Pilot Study to Determine Accuracy of Posterior Approach Ultrasound for Shoulder Dislocation by Novice Sonographers

Shadi Lahham, Brent Becker, Alan Chiem, Linda M Joseph, Craig L Anderson, Sean P Wilson, Mohammad Subeh, Alex Trinh, Eric Viquez, John C Fox, Shadi Lahham, Brent Becker, Alan Chiem, Linda M Joseph, Craig L Anderson, Sean P Wilson, Mohammad Subeh, Alex Trinh, Eric Viquez, John C Fox

Abstract

Introduction: The goal of this study was to investigate the efficacy of diagnosing shoulder dislocation using a single-view, posterior approach point-of-care ultrasound (POCUS) performed by undergraduate research students, and to establish the range of measured distance that discriminates dislocated shoulder from normal.

Methods: We enrolled a prospective, convenience sample of adult patients presenting to the emergency department with acute shoulder pain following injury. Patients underwent ultrasonographic evaluation of possible shoulder dislocation comprising a single transverse view of the posterior shoulder and assessment of the relative positioning of the glenoid fossa and the humeral head. The sonographic measurement of the distance between these two anatomic structures was termed the Glenohumeral Separation Distance (GhSD). A positive GhSD represented a posterior position of the glenoid rim relative to the humeral head and a negative GhSD value represented an anterior position of the glenoid rim relative to the humeral head. We compared ultrasound (US) findings to conventional radiography to determine the optimum GhSD cutoff for the diagnosis of shoulder dislocation. Sensitivity, specificity, positive predictive value, and negative predictive value of the derived US method were calculated.

Results: A total of 84 patients were enrolled and 19 (22.6%) demonstrated shoulder dislocation on conventional radiography, all of which were anterior. All confirmed dislocations had a negative measurement of the GhSD, while all patients with normal anatomic position had GhSD>0. This value represents an optimum GhSD cutoff of 0 for the diagnosis of (anterior) shoulder dislocation. This method demonstrated a sensitivity of 100% (95% CI [82.4-100]), specificity of 100% (95% CI [94.5-100]), positive predictive value of 100% (95% CI [82.4-100]), and negative predictive value of 100% (95% CI [94.5-100]).

Conclusion: Our study suggests that a single, posterior-approach POCUS can diagnose anterior shoulder dislocation, and that this method can be employed by novice ultrasonographers, such as non-medical trainees, after a brief educational session. Further validation studies are necessary to confirm these findings.

Figures

Figure 1
Figure 1
Superior view illustrating a posterior approach to a right shoulder ultrasound.
Figure 2
Figure 2
Schematic illustration demonstrating anatomic probe position of the right shoulder with an overhead view. G, glenoid; HH, humeral head
Figure 3
Figure 3
Ultrasound image depicting dislocated right shoulder. Both the humeral head (HH) and glenoid fossa (GF) are depicted with an illustration of the measured glenohumeral separation distance (GhSD).
Figure 4
Figure 4
Ultrasound image depicting normal right shoulder anatomy. Both the humeral head (HH) and glenoid fossa (GF) are depicted with an illustration of the measured glenohumeral separation distance (GhSD).
Figure 5
Figure 5
103 patients were screened for enrollment; 19 were ineligible and 84 patients consented and were enrolled. Of these, 19 had shoulder dislocations and 64 patients did not. POCUS, point of care ultrasound
Figure 6
Figure 6
The measured glenohumeral separation of patients arranged by positive and negative dislocation.

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