Sebastian A Cruz1,2, Hector Castillo1,2, Ravi Theja V Chintapalli1,2, Olufemi E Adams1,2, Vince K Morgan1,2, Jason L Koh3, Michael J Lee2,4, Lewis L Shi2,4. 1. University of Chicago Pritzker School of Medicine, Chicago, IL. 2. Operative Performance Research Institute, University of Chicago Medicine, Chicago, IL. 3. NorthShore Orthopaedic Institute, NorthShore University HealthSystem, Evanston, IL; and. 4. Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Medicine, Chicago, IL.
Abstract
OBJECTIVES: To investigate the clinical utility of additional axillary or Velpeau views in evaluating potential shoulder trauma after a standard radiograph series of anteroposterior, Grashey, and/or trans-scapular views. DESIGN: Retrospective study. SETTING: Level I academic medical center. PATIENTS: All patients in a 10-year span who received an initial shoulder radiograph series followed by additional axillary/Velpeau views within 24 hours. MAIN OUTCOME MEASUREMENTS: The clinical utility of the additional axillary/Velpeau views, including the final diagnosis and treatment plan, as ascertained through examination of radiology reports, progress notes, and radiograph images. RESULTS: A total of 271 cases were reviewed, with 35 patients being excluded from the final cohort because they received post-treatment radiographs to confirm a successful therapeutic outcome. The additional axillary/Velpeau views did not affect clinical decision making in 230 (97.5%) of the remaining 236 cases. All 6 patients whose care benefitted from the additional views carried the diagnosis of shoulder instability, accounting for 40% of this diagnostic group. The additional views confirmed an equivocal finding in 5 of these 6 cases and changed the diagnosis (demonstrating a posterior dislocation that was not evident on initial radiographs) and treatment plan (leading to a closed glenohumeral reduction procedure) in the other case. CONCLUSIONS: Additional axillary/Velpeau views of suspected shoulder trauma rarely led to a change in the final treatment plan, except in patients in which a definitive diagnosis of stability or instability could not be made based on initial radiographs. A cost/benefit analysis is required to weigh the cost of additional radiographs with the benefit of capturing infrequent yet serious dislocations (usually posterior). LEVEL OF EVIDENCE: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
OBJECTIVES: To investigate the clinical utility of additional axillary or Velpeau views in evaluating potential shoulder trauma after a standard radiograph series of anteroposterior, Grashey, and/or trans-scapular views. DESIGN: Retrospective study. SETTING: Level I academic medical center. PATIENTS: All patients in a 10-year span who received an initial shoulder radiograph series followed by additional axillary/Velpeau views within 24 hours. MAIN OUTCOME MEASUREMENTS: The clinical utility of the additional axillary/Velpeau views, including the final diagnosis and treatment plan, as ascertained through examination of radiology reports, progress notes, and radiograph images. RESULTS: A total of 271 cases were reviewed, with 35 patients being excluded from the final cohort because they received post-treatment radiographs to confirm a successful therapeutic outcome. The additional axillary/Velpeau views did not affect clinical decision making in 230 (97.5%) of the remaining 236 cases. All 6 patients whose care benefitted from the additional views carried the diagnosis of shoulder instability, accounting for 40% of this diagnostic group. The additional views confirmed an equivocal finding in 5 of these 6 cases and changed the diagnosis (demonstrating a posterior dislocation that was not evident on initial radiographs) and treatment plan (leading to a closed glenohumeral reduction procedure) in the other case. CONCLUSIONS: Additional axillary/Velpeau views of suspected shoulder trauma rarely led to a change in the final treatment plan, except in patients in which a definitive diagnosis of stability or instability could not be made based on initial radiographs. A cost/benefit analysis is required to weigh the cost of additional radiographs with the benefit of capturing infrequent yet serious dislocations (usually posterior). LEVEL OF EVIDENCE: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Authors: David W Shields; James G Jefferies; Andrew J Brooksbank; Neal Millar; Paul J Jenkins Journal: J Shoulder Elbow Surg Date: 2017-11-10 Impact factor: 3.019
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Authors: P van Gerven; J M van Dongen; S M Rubinstein; M F Termaat; M El Moumni; W P Zuidema; P Krijnen; I B Schipper; M W van Tulder Journal: BMC Health Serv Res Date: 2020-09-22 Impact factor: 2.655