title: Ultrasound-diagnosed disorders in shoulder patients in daily general practice: a retrospective observational study.
abstract: BACKGROUND
  Ultrasound imaging (US) is considered an accurate and widely available method to diagnose subacromial disorders. Yet, the frequency of the specific US-diagnosed shoulder disorders of patients with shoulder pain referred from general practice is unknown. We set out to determine the frequency of specific US-diagnosed shoulder disorders in daily practice in these patients and to investigate if the disorders detected differ between specific subgroups based on age and duration of pain.
  
  
  METHODS
  A predefined selection of 240 ultrasound reports of patients with shoulder pain (20 reports for each month in 2011) from a general hospital (Orbis Medical Centre Sittard-Geleen, The Netherlands) were descriptively analysed. Inclusion criteria were: (i) referral from general practice, (ii) age ≥ 18 years, and (iii) unilateral shoulder examination. Subgroups were created for age (<65 years and ≥ 65 years) and duration of pain (acute or subacute (<12 weeks) and chronic (≥ 12 weeks)). The occurrence of each specific disorder is expressed as absolute and relative frequencies.
  
  
  RESULTS
  With 29%, calcific tendonitis was the most frequently diagnosed disorder, followed by subacromial-subdeltoid bursitis (12%), tendinopathy (11%), partial-thickness tears (11%), full-thickness tears (8%) and AC-osteoarthritis (0.4%). For 40% of patients, no disorders were found on US. Significantly more full thickness-tears were found in the ≥ 65 years group. 'No disorders' was reported significantly more often in the <65 years group. The supraspinatus tendon was the most frequently affected tendon (72%).
  
  
  CONCLUSIONS
  Calcific tendonitis is the most common US-diagnosed disorder affecting patients in general practice, followed by subacromial-subdeltoid bursitis, tendinopathy, partial- and full-thickness tears and AC-osteoarthritis. Full-thickness tears were diagnosed significantly more frequently in patients ≥ 65 years, while 'no disorders' was more frequently reported in patients <65 years. Our findings imply that patients can be stratified into diagnostic subgroups, allowing more tailored treatment than currently applied.
authors.affiliation: Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, Maastricht, MD 6200, The Netherlands. ramon.ottenheijm@maastrichtuniversity.nl.
authors.forename: Ramon P G
authors.initials: RP
authors.lastname: Ottenheijm
authors.forename: Inge G M
authors.initials: IG
authors.lastname: van't Klooster
authors.forename: Laurens M M
authors.initials: LM
authors.lastname: Starmans
authors.forename: Kurt
authors.initials: K
authors.lastname: Vanderdood
authors.forename: Rob A
authors.initials: RA
authors.lastname: de Bie
authors.forename: Geert-Jan
authors.initials: GJ
authors.lastname: Dinant
authors.forename: Jochen W L
authors.initials: JW
authors.lastname: Cals
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D058006:General Practice; D006801:Humans; D007592:Joint Diseases / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000000981:diagnostic imaging*; D020069:Shoulder Pain / Q000000981:diagnostic imaging*; D014463:Ultrasonography