Ultrasound-detected pathologies cluster into groups with different clinical outcomes: data from 3000 community referrals for shoulder pain

Abstract

BackgroundUltrasound is increasingly used to evaluate shoulder pain, but the benefits of this are unclear. In this study, we examined whether ultrasound-defined pathologies have implications for clinical outcomes.MethodsWe extracted reported pathologies from 3000 ultrasound scans of people with shoulder pain referred from primary care. In latent class analysis (LCA), we identified whether individual pathologies clustered in groups. Optimal group number was determined by the minimum Bayesian information criterion. A questionnaire was sent to all patients scanned over a 12-month period (n = 2322). Data collected included demographics, treatments received, current pain and function. The relationship between pathology-defined groups and clinical outcomes was examined.ResultsLCA revealed four groups: (1) bursitis with limited inflammation elsewhere (n = 1280), (2) bursitis with extensive inflammation (n = 595), (3) rotator cuff tears (n = 558) and (4) limited pathology (n = 567). A total of 777 subjects (33%) completed questionnaires. The median (IQR) duration post-ultrasound scan was 25 (22–29) months. Subsequent injections were most common in groups 1 and 2 (groups 1–4 76%, 67%, 48% and 61%, respectively); surgery was most common in group 3 (groups 1–4 23%, 21%, 28% and 16%, respectively). Shoulder Pain and Disability Index scores were highest in group 3 (median 48 and 30, respectively) and lowest in group 4 (median 32 and 9, respectively). Patients in group 4 who had surgery reported poor outcomes.ConclusionsIn a community-based population, we identified clusters of pathologies on the basis of ultrasound. Our retrospective data suggest that these groups have different treatment pathways and outcomes. This requires replication in a prospective study to determine the value of a pathology-based classification in people with shoulder pain.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-017-1235-y) contains supplementary material, which is available to authorized users.

What Imaging‐Detected Pathologies Are Associated With Shoulder Symptoms and Their Persistence? A Systematic Literature Review

“…Studies have shown that numerous pathologies commonly coexist in the same symptomatic individual, although most studies in this review did not compare multiple pathologies with symptoms 75, 76. Only 1 unadjusted, low‐quality study evaluated shoulder pain with multiple pathologies in this review, and the authors found that SAB effusion may be associated with pain.…”

“…Only 1 unadjusted, low-quality study evaluated shoulder pain with multiple pathologies in this review, and the authors found that SAB effusion may be associated with pain. Recent work suggests that these multiple pathologies may cluster into groups that could contribute to different outcomes, further confounding structure-pain analyses (75).…”

Investigating the patient acceptable symptom state cut-offs: longitudinal data from a community cohort using the shoulder pain and disability index

“…However, the PASS cut-off on the total SPADI score at 6 months was dependent on the baseline score; this was primarily driven by the disability subscale, rather than the pain subscale. Our SPADI PASS cut-offs differed from the only other study assessing PASS and SPADI, although that crosssectional cohort recruited post-surgical patients [10]. Our cut-offs also varied according to the methods used; the optimum methods for calculating PASS are unknown and may depend on the purpose [18].…”

“…This paper has several strengths. While previous studies used different wordings and time anchors for PASS [7,10] we used the timeframe of "next few months" recommended by OMERACT [12]. Standardisation of the wording is important for comparison across studies and variations may influence results [18].…”

“…Exclusion criteria were: inflammatory arthritis; previous fracture/dislocation/surgery of the affected shoulder; steroid injection or physiotherapy for target shoulder within prior 6 weeks (to exclude effects of treatment, which are short term [9], on baseline symptoms); or complex regional pain syndrome. To avoid recruitment bias, quota sampling was used in four categories: gender (male/female) and age (younger/older split at the median); target proportions of these categories were determined from a previous study [10]: males aged < 54 (25%), males aged ≥ 54 (22%), females aged < 54 (25%), females aged ≥ 54 (28%).…”