title: Surgeon-operated ultrasonography in a one-stop shoulder clinic.
abstract: BACKGROUND
  Nearly 1 in 40 of the population seeks medical advice related to a shoulder problem every year. The majority pertain to rotator cuff pathology. Prior to intervention in such patients it is imperative to define whether the tendons are intact or torn. Ultrasonography has  become an essential adjunct to clinical assessment in diagnosing rotator cuff tears. This study was designed to investigate if a surgeon using a portable ultrasonography machine in a one-stop shoulder clinic could significantly reduce the time a patient waited from initial outpatient presentation  to the end of the treatment episode (be it surgery, injection or conservative management).
  
  
  METHODS
  A total of 77 patients were allocated to one of two groups: Group A, consisting of 37 patients who were assessed and had ultrasonography as outpatients, and Group B, consisting of 40 patients  who were assessed and referred for departmental ultrasonography where appropriate. Three clear outcome groups were defined: those who required surgical repair, those who had irreparable tears and those who declined surgery.
  
  
  RESULTS
  For all outcomes (surgery, irreparable tears and conservative  treatment), the patients in Group A all completed their clinical episodes significantly quicker than those in Group B (p<0.02). As well as the time saving benefits, there was a substantial financial saving for Group A. By performing ultrasonography in the outpatients department,  those patients avoided the requirement of departmental imaging (£120) and subsequent follow-up appointments (£73) to discuss results and management, resulting in a saving of nearly £200 per patient.
  
  
  CONCLUSIONS
  The use of a portable ultrasonography machine by an orthopaedic  surgeon can significantly reduce the time to treatment and the financial cost for patients with rotator cuff tears.
authors: Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon EX2 5DW, UK. robin.seagger@gmail.com
authors: R
authors: R
authors: Seagger
authors: T
authors: T
authors: Bunker
authors: P
authors: P
authors: Hamer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000601:surgery; D000070636:Rotator Cuff Injuries; D012421:Rupture / Q000000981:diagnostic imaging / Q000601:surgery; D012782:Shoulder / Q000000981:diagnostic imaging* / Q000601:surgery; D000070599:Shoulder Injuries; D013997:Time Factors; D014463:Ultrasonography; D014850:Waiting Lists