Comparison between Ultrasound-Guided and Palpatory Localization of the Dorsal Joint Space of the Shoulder Joint

Stephan Stein; Andreas Weimer; Svenja Berthold; Johannes Matthias Weimer; Arnold J Suda; Christopher Tuffs; Gerhard Schmidmaier; Christian T Schamberger

doi:10.3390/diagnostics14060650

Comparison between Ultrasound-Guided and Palpatory Localization of the Dorsal Joint Space of the Shoulder Joint

Diagnostics (Basel). 2024 Mar 20;14(6):650. doi: 10.3390/diagnostics14060650.

Authors

Stephan Stein¹, Andreas Weimer¹, Svenja Berthold², Johannes Matthias Weimer³, Arnold J Suda⁴, Christopher Tuffs⁵, Gerhard Schmidmaier¹, Christian T Schamberger¹

Affiliations

¹ Clinic for Trauma and Reconstructive Surgery, University Clinic Heidelberg, 69118 Heidelberg, Germany.
² Department for Orthopaedics and Trauma Surgery, University Medical Centre Mannheim, 68167 Mannheim, Germany.
³ Rudolf Frey Learning Clinic, University Medical Centre of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany.
⁴ Department of Orthopaedics and Trauma Surgery, AUVA Trauma Center Salzburg, 5010 Salzburg, Austria.
⁵ Department of General, Visceral, Thoracic and Transplantation Surgery, University of Giessen, 35390 Giessen, Germany.

Abstract

Aim of the study: Arthroscopy ranks among the frequently performed interventions in orthopedics. The aim of this study was to compare the palpation technique with the ultrasound technique for locating the dorsal glenohumeral joint space (JS) in shoulder joint punctures.

Material and methods: Participants inexperienced in ultrasound examinations were included. Palpatory and ultrasound finding of the joint space by the participants was performed according to current recommendations and was initially demonstrated by an instructional video. The ideal point (IP) was marked under ultrasound visualization by an experienced ultrasound examinator and shoulder-elbow surgeon. Furthermore, a corridor for a safe puncture was defined. The palpatorily determined point (pdP) was marked by the participants and evaluated by means of a coordinate system. The evaluation of the sonographically determined point (sdP) was performed similarly to that of the palpatory procedure.

Results: Fifty-four participants were included in the study, and the mean length of work experience was 6.3 years. On average, participants had performed 16.5 punctures of the shoulder joint and 6.8 arthroscopies of the shoulder joint. The mean experience in performing sonographic examinations of the shoulder was 27.6 examinations. A total of 100 shoulder joints were examined (54 left, 46 right shoulders). The mean deviation from the ideal point (IP) for the palpatory approach was 17.1 mm with a maximum deviation of 59.5 mm; for the sonographic technique, the mean deviation was 10.3 mm (max. 30.2 mm). Overall, 22% of pdPs were within the defined corridor, while 42% of sdPs were within the target corridor. The average difference between palpatory and sonographic approaches was 9.0 mm in favor of the sonographic technique (max. 46.5 mm). A significantly greater deviation (p < 0.001) from the IP was observed with the palpatory approach than with the sonographic approach.

Conclusion: Based on the results, the authors recommend ultrasound imaging of the shoulder joint as well as ultrasound-assisted punctures, especially for inexperienced users. Furthermore, training in ultrasound-assisted interventions should be implemented in future training curricula.

Keywords: arthroscopy; musculoskeletal ultrasound; physical examination; shoulder joint puncture; shoulder puncture; ultrasound; ultrasound-guided procedure; video-based learning.

Grants and funding

For the publication fee we acknowledge financial support by Heidelberg University.