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

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    Authors
    O’Rourke, S
    Kelly, P
    Affiliation
    Midland Regional Hospital, Tullamore
    Issue Date
    2012-09-20
    Keywords
    EMERGENCY MEDICAL CARE
    INJURY
    IMAGING
    ULTRASOUND
    Local subject classification
    X-RAY
    ROTATOR CUFF
    
    Metadata
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    Is Part Of
    Faculty Sports & Exercise, RCPI & RCSI Medicine Annual Scientific Conference
    Publisher
    Royal College of Surgeons in Ireland (RCSI)
    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
    Collections
    Midland Regional Hospital Tullamore

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