title: Impact of the use of musculoskeletal ultrasound by rheumatologists in patients with shoulder and hand complaints compared with traditional clinical care.
abstract: OBJECTIVE
  To compare the routine use of musculoskeletal ultrasonography (MSUS) with traditional clinical care in daily practice at shoulder and hand level.
  
  
  METHODS
  An observational study was performed in four rheumatology departments. Within each department, 2 rheumatologists were selected; one rheumatologist used MSUS, and the other followed traditional rheumatology care. Consecutive patients with nontraumatic pain, hand numbness or disability, or pain and/or limitations in the shoulder were selected. We collected information regarding the clinical and MSUS diagnoses, changes in diagnosis and treatment following MSUS, local injections, the rheumatologist's satisfaction and the use of health care resources. A descriptive analysis was performed.
  
  
  RESULTS
  A total of 168 patients were analysed, with 104 and 64 patients in the MSUS and traditional care groups, respectively. MSUS led to a diagnosis and therapeutic change in 53 (52%) and 55 patients (54%), respectively. The rate of local injection was 47% in the MSUS group (73% unexpected, 61% performed using US) compared with 21% in the traditional group (p=0.001). According to the rheumatologists, MSUS was useful in 72 cases (71%) and extremely useful in 20 cases (20%), and the rheumatologists reported a higher satisfaction with their patient evaluations (p<0.001). The MSUS group required fewer additional tests (38% vs. 81%, respectively, p<0.001), fewer medical visits (46% vs. 84%, p<0.001), and lower direct costs (11 vs. 30 euros, p<0.001) than the traditional care group.
  
  
  CONCLUSIONS
  Compared with traditional care, the routine use of MSUS in rheumatology practice at hand and shoulder level can lead to important improvements in care, thereby reducing the number of additional tests and medical visits.
authors.affiliation: Rheumatology Department, Hospital Universitario de Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain. anarher@gobiernodecanarias.org
authors.forename: Antonio
authors.initials: A
authors.lastname: Naranjo
authors.forename: F Gabriel
authors.initials: FG
authors.lastname: Jiménez-Núñez
authors.forename: Julio
authors.initials: J
authors.lastname: Medina-Luezas
authors.forename: J Miguel
authors.initials: JM
authors.lastname: Senabre
authors.forename: Ana
authors.initials: A
authors.lastname: Rodríguez-García
authors.forename: Mónica
authors.initials: M
authors.lastname: Vázquez
authors.forename: Carlos
authors.initials: C
authors.lastname: Santos-Ramírez
authors.forename: María
authors.initials: M
authors.lastname: Alvarez de Buergo
authors.forename: María
authors.initials: M
authors.lastname: López-Lasanta
authors.forename: Estibaliz
authors.initials: E
authors.lastname: Loza
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005260:Female; D006225:Hand / Q000000981:diagnostic imaging*; D017048:Health Care Costs; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000191:economics; D010147:Pain Measurement; D011237:Predictive Value of Tests; D011379:Prognosis; D011787:Quality of Health Care; D012017:Referral and Consultation; D012720:Severity of Illness Index; D012782:Shoulder / Q000000981:diagnostic imaging*; D013030:Spain; D013256:Steroids / Q000008:administration & dosage; D014463:Ultrasonography
chemical_list: D013256:Steroids