Impact of Shoulder Sonography on Clinical Decision Making

Objectives To assess the impact of musculoskeletal shoulder sonography (US) on clinical decision making. Methods This Health Insurance Portability and Accountability Act–compliant retrospective study received Institutional Review Board approval with a waiver of informed consent. Consecutive musculoskeletal shoulder US examinations ordered over a 12‐month period were retrospectively reviewed. The medical records of each patient were analyzed, recording immediate pre‐ and post‐US treatment plans. Treatment plans were categorized as follows: 1, no further treatment; 2, conservative management/physical therapy; 3, therapeutic injection; 4, surgical intervention; 5, change in diagnosis; and 6, need additional imaging. Data were analyzed by nonparametric statistical methods. Results A total of 935 patient examinations met inclusion criteria. Of 935 patients, 591 (63.2%) had a post‐US treatment plan that differed from pre‐US treatment, showing a statistically significant impact on patient treatment (P < .001). In 744 of the 935 examinations (79.6%), the treating physician initially prescribed conservative therapy as a treatment plan; 423 of those 744 patients (56.9%) were subsequently prescribed a more invasive form of treatment. Of the remaining 191 of 935 patients (20.4%) initially treated with invasive treatment, 101 (52.9%) received a change in the treatment plan after the US examinations, with 46 patients (24.1%) relegated to noninvasive treatment. Sonography also played a role in surgical planning, with 25 studies (2.7%) specifically performed to evaluate rotator cuff integrity when deciding between conventional and reverse shoulder arthroplasty. Conclusions Musculoskeletal shoulder US has a substantial impact on clinical decision making and patient treatment.