Point-of-care ultrasound for the diagnosis of shoulder dislocation: A systematic review and meta-analysis

Abstract

Introduction: Shoulder dislocations are a common injury causing patients to present to the emergency department. Point-of-care ultrasound (POCUS) has the potential to reduce time, radiation exposure, and healthcare costs among patients presenting with shoulder dislocations. We performed this systematic review and meta-analysis to determine the diagnostic accuracy of ultrasound compared with plain radiography in the assessment of shoulder dislocations.

Methods: PubMed, Scopus, CINAHL, LILACS, the Cochrane databases, Google Scholar, and bibliographies of selected articles were assessed for all prospective and randomized control trials evaluating the accuracy of POCUS for identifying shoulder dislocation. Data were dual extracted into a predefined worksheet and quality analysis was performed with the QUADAS-2 tool. Data were summarized and a meta-analysis was performed with subgroup analyses by technique. Diagnostic accuracy of identifying associated fractures was assessed as a secondary outcome.

Results: Seven studies met our inclusion criteria, comprising 739 assessments with 306 dislocations. Overall, POCUS was 99.1% (95% CI 84.9% to 100%) sensitive and 99.9% (95% CI 88.9% to 100%) specific for the diagnosis of shoulder dislocation with a LR+ of 796.2 (95% CI 8.0 to 79,086.0) and a LR- of 0.01 (95% CI 0 to 0.17). There was no statistically significant difference between techniques. POCUS was also 97.9% (95% CI 10.5% to 100%) sensitive and 99.8% (95% CI 28.0% to 100%) specific for the diagnosis of associated fractures.

Conclusions: POCUS is highly sensitive and specific for the identification of shoulder dislocations and reductions, as well as associated fractures. POCUS may be considered as an alternate diagnostic method for the management of shoulder dislocations.

Keywords: Dislocation; Musculoskeletal; Reduction; Shoulder; Ultrasound.