Article

There has been a significant increase in the number of costly
investigations of the shoulder joint over the past decade.
The purposes of this
study were to (1) describe the diagnostic imaging investigations ordered for
injured workers seen at an Early Shoulder Physician Assessment (ESPA) program,
(2) evaluate the impact of these investigations on final diagnosis and
management, and (3) examine how efficient the program was by determining the
appropriateness of referrals and whether costly imaging was justified. Methods:
This was a retrospective review of the electronic files of injured workers who
had been referred to an early assessment program because they had not progressed
in their recovery or return-to-work plan within 16 weeks of the injury or
reoccurrence. Results: The data of 750 consecutive patients-337 women (45%) and
413 men (55%), mean age 49 (SD 11) years-were reviewed.
A total of 183 patients
(24%) had been referred for further investigation. Of these, 90 (49%) were
considered candidates for surgery (group 1), 58 (32%) had a change in diagnosis
or management (group 2), and 17 (9%) had no change in diagnosis or management
(group 3); 18 (10%) patients were lost to follow-up. We noticed a pattern in the
type of diagnosis and the groups: full-thickness rotator cuff (RC) tear was the
predominant diagnosis (Fisher's exact test [FET]=0.001, p<0.0001) for group 1. No
statistically significant differences were found among the groups in the
prevalence of labral pathology (FET=0.010, p=0.078), impingement syndrome
(FET=0.012, p=0.570), partial-thickness RC tear (FET=0.004, p=0.089), or biceps
pathology (FET=0.070, p=0.149). Ultrasound investigations were more prevalent in
group 2 (FET=0.004, p=0.047). No pattern was found for use of magnetic resonance
imaging and group allocation. However, all magnetic resonance arthrogram
investigations (FET=0.007, p=0.027) had been ordered for patients who required
labral or instability-related surgery. Conclusions: Of the injured workers we
studied, 24% had further investigation, and the type and severity of pathology
had affected the type of investigation. For the 165 patients who were included in
groups 1-3, the ESPA was 90% efficient, with only 10% of patients not having had
a change in diagnosis or management.

Langue : ANGLAIS