Background The acute atraumatic shoulder pain is a frequent complaint in the emergency room. The power-Doppler ultrasonography (PDUS) is a useful tool in the evaluation of shoulder pathology in outpatients, but there are no previous studies in the emergency department.
Objectives To determine the frequency and types of ultrasound findings in patients with acute shoulder pain who consult to the emergency department of a tertiary hospital.
Methods This study included patients with acute atraumatic shoulder pain who consulted to the Unit of Rheumatology and Musculoskeletal Pathology of the Emergency Department of our center during the period from July to December 2013. A PDUS of affected shoulder was performed as part of the assessment protocol in these patients. The evaluated structures were the long head of the biceps tendon, subacromiodeltoid (SA) bursa, rotator cuff tendons, and glenohumeral (GH) and acromioclavicular (AC) joints. Results were expressed as measures of central tendency and dispersion, and proportions with confidence intervals (CI) of 95%.
Results A total number of 116 pacientes were attended during this period, and PDUS was performed in 94 (81%). The mean age of patients was 58±4.9 years and 62.7% were female. PDUS identified 122 tendon injuries. Involvement of supraspinatus tendon was detected in 79.5% [CI 71.5-85.7], biceps tendon 26.2% [CI 19.2-34.67], subscapularis tendon 24.5% [CI 17.8-32.9], and infraspinatus tendon 9.8% [CI 6-19.6] (table). The age of the patients was not related to the presence of any particular type of lesion except for synovial effusion (SE) in the AC joint, whose prevalence was increased according to the quintile of patient age.
Conclusions This is the first work that characterizes acute shoulder pain based on PDUS findings in emergency setting. The shoulder pain in outpatient clinics tends to be less intense, slowly progressive, and intermittent compared to that is assessed in the emergency department. Previous studies in inflammatory conditions demostrate a high frequency of SA bursa involvement, tenosynovitis and increased power-Doppler activity. In contrast, in our series the mechanical processes of the rotator cuff predominated and age does not seem to influence on PDUS findings unlike that is observed in the usual rheumatologic consultation.
Disclosure of Interest : None declared
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