Acute shoulder injury with a normal x-ray: a simple algorithm of patient assessment to guide the need for further imaging

Hdl Handle:
http://hdl.handle.net/10147/245012
Title:
Acute shoulder injury with a normal x-ray: a simple algorithm of patient assessment to guide the need for further imaging
Authors:
O’Rourke, S; Kelly, P
Is Part Of:
Faculty Sports & Exercise, RCPI & RCSI Medicine Annual Scientific Conference
Affiliation:
Midland Regional Hospital, Tullamore
Publisher:
Royal College of Surgeons in Ireland (RCSI)
Issue Date:
20-Sep-2012
URI:
http://hdl.handle.net/10147/245012
Abstract:
Purpose: Patients presenting to their General Practitioner or to the Emergency Department following an acute shoulder injury but a normal x-ray may have a significant underlying injury to the Rotator Cuff. Imaging (whether by ultrasound or MRI) is often indicated but available clinical evidence has yet to establish what group of patients benefit most from early imaging. Method: In March 2012 a multidisciplinary approach has been introduced to assess adult patients attending the Emergency Department with acute shoulder injuries, severe pain and/or restricted shoulder movement, but a normal x-ray. This involved a senior medical assessment within 7 days following presentation. All patients with pseudo-paralysis (defined as the inability to abduct the shoulder beyond 45°) and patients with abduction in the range of 45-90° with positive clinical tests suggesting significant rotator cuff involvement are referral for urgent ultrasound. Image confirmed acute, full thickness rotator cuff tears were seen within ten days by an orthopaedic surgeon with a special interest in shoulder surgery. Results: To date 25 patients have been assessed. 11 patients (aged between 42 and 80 years) have met the criteria for early imaging for acute rotator cuff tears. Five confirmed acute tears of the rotator cuff have been referred for early surgical intervention. One patient had a fracture of the greater tuberosity not seen on x-ray. Conclusion: Early post-trauma assessment of patients with acute shoulder injuries with normal x-rays using simple assessment criteria will identify patients at significant risk of acute rotator cuff tears requiring early surgical intervention.
Item Type:
Conference Presentation
Language:
en
Keywords:
EMERGENCY MEDICAL CARE; INJURY; IMAGING; ULTRASOUND
Local subject classification:
X-RAY; ROTATOR CUFF

Full metadata record

DC FieldValue Language
dc.contributor.authorO’Rourke, Sen_GB
dc.contributor.authorKelly, Pen_GB
dc.date.accessioned2012-09-19T15:04:36Z-
dc.date.available2012-09-19T15:04:36Z-
dc.date.issued2012-09-20-
dc.identifier.urihttp://hdl.handle.net/10147/245012-
dc.description.abstractPurpose: Patients presenting to their General Practitioner or to the Emergency Department following an acute shoulder injury but a normal x-ray may have a significant underlying injury to the Rotator Cuff. Imaging (whether by ultrasound or MRI) is often indicated but available clinical evidence has yet to establish what group of patients benefit most from early imaging. Method: In March 2012 a multidisciplinary approach has been introduced to assess adult patients attending the Emergency Department with acute shoulder injuries, severe pain and/or restricted shoulder movement, but a normal x-ray. This involved a senior medical assessment within 7 days following presentation. All patients with pseudo-paralysis (defined as the inability to abduct the shoulder beyond 45°) and patients with abduction in the range of 45-90° with positive clinical tests suggesting significant rotator cuff involvement are referral for urgent ultrasound. Image confirmed acute, full thickness rotator cuff tears were seen within ten days by an orthopaedic surgeon with a special interest in shoulder surgery. Results: To date 25 patients have been assessed. 11 patients (aged between 42 and 80 years) have met the criteria for early imaging for acute rotator cuff tears. Five confirmed acute tears of the rotator cuff have been referred for early surgical intervention. One patient had a fracture of the greater tuberosity not seen on x-ray. Conclusion: Early post-trauma assessment of patients with acute shoulder injuries with normal x-rays using simple assessment criteria will identify patients at significant risk of acute rotator cuff tears requiring early surgical intervention.en_GB
dc.language.isoenen
dc.publisherRoyal College of Surgeons in Ireland (RCSI)en_GB
dc.relation.ispartofFaculty Sports & Exercise, RCPI & RCSI Medicine Annual Scientific Conferenceen_GB
dc.subjectEMERGENCY MEDICAL CAREen_GB
dc.subjectINJURYen_GB
dc.subjectIMAGINGen_GB
dc.subjectULTRASOUNDen_GB
dc.subject.otherX-RAYen_GB
dc.subject.otherROTATOR CUFFen_GB
dc.titleAcute shoulder injury with a normal x-ray: a simple algorithm of patient assessment to guide the need for further imagingen_GB
dc.typeConference Presentationen
dc.contributor.departmentMidland Regional Hospital, Tullamoreen_GB
dc.description.provinceLeinsteren
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