoulder dislocation is a common joint dislocation managed by the emergency physicians in the emergency departments. Pre- and post-reduction radiographic examinations have long been the standard practice to confirm the presence of dislocation and the successful reduction. However, shoulder ultrasonography has recently been proposed as an alternative to the radiographic examination. This study aimed to assess the accuracy of ultrasonography in evaluating proper reduction of the dislocated joint.MethodsThis was a prospective observational study. All patients with confirmed anterior shoulder dislocation were examined by both ultrasonography and radiography after the attempt for reduction of the dislocated joint. The examiners were blinded to the result of the other imaging modality. Results of the two methods were then compared.ResultsOverall, 108 patients with confirmed anterior shoulder dislocation were enrolled in the study. Ninety-one (84.3%) of the patients were males. Mean age of the participants was (30.11 ± 11.41) years. The majority of the patients had a recurrent dislocation. Bedside ultrasonography showed a sensitivity of 53.8% (95% CI: 29.1%–76.8%) and a specificity of 100% (95% CI: 96.1%–100%) in detecting inadequate reductions. The results of ultrasonography had a statistically significant agreement with the results of radiography (Kappa = 0.672, p < 0.001).ConclusionThe results suggest that the sensitivity of post-reduction ultrasound is not sufficient for it to serve as a substitute for radiography.

Ultrasound for the diagnosis of shoulder dislocation and reduction: A systematic review and meta‐analysis

“…Nine were conducted in the ED, 10–13,19–23 while one did not describe where it occurred 18 . The majority of POCUS examinations were performed by Emergency Medicine clinicians 10–13,19–21,23 . Training protocols included a combination of lecture and hands‐on practice with most training sessions being 1 or 2 h in length (Appendix ).…”

“…Studies were at overall low risk of bias and applicability concerns for most parameters (Table 2). Eight studies were at unclear risk of bias for patient selection due to the use of a convenience sample 10–12,18–22 . Two studies were at unclear risk of bias for the index test because the blinding was not well‐described 18 or the physical examination occurred concurrent with the POCUS examination 13 .…”

“…Two studies were at unclear risk of bias for the reference standard due to inadequate description of the blinding technique 10,18 . One study was at unclear applicability for patient selection due to exclusion of posterior dislocations and patients with a body‐mass index >35 kg/m 2 , 20 while a second study was at unclear applicability because they only included patients with a high clinical suspicion of shoulder dislocation 10 . Two studies were at unclear applicability for the index test because one did not specifically describe the ultrasound technique utilized, 10 while another used students 22 .…”

“…Two studies were at unclear applicability for the index test because one did not specifically describe the ultrasound technique utilized, 10 while another used students 22 . Two studies were at unclear applicability for the reference standard due to the use of a single‐view radiograph for confirming reductions 20 or inadequate description of the radiologic imaging 10 . No studies were at high risk for bias or applicability.…”

“…Ten studies, comprising 1836 total assessments, were selected for the final analysis (Table 1). Nine of the studies were prospective, observational trials [10][11][12][18][19][20][21][22][23] and one was a randomized control trial. 13 Four studies were conducted in the United States, 11,12,18,22 F I G U R E 1 PRISMA flow diagram four studies were performed in Iran, 10,19,20,23 one took place in Turkey, 21 and one was conducted in Malta.…”