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Reviews
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What are the main claims of the paper and how important are they?
The authors compare the accuracy of ultrasound for rotator cuff tears when performed by radiologists and surgeons. The paper demonstrates that high levels of accuracy can be achieved by the surgeon especially for the diagnosis of full thickness rotator cuff tears. This would be advantageous for patients as they can be treated in a one-stop clinic, whereby they are assessed by the surgeon with immediate imaging to confirm the pathology so that the diagnosis can be confirmed and management plan formulated within the same appointment. Radiologists perform better than surgeons when considering partial thickness tears which are more difficult to diagnose.
Good summary of the evidence to make this statement.
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Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.
Yes - no other review papers in the literature have looked at this previously
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Are the claims properly placed in the context of the previous literature?
Yes - see above - no other literature to compare. The summarised evidence supports the conclusions made from the review demonstrating that orthopaedic surgeons can achieve high levels of accuracy using shoulder ultrasound moreso for full thickness tears than for partial thickness tears which are more difficult to diagnose.
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Do the results support the claims? If not, what other evidence is required?
Yes - see above statement. This paper has included a complex analysis of the data and has summarised the best evidence by quality to support the conclusions made which appear valid.
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If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?
Not really relevant. Excellent systematic literature search with reproducible methodology presented.
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Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?
Yes this is a strong point in this paper. Not included grey literature though in the search. The methodology is well detailed especially the search strategy, inclusion/exclusion criteria, use of validated scoring system for the papers and demonstrating the methods and reasons by which studies were included/excluded.
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Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?
No - the literature search is fairly extensive and incudes a large number of studies to make the conclusions.
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Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?
Yes i think that it is a useful paper - the conclusions are important to note, demonstrating that orthopaedic surgeons can achieve good results with shoulder ultrasound especially when diagnosing full thickness rotator cuff tears which are of most importance with respect to guiding the management. This also has important implications for organising how these patients are assessed in the outpatients and perhaps further emphasis in educating more surgeons to use this technique may improve efficiency and reduce costs compared to investigating these patients in the radiology department which would require more clinic visits and follow up aswell as delaying the diagnosis and treatment plan.
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Other Comments:
No
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Competing interests:
No
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Invited by the author to review this article? :
Yes -
Have you previously published on this or a similar topic?:
No
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References:
No
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Experience and credentials in the specific area of science:
Treating patients with shoulder pain and investigating them.
- How to cite: Anonymous.Uss for Rotator Cuff Tears[Review of the article 'Office-based Versus Radiologist-based Ultrasonography for the Diagnosis of Rotator Cuff Tears ' by Modi C].WebmedCentral 2012;3(10):WMCRW002284
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The paper claims that ultrasound scans (USS) of the shoulder are animportnat adjunct and if performed in clinic they can aid the clinician in the making of a rapid diagnosis. Furthermore, results of trained orthopaedic surgeons are comparable to those of radiologists.
This is important as we are all aware of how long it can take to have these investigations performed leading to morbidity of the patient. If trianed orthopaedic surgeons have comparable if not better results than radiologists then it is a service that should be offered routinely in clinic.
It is not particularly novel as it is a review of the literature, but it refines what has been published before on this topic anddirectly compares surgeons with radiologists so it adds a fresh spin on the topic.
Yes
The results are a well measured conclusion of the papers reviewed
The protocol of a systematic review is provided
The methodology is the standard one used in systemtic reviews and is easily reproducible
The author has searched exhaustively and at present cannot be improved upon
It is a good paper as its recommendations may lead to a radical shift in the diagnosis of patients with suspected rotator cuff tears, and the methodology and presentation makes it possible for individual clinicians to review the evidence effortlessly and come to their own conclusions.
No
No
Yes
No
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Orthopaedic Registrar - 6 years experience