title: Impact of Shoulder Sonography on Clinical Decision Making.
abstract: OBJECTIVE
  To assess the impact of musculoskeletal shoulder sonography (US) on clinical decision making.
  
  
  METHODS
  This Health Insurance Portability and Accountability Act-compliant retrospective study received Institutional Review Board approval with a waiver of informed consent. Consecutive musculoskeletal shoulder US examinations ordered over a 12-month period were retrospectively reviewed. The medical records of each patient were analyzed, recording immediate pre- and post-US treatment plans. Treatment plans were categorized as follows: 1, no further treatment; 2, conservative management/physical therapy; 3, therapeutic injection; 4, surgical intervention; 5, change in diagnosis; and 6, need additional imaging. Data were analyzed by nonparametric statistical methods.
  
  
  RESULTS
  A total of 935 patient examinations met inclusion criteria. Of 935 patients, 591 (63.2%) had a post-US treatment plan that differed from pre-US treatment, showing a statistically significant impact on patient treatment (P < .001). In 744 of the 935 examinations (79.6%), the treating physician initially prescribed conservative therapy as a treatment plan; 423 of those 744 patients (56.9%) were subsequently prescribed a more invasive form of treatment. Of the remaining 191 of 935 patients (20.4%) initially treated with invasive treatment, 101 (52.9%) received a change in the treatment plan after the US examinations, with 46 patients (24.1%) relegated to noninvasive treatment. Sonography also played a role in surgical planning, with 25 studies (2.7%) specifically performed to evaluate rotator cuff integrity when deciding between conventional and reverse shoulder arthroplasty.
  
  
  CONCLUSIONS
  Musculoskeletal shoulder US has a substantial impact on clinical decision making and patient treatment.
authors.affiliation: Washington University School of Medicine, Mallinckrodt Institute of Radiology, St Louis, Missouri USA.
authors.forename: Michael V
authors.initials: MV
authors.lastname: Friedman
authors.affiliation: Washington University School of Medicine, Mallinckrodt Institute of Radiology, St Louis, Missouri USA.
authors.forename: Travis J
authors.initials: TJ
authors.lastname: Hillen
authors.affiliation: Washington University School of Medicine, Mallinckrodt Institute of Radiology, St Louis, Missouri USA.
authors.forename: David V
authors.initials: DV
authors.lastname: Holland
authors.affiliation: Washington University School of Medicine, Mallinckrodt Institute of Radiology, St Louis, Missouri USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Essenberg
authors.affiliation: Washington University School of Medicine, Mallinckrodt Institute of Radiology, St Louis, Missouri USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Demertzis
mesh_terms: D000293:Adolescent; D000328:Adult; D000369:Aged, 80 and over; D001178:Arthroplasty / Q000706:statistics & numerical data*; D000066491:Clinical Decision-Making / Q000379:methods; D015897:Comorbidity; D000072700:Conservative Treatment / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D000070636:Rotator Cuff Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy*; D000070599:Shoulder Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy*; D020069:Shoulder Pain / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D014463:Ultrasonography / Q000706:statistics & numerical data*; D057832:Watchful Waiting / Q000706:statistics & numerical data; D055815:Young Adult
keywords: clinical management; impact; shoulder; sonography