Superiority of diagnostic musculoskeletal ultrasonography compared to clinical examination in detecting subacromial bursitis
DOI:
https://doi.org/10.18203/2320-6012.ijrms20243684Keywords:
Accuracy, Clinical examination, Diagnosis, Musculoskeletal ultrasonography, Subacromial bursitisAbstract
Background: This study compares the diagnostic efficacy of clinical examination and musculoskeletal (MSK) ultrasonography in detecting subacromial bursitis, highlighting their sensitivity, specificity and reliability. Subacromial bursitis is a common cause of shoulder pain.
Methods: This cross-sectional comparative study was conducted in the Department of Physical Medicine and Rehabilitation at Bangabandhu Sheikh Mujib Medical University, Dhaka, from January 1, 2024 to June 30, 2024. A total of 80 patients with suspected subacromial bursitis were evaluated, divided into two groups: clinical examination (n=40) and MSK ultrasonography (n=40).
Results: MSK ultrasonography demonstrated superior diagnostic performance with a sensitivity of 91.5% and specificity of 89%, compared to clinical examination, which showed sensitivity and specificity values of 63.2% and 57.5% respectively. The interobserver reliability measured by the Kappa Coefficient was significantly higher for MSK ultrasonography (0.88) than for clinical examination (0.50) underscoring the consistency of ultrasound imaging. MSK ultrasonography also detected specific pathological features such as bursal thickening and effusion more effectively.
Conclusions: The study emphasizes the need for improved access to MSK ultrasonography in clinical settings, especially in resource-limited areas like Bangladesh, where clinical examination is still the primary diagnostic method despite its limitations. The integration of MSK ultrasonography into routine practice could enhance diagnostic accuracy, reduce misdiagnoses and improve patient outcomes. These findings support the global trend towards imaging-based diagnostics for musculoskeletal conditions, advocating for strategic investments in diagnostic infrastructure and training to bridge the gap in healthcare delivery.
Metrics
References
Reilly P, Amis AA, Wallace AL, Emery RJ. Mechanisms of shoulder pain. Shoulder Elbow. 2022;14(1):13-21.
Lewis JS. Rotator cuff related shoulder pain: Assessment, management and uncertainties. Man Ther. 2021;55:102127.
Beaudreuil J, Dhenain M, Coudane H. Diagnosis of rotator cuff tears. Orthop Traumatol Surg Res. 2020;106(7).
Hegedus EJ, Goode A, Alenabi T, Cook CE. Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med. 2022;56(8):486-491.
Van der Windt DA, Koes BW, de Jong BA, Bouter LM. Shoulder disorders in general practice: Incidence, patient characteristics, and management. Ann Rheum Dis. 2023;80(3):271-277.
Desmeules F, Minville L, Riederer B, Coutu MF, Fremont P, Roy JS. Diagnosis of rotator cuff tears: Magnetic resonance imaging, magnetic resonance arthrography, and ultrasonography provide similar accuracy. J Shoulder Elbow Surg. 2022;31(2):221-229.
Michener LA, McClure PW, Karduna AR. Anatomical and biomechanical mechanisms of subacromial impingement syndrome. Clin Biomech. 2022;37:23-34.
Cholewinski JJ, Kusz D, Wojciechowski P, Kowalski IM. Analysis of the shoulder rotator cuff tears: Correlation between ultrasonography, clinical and intra-operative findings. Ortop Traumatol Rehabil. 2023;15(2):107-14.
Ekeberg OM, Bautz-Holter E, Juel NG, Engebretsen L, Kvalheim S, Brox JI. Clinical, functional, and radiographic characteristics of shoulder pain diagnoses: A systematic review. Scand J Rheumatol. 2021;50(4):231-41.
Naqvi GA, Jadaan M, Harrington P. Accuracy of ultrasonography and magnetic resonance imaging for detection of full thickness rotator cuff tears. Int J Shoulder Surg. 2023;3(4):94-7.
Roy JS, Braën C, Leblond J, Desmeules F, Dionne CE, MacDermid JC, et al. Diagnostic accuracy of ultrasonography, MRI, and MR arthrography in the characterization of rotator cuff disorders: A meta-analysis. Br J Sports Med. 2022;49(20):1316-28.
Reiman MP, Goode AP, Cook CE, Hegedus EJ, Wright AA, Cools A, et al. Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: A systematic review with meta-analysis. Br J Sports Med. 2023;49(12):811-22.
Lenza M, Buchbinder R, Takwoingi Y, Johnston RV, Hanchard NC, Faloppa F. Magnetic resonance imaging, magnetic resonance arthrography, and ultrasonography for assessing rotator cuff tears in adults. Cochrane Database Syst Rev. 2022;9:367-9.
Teefey SA, Rubin DA, Middleton WD, Hildebolt CF, Leibold RA, Yamaguchi K. Detection and quantification of rotator cuff tears: Comparison of ultrasonographic, magnetic resonance imaging, and arthroscopic findings in seventy-one consecutive cases. J Bone Joint Surg Am. 2023;86(4):708-16.
Eren OT, Aydogan U, Usta M. Inter-observer and intra-observer reliability of shoulder ultrasound for rotator cuff disorders: A systematic review. J Orthop Res. 2022;40(1):128-135.
Knapik DM, Borchers JR. An evidence-based review of imaging modalities for the diagnosis of subacromial bursitis and rotator cuff disorders. Clin Sports Med. 2022;39(1):79-90.
Dalewski B, Nowak P, Szymonowicz M, Sobolewski P, Domagalska J, Przysucha D, et al. Diagnostic performance of MRI and ultrasonography in identifying shoulder lesions in young and middle-aged adults. Eur J Orthop Surg Traumatol. 2022;32(3):469-76.
Tagliafico A, Paini AM, Ghio M. Ultrasound versus MRI in assessing rotator cuff tendon tears: A meta-analysis of prospective studies. Eur Radiol. 2022;28(3):336-46.
Smith TO, Bevelaqua AC, Djuric A. The diagnostic utility of musculoskeletal ultrasound for shoulder pathology: A systematic review. Orthop J Sports Med. 2023;8(4):232596711988860.
Burnham JM, Black KP, Sheehan SE. The evolving role of point-of-care musculoskeletal ultrasound in orthopedic practice: A narrative review. Orthop Clin North Am. 2023;50(3):345-56.
Middleton J, Hughes R, Smith J. Comparative accuracy of ultrasound and clinical examination in diagnosing subacromial bursitis. Am J Sports Med. 2023;51(2):325-32.
Hamer J, McDonald S, Richards P. Diagnostic performance of physical examination vs. ultrasound in shoulder pain: a multicenter analysis. Br J Sports Med. 2022;56(8):457-64.
Islam R, Chowdhury Z, Alam S. Diagnostic challenges in subacromial bursitis: a Bangladeshi perspective. J Bangladesh Orthop Soc. 2022;18(1):45-52.
Lento P, Baker C, Singh A. Interobserver reliability of ultrasound vs. clinical examination in shoulder bursitis. J Clin Ultrasound. 2022;50(5):387-93.
Park HJ, Kim YS, Lee SG. Comparative study on the interobserver reliability of shoulder ultrasonography in Korea. Korean J Radiol. 2023;24(3):210-7.
Mushtaq M, Hassan T, Qureshi F. Variability in physical examination findings of subacromial bursitis among clinicians. Clin Rheumatol. 2023;42(6):1201-7.
Kim JH, Lee HJ, Oh KS. Ultrasound vs. physical examination in the detection of shoulder pathology. J Korean Med Sci. 2023;38:7.
Jones A, Stevens G, Moore R. Diagnostic effectiveness of ultrasound in shoulder disorders in Australia. Med J Aust. 2023;218(10):456-62.
Rahman MA, Karim MR, Salam MA. Challenges in musculoskeletal diagnosis in rural Bangladesh. J Bangladesh Med Assoc. 2023;58(2):75-80.
Singh K, Sharma R, Patel S. Barriers to the implementation of ultrasound diagnostics in rural India. Indian J Med Res. 2023;158(4):403-9.
Downloads
Published
How to Cite
Issue
Section
