Accuracy of Ultrasonography in Diagnosis of Shoulder Dislocation: A Systematic Review
Context: This meta-analysis of clinical trials was conducted to compare the diagnostic accuracy of ultrasound in comparison to plain radiography in shoulder dislocation. Evidence acquisition: MEDLINE, Cochrane Database of Systematic Reviews, clinicaltrials.gov, Google scholar, and Scopus were searched for clinical trials. Diagnosis of shoulder dislocation and confirmation of shoulder reduction were the outcomes of interest. Sensitivity, specificity, positive predictive value and negative predictive value of included clinical trials were calculated. Results: Seven studies met our inclusion criteria and were analyzed. All included studies except two had a sensitivity and specificity of 100% for ultrasound (one with a sensitivity of 54% and one with a specificity of 60%). Conclusion: It can be suggested that ultrasound can be used as a reliable alternative diagnostic method for detection of both dislocation and reduction in shoulder joint. This may decrease the delay in treatment, cost, radiation exposure, and need for repeated sedation.
2. Zacchilli MA, Owens BD. Epidemiology of shoulder dislocations presenting to emergency departments in the United States. J Bone Joint Surg Am. 2010;92(3):542-9.
3. Beck S, Chilstrom M. Point-of-care ultrasound diagnosis and treatment of posterior shoulder dislocation. Am J Emerg Med. 2013;31(2):449.e3-5.
4. Halberg MJ, Sweeney TW, Owens WB. Bedside ultrasound for verification of shoulder reduction. Am J Emerg Med. 2009;27(1):134.e5-6.
5. Yuen CK, Chung TS, Mok KL, Kan PG, Wong YT. Dynamic ultrasonographic sign for posterior shoulder dislocation. Emerg Radiol. 2011;18(1):47-51.
6. Akyol C, Gungor F, Akyol AJ, Kesapli M, Guven R, Cengiz U, et al. Point-of-care ultrasonography for the management of shoulder dislocation in ED. Am J Emerg Med. 2016;34(5):866-70.
7. Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol. 2003; 3: 25.
8. Abbasi S, Molaie H, Hafezimoghadam P, Zare MA, Abbasi M, Rezai M, et al. Diagnostic accuracy of ultrasonographic examination in the management of shoulder dislocation in the emergency department. Ann Emerg Med. 2013;62(2):170-5.
9. Ahmadi K, Hashemian AM, Sineh-Sepehr K, Afzal-Aghaee M, Jafarpour S, Rahimi-Movaghar V. Bedside ultrasonography for verification of shoulder reduction: A long way to go. Chin J Traumatol. 2016;19(1):45-8.
10. Bianchi S, Zwass A, Abdelwahab I. Sonographic evaluation of posterior instability and dislocation of the shoulder: prospective study. J Ultrasound Med. 1994;13(5):389-93.
11. Blakeley C, Spencer O, Newman-Saunders T, Hashemi K. A novel use of portable ultrasound in the management of shoulder dislocation. Emerg Med J. 2009;26(9):662-3.
12. Lahham S, Becker B, Chiem A, Joseph LM, Anderson CL, Wilson SP, et al. Pilot Study to Determine Accuracy of Posterior Approach Ultrasound for Shoulder Dislocation by Novice Sonographers. West J Emerg Med. 2016;17(3):377-82.
13. Seyedhosseini J, Saiidian J, Taheri AH, Vahidi E. Accuracy of point-of-care ultrasound using low frequency curvilinear transducer in the diagnosis of shoulder dislocation and confirmation of appropriate reduction. Turk J Emerg Med. 2017;17(4):132-5.
14. Hunter JD, Franklin K, Hughes PM. The ultrasound diagnosis of posterior shoulder dislocation associated with Erb's palsy. Pediatr Radiol. 1998;28(7):510-1.
15. Mackenzie DC, Liebmann O. Point-of-care ultrasound facilitates diagnosing a posterior shoulder dislocation. J Emerg Med. 2013;44(5):976-8.
16. Yuen C, Mok K, Kan P, Wong Y. Ultrasound diagnosis of anterior shoulder dislocation. Hong Kong J Emerg Med. 2009;16(1):29-34.
17. Higgin J, Thompson S, Deeks J, Altman D. Measuring inconsistency in meta-analysis. BMJ. 2003;327(7414):557-60.
18. Allen GM. Shoulder ultrasound imaging-integrating anatomy, biomechanics and disease processes. Eur J Radiol. 2008;68(1):137-46.
19. Cuffolo G, Coomber R, Burtt S, Gray J. Posterior shoulder dislocation while lifting weights: a missed diagnosis. BMJ Case Rep. 2014;2014:bcr2013202156.
20. Saul T, Ng L, Lewiss RE. Point-of-care ultrasound in the diagnosis of upper extremity fracture-dislocation. A pictorial essay. Med Ultrason. 2013;15(3):230-6.
21. Shuster M, Abu-Laban RB, Boyd J. Prereduction radiographs in clinically evident anterior shoulder dislocation. Am J Emerg Med. 1999;17(7):653-8.
22. Brulhart L, Ziswiler H, Tamborrini G, Zufferey P. The importance of sonographer experience and machine quality with regards to the role of musculoskeletal ultrasound in routine care of rheumatoid arthritis patients. Clin Exp Rheumatol. 2015;33(1):98-101.
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