Diagnostic Accuracy of Point-of-Care Ultrasound (POCUS) For Identifying Shoulder Dislocations
Date First Published:
July 2, 2021
Last Updated:
July 2, 2021
Report by:
Jordan Johnson MD, Mariah Barnes MD, EM Senior Resident, EM Faculty (Spectrum Health/Michigan State University Emergency Medicine Residency Program)
Search checked by:
Jeffrey Jones MD, Spectrum Health/Michigan State University Emergency Medicine Residency Program
Three-Part Question:
What is the [diagnostic accuracy] of [point-of-care ultrasound (POCUS)] for identifying [shoulder dislocation in emergency department patients] when compared with [standard radiographs]?
Clinical Scenario:
A 23-year-old male presents with right shoulder pain after falling and catching himself. Physical exam demonstrates a squared off right shoulder with anterior fullness, with the patient holding his arm in slight abduction and external rotation. Anterior shoulder dislocation is suspected. The x-ray department is backed up, and you are wondering if point-of-care ultrasound is appropriate for diagnosing a shoulder dislocation.
Search Strategy:
Medline 1966-07/21 using PubMed, Cochrane Library (2021), and Embase
Search Details:
[(Shoulder Dislocation/diagnostic imaging [MAJR]) AND (Ultrasonography [MAJR])]. LIMIT to English language.
Outcome:
105 studies were identified: three studies addressed the clinical question. These studies include a meta-analysis, a systematic review, and a prospective observational study that was published after the meta-analysis and systematic review.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Point-of-care ultrasound for the diagnosis of shoulder dislocation: A systematic review and meta-analysis. Gottlieb M, Holladay D, Peksa GD. Apr-19 USA | 7 studies (739 total patients) including patients of all ages who underwent both ultrasonography and confirmatory imaging (plain radiography or CT) | Meta-analysis | Overall sensitivity and specificity of ultrasound for diagnosing shoulder dislocations | Sensitivity was 99.1% and specificity was 99.9% | No randomized controlled trials; providers performing ultrasound were not blinded to physical exam findings |
| Overall sensitivity and specificity of ultrasound for detecting presence of associated fracture | Sensitivity was 97.9% and specificity was 99.8% | ||||
| Accuracy of Ultrasonography in Diagnosis of Shoulder Dislocation: A Systematic Review. Entezari P, Jalili M, Seyedhosseini J, Doosti-Irani A, Mirfazaelian H. Oct-19 Iran | 6 studies and 1 unpublished data (467 total patients) including patients of all ages who underwent both ultrasonography and plain radiography | Systematic review | Sensitivity of ultrasound for diagnosing shoulder dislocations | Sensitivity was 100% in four studies. One study found a sensitivity of 99% and other study found a sensitivity of 54% | No randomized controlled trials. Includes data from relatively small studies (n=5 and n=10), and one unpublished study. Providers performing ultrasound were not blinded to physical exam findings |
| Specificity of ultrasound for diagnosing shoulder dislocations | Specificity was 100% in five studies. Specificity was 60% in one study. | ||||
| Musculoskeletal Ultrasonography to Diagnose Dislocated Shoulders: A Prospective Cohort. Secko MA, Reardon L, Gottlieb M, Morley EJ, Lohse MR, Thode HC Jr, Singer AJ. Aug-20 USA | 65 total patients aged 18 and older from two university-based emergency departments who underwent both ultrasonography and plain radiography | Prospective observational study | Sensitivity and specificity of ultrasonography | Sensitivity was 100% and specificity was 100% | Ultrasounds were performed by ultrasonography fellows or fellowship-trained emergency physicians; convenience sample; and not randomized. |
| Proportion of associated fractures identified by ultrasonography | 52% of fractures identified on radiographs were also identified by ultrasonography | ||||
| Time to diagnosis from triage | 51 min for ultrasonography versus 101 min for radiography |
Author Commentary:
Shoulder dislocations are common injuries encountered in emergency departments. Potential benefits of point-of-care ultrasonography over plain radiography for diagnosing shoulder dislocations include decreased time to diagnosis and radiation exposure, and the ability to confirm reduction rapidly at bedside while the patient is still sedated. The available evidence suggests that ultrasonography is an appropriate alternative to plain radiography for diagnosing shoulder dislocations.
Bottom Line:
Point-of-care ultrasound has high sensitivity and specificity for diagnosing shoulder dislocations.
References:
- Gottlieb M, Holladay D, Peksa GD. . Point-of-care ultrasound for the diagnosis of shoulder dislocation: A systematic review and meta-analysis.
- Entezari P, Jalili M, Seyedhosseini J, Doosti-Irani A, Mirfazaelian H. . Accuracy of Ultrasonography in Diagnosis of Shoulder Dislocation: A Systematic Review.
- Secko MA, Reardon L, Gottlieb M, Morley EJ, Lohse MR, Thode HC Jr, Singer AJ. . Musculoskeletal Ultrasonography to Diagnose Dislocated Shoulders: A Prospective Cohort.