A 'one-stop clinic' for the diagnosis and management of rotator cuff pathology: Getting the right diagnosis first time

Abstract

Background: We have introduced a one-stop clinic for the diagnosis and management of rotator cuff tears (RCTs). The aim of the study was to determine the effect of the one-stop clinic on the interval and delay in management for patients with suspected rotator cuff pathology. Patients and methods: Seventy-four patients were reviewed retrospectively; 39 had an ultrasound of the shoulder before (group 1), and 35 patients after (group 2) the new protocol was introduced. Patients in group 2 had a shoulder ultrasound scan (USS) on the day of their clinic appointment or beforehand based upon the General Practitioners (GP) letter. Indications included patients over the age of 30, or patients with a history of trauma or a painful shoulder. Results: Twenty-four patients were diagnosed with RCTs on USS with an overall sensitivity of 93.75%, specificity 100% and accuracy of 91% for full thickness tears. Clinical detection alone had an overall sensitivity of 80%, a specificity of 91% and accuracy of 87%. Mean time from GP referral to definitive management plan was 6.49 months (SD 2.74) in group 1, compared with 4.63 months (SD 1.43) in group 2 with an overall reduction in half the number of clinic appointments. This was statistically significant (p < 0.001). Conclusions: Ultrasound scan of the shoulder is an accurate and reliable method of detecting full thickness RCTs. The one-stop clinic significantly shortened the interval between GP referral and definitive management. © 2008 The Authors.