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North American musculoskeletal ultrasound scanning protocol of the shoulder, elbow, wrist, and hand: update of a Delphi Consensus Study

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Abstract

Introduction/Objectives

There has been an increase in the proficiency and utilization of ultrasound among North American rheumatologists over the past decade. This study aims to create an updated upper extremity scanning protocol to inform ultrasound curriculum development for the American College of Rheumatology affiliated fellowship programs and guide clinical practice patterns in North America.

Method

Three Delphi survey rounds were used to reach consensus on tiered-mastery designations for scan views of the shoulder, elbow, wrist, and hand joints. The survey was disseminated by Qualtrics™ to 101 potential participants with ultrasound experience. High agreement was defined as having ≥ 85% consensus and final tier designation as > 50% agreement for a preferred tier. Changes in responses were evaluated by McNemar’s chi-square test.

Results

Consensus was achieved for 70% of scan views of the upper extremity joints. Two views—ulnar transverse view of the wrist and the radial/ulnar orthogonal views over metacarpophalangeal joints 2 and 5 of the hand—were upgraded from tier 2 to tier 1. The suprascapular transverse and the axillary longitudinal views of the shoulder were downgraded from tier 2 to tier 3. A new anterior transverse view of the elbow was added to the protocol with tier 1 designation.

Conclusions

This study reflects the current opinions of North American rheumatologists for scanning upper extremity joints and provides support for the updated protocol and guidance for educators in rheumatology ultrasound.

Key Points

• Ultrasound scan views of the metacarpophalangeal, wrist, elbow, and glenohumeral joint recesses and views of the biceps and rotator cuff tendons at the shoulder were perceived as essential views of the upper extremity scanning protocol for rheumatologists to master and perform routinely.

• A targeted scanning approach of the upper extremity joints may be considered when focal symptoms are present.

• The North American Musculoskeletal Ultrasound Scanning Protocol shares some similarities with existing musculoskeletal ultrasound protocols of other specialties and worldwide rheumatology societies but varies in the extent of examination and emphasis on certain specialty-specific focuses.

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Authors and Affiliations

  1. Division of Rheumatology and Clinical Immunology, University of Vermont Medical Center, Burlington, VT, 05401, USA

    Narandra K. Bethina

  2. Division of Rheumatology, Department of Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA

    Karina D. Torralba

  3. Division of Rheumatology, University of CA—Los Angeles, Los Angeles, CA, USA

    Kristal S. Choi

  4. Division of Immunology and Rheumatology, Stanford University, Stanford, CA, USA

    Robert M. Fairchild

  5. Division of Rheumatology, University of Nebraska Medical Center, Omaha, NE, USA

    Amy C. Cannella

  6. School of Medicine, Loma Linda University, Loma Linda, CA, USA

    Lorena Salto

  7. Division of Rheumatology, Boston University, Boston, MA, USA

    Eugene Y. Kissin

  8. Division of Rheumatology, Harvard Medical School, Boston, MA, USA

    Janeth Yinh

  9. Division of Rheumatology, Loma Linda University Health, Loma Linda, CA, USA

    Manushi Aggarwal

  10. Division of Allergy/Immunology and Rheumatology, University of Rochester, Rochester, NY, USA

    Ralf Thiele

  11. John Muir Rheumatology, Walnut Creek, CA, USA

    Midori J. Nishio

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Correspondence to Narandra K. Bethina.

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This study was reviewed and approved by the LomaLinda University Medical Center Institutional Review Board. All authors met requirements for authorship set by ICJME.

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Bethina, N.K., Torralba, K.D., Choi, K.S. et al. North American musculoskeletal ultrasound scanning protocol of the shoulder, elbow, wrist, and hand: update of a Delphi Consensus Study. Clin Rheumatol 41, 3825–3835 (2022). https://doi.org/10.1007/s10067-022-06337-2

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