Shoulder Ultrasound for Clinicians

Ultrasound of the shoulder is generally performed by radiologists in the UK and USA, but by surgeons and clinicians on the European mainland. This is purely historical, determined by who adopted the technology first and applied it clinically.

With the advent of small portable devices and the rapidly improving visualization technology of ultrasound it is becoming easier for clinicians to use these devices.

Ultrasound is however dependent on the experience of the operator and thorough training in it's use is essential. This can be very difficult for a clinician to acquire. The Royal College of Radiologists in the UK and EULAR offer guidance on training, but hands-on practice is essential under the supervision of an experienced ultrasonographer. Surgeons, however, do have the unique advantage of being able to validate their scans at surgery. Thus, shortening the learning curve substantially.

Office Ultrasound

Office ultrasound of the shoulder, performed at the time of first presentation offers the following advantages:

  1. Immediate diagnosis and confirmation of the rotator cuff pathology, allowing:
    1. One stop clinic, avoiding patients being sent away for a scan and then return a few weeks (or months) later with the result.
    2. Management planning and listing for the appropriate surgery at that visit, thus reducing waiting time for surgery.
    3. Patients to know their diagnosis immediately and plan accordingly.
  2. Allows therapists treating patient to manage accordingly
  3. Patient convenience
  4. Surgeon convenience
  5. Cheap - avoids cost of MRI and the radiology department costs.
  6. Quick
  7. Safe - no dangerous radiation
  8. Elimination of unnecessary injections - if a patient has a rotator cuff tear I would not inject the subacromial bursa with steroid usually.

This 'One-stop clinic' approach is popular with patients and is excellent for teaching purposes and honing clinical examination skills.

Ultrasound Machine

I currently use both the Sonosite MicroMaxx and GE Logiq E machines with a high frequency 38mm linear array transducer. It has the following advantages for me:

  • Portability:
    • light and easy to transfer between cubicles and rooms in a busy clinic setting.
    • Long life rechargeable battery, so no need to plug-in all the time.
    • Backpack allowing easy transfer between hospital sites
  • Quick - starts up quickly and shuts down with the click of a button
  • Comfortable and easy to use probe
  • Measurement Tools - easy to measure objects
  • Easy to enter patient information with keyboard
  • Fully digital so images are saved as seen, with all patient and measurement data
  • Connectivity to external monitors, TV screen, various printers etc.
  • The ability to save images video sequences and download them CD and flash drives for patients to keep.
  • Simple backup to save all examinations onto my PC and automatically organises all the examinations in logical files, so they are easy to retrieve.