Ultrasound imaging to tailor the treatment of acute shoulder pain: a randomised controlled trial in general practice

OBJECTIVE To determine the clinical effectiveness of ultrasound tailored treatment in patients with acute subacromial disorders. DESIGN Pragmatic randomised controlled trial. SETTING Dutch general practice. PARTICIPANTS Patients aged 18-65 years with acute (duration <3 months) unilateral shoulder pain and no previous treatment, in whom the general practitioner suspected a subacromial disorder was enrolled. INTERVENTIONS All patients underwent ultrasound imaging of the affected shoulder. Patients who were still symptomatic after a qualification period of 2 weeks with standard treatment were randomised to treatment tailored to ultrasound diagnosis (disclosure of the ultrasound diagnosis) or usual care (non-disclosure of the ultrasound diagnosis). PRIMARY OUTCOME MEASURE Patient-perceived recovery using the Global Perceived Effect questionnaire at 1 year. RESULTS 129 patients were included. 18 patients recovered during the 2-week qualification period, resulting in 111 randomised patients; 56 were allocated to ultrasound tailored treatment and 55 to usual care. After 1 year, no statistically significant differences in recovery were found between the ultrasound tailored treatment group (72.5% (37/51)) and the usual care group (60% (30/50), OR 2.24 (95% CI 0.72 to 6.89; p=0.16)). Also, healthcare use was similar. CONCLUSIONS This study has shown no clinically significant difference in the primary outcome measure between the ultrasound tailored treatment and usual care groups. Furthermore, there was no overall difference in healthcare resources used between groups. Although no formal cost data are included, one can only assume that the ultrasound examinations are additional costs for the intervention group, which cannot be justified in routine practice based on this trial. Based on this study, no change in current pragmatic guidelines to incorporate early ultrasound imaging can be recommended. TRIAL REGISTRATION NUMBER NTR2403; Results.