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POS1269 (2021)
THE UTILITY OF ULTRASOUND TO PREDICT PATIENT OUTCOMES IN SHOULDER PAIN: A PROSPECTIVE OBSERVATIONAL STUDY OF 500 PATIENTS
G. Tran1,2,3, S. Kingsbury1,2, E. Hensor1,2, P. G. Conaghan1,2
1Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, United Kingdom
2National Institute for Health Research Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, United Kingdom
3Harrogate and District NHS Foundation Trust, Department of Rheumatology, Harrogate, United Kingdom

Background: Shoulder pain is common and persistent, with a large socioeconomic burden. Ultrasound (US) scans are used for diagnosing and managing shoulder pain, but the extent to which it informs management and improves outcomes is unknown. A recent retrospective study identified groups with different patterns of US pathologies.


Objectives: To confirm the existence of US-based groups of shoulder pain and determine if US-detected pathology (grouped or individual) predicts outcomes in the context of usual care. Response to local steroid injection was also evaluated.


Methods: This was a 6 month, prospective, single centred, community based, observational cohort study. Inclusion: shoulder pain, ≥18 years, first shoulder US. Exclusion: shoulder surgery, inflammatory arthritis, steroid/physiotherapy in prior 6 weeks. Standardised reporting for 10 US pathologies was employed. Latent class analysis (LCA) identified pathology-based groups. Multiple linear regression analysis explored associations between baseline pathologies, subsequent treatment and 6-month Shoulder Pain and Disability Index (SPADI). Growth mixture modelling (GMM) identified groups with common trajectories of change.


Results: Of 500 patients (mean age 53.6; 52% female), 330 completed follow-up. LCA identified 4 groups: bursitis without acromioclavicular joint degeneration (ACJD) (group 1), bursitis with ACJD (group 2), rotator cuff tear (group 3), no bursitis/tear (group 4). SPADI was higher at baseline for tears (55.1 vs. 49.7-51.3) (overall p=0.005), but groups did not differ at 6 months (p=0.379) ( Table 1 ). No individual pathologies predicted 6-month outcomes. Response to baseline injection at week 2 did not differ between groups (p=0.423). GMM found 4 trajectories; the majority of patients followed trajectory 1 (little change), irrespective of US pathology group (79%, 77%, 87%, 70% of US groups 1-4 respectively) ( Figure 1 ).


Conclusion: This is the largest prospective study involving US of symptomatic shoulders, and the first to investigate groups with distinct patterns of US pathologies in predicting outcome. US-based classification of pathology (as groups or individually) did not predict 6-month outcomes with current treatments and there were no differences in short-term response to steroids between groups. The role of routine diagnostic US for shoulder pain needs consideration; it may be useful if evidence-based therapies for specific pathologies are established.

Predictors of SPADI score at 6 months

Baseline characteristic Coefficient* (95% CI), p-value
Pathology group:Bursitis w/o ACJ degeneration (group 1) Reference
Bursitis with ACJ degeneration (group 2) 0.08 (-5.15, 5.32), p=0.975
RC tear (group 3) 5.01 (-1.48, 11.50), p=0.130
No bursitis, no RC tear (group 4) 1.98 (-4.00, 7.96), p=0.516
Injection at scan 4.87 (0.40, 9.34), p=0.033
Age, years -0.01 (-0.17, 0.15), p=0.898
Female -1.51 (-5.42, 2.40), p=0.448
Symptom duration, months 0.00 (-0.04, 0.05), p=0.879
Uses arms to rise from chair 2.65 (-1.50, 6.81), p=0.210
Physiotherapy before baseline -0.23 (-4.78, 4.31), p=0.920
1 injection before baseline 2.35 (-2.87, 7.56), p=0.377
≥2 injections before baseline 6.53 (-2.50, 15.57), p=0.156
Total SPADI 0.62 (0.35, 0.89), p<0.001
Shoulder activity score -0.59 (-1.15, -0.04), p=0.037
P-SEQ score -0.20 (-0.46, 0.07), p=0.141
Brief IPQ score 0.19 (-0.16, 0.54), p=0.298
HADS score 0.01 (-0.38, 0.41), p=0.947
Constant** 35.44 (29.50, 41.38), p<0.001

*Interpreted as unit difference in Rasch-transformed SPADI score per 1 additional unit of the independent variable **Estimated SPADI at 26 weeks in patients in the reference category for all categorical variables and with mean values for continuous covariates. ACJ=acromioclavicular joint; HADS=hospital anxiety and depression scale; IPQ=illness perception questionnaire; P-SEQ=pain self-efficacy questionnaire; RC=rotator cuff; SPADI=shoulder pain and disability index

Trajectories of total SPADI over time by the pathology groups found and response to injections


Acknowledgements: This research was funded by the National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC) and by a NIHR Doctoral Research Fellowship (GT; DRF-2016-09-159). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. This study was also part-funded through the Arthritis Research UK Leeds Experimental Osteoarthritis Treatment Centre (20083).


Disclosure of Interests: None declared

Citation: Ann Rheum Dis, volume 80, supplement 1, year 2021, page 919
Session: Spine, mechanical musculoskeletal problems, local soft tissue disorders (POSTERS only)