Shoulder and Knee Arthroscopy Access Point: Prospective Comparison of
                    Sonographic and Palpatory Detection – Which Method is Better for
                    Novices?

Andreas Michael Weimer; Johannes M. Weimer; Svenja Berthold; Stephan Stein; Lukas Müller; Holger Buggenhagen; Gerd Balser; Kay Stankov; Mirco Sgroi; Gerhard Schmidmaier; Roman Kloeckner; Christian Schamberger

doi:10.1055/a-2271-0098

Ultrasound International Open, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Ultrasound Int Open 2024; 10: a22710098
DOI: 10.1055/a-2271-0098

Original Article

Shoulder and Knee Arthroscopy Access Point: Prospective Comparison of Sonographic and Palpatory Detection – Which Method is Better for Novices?

Andreas Michael Weimer^‡

¹Clinic for Trauma and Reconstructive Surgery, University Hospital Heidelberg, Heidelberg, Germany (Ringgold ID: RIN27178)

,

Johannes M. Weimer ^‡

²Rudolf-Frey Teaching Department, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (Ringgold ID: RIN39068)

,

Svenja Berthold

³Department for Orthopaedics and Trauma Surgery, University Medical Centre Mannheim, Mannheim, Germany (Ringgold ID: RIN36642)

,

Stephan Stein

¹Clinic for Trauma and Reconstructive Surgery, University Hospital Heidelberg, Heidelberg, Germany (Ringgold ID: RIN27178)

,

Lukas Müller

⁴Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (Ringgold ID: RIN39068)

,

Holger Buggenhagen

²Rudolf-Frey Teaching Department, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (Ringgold ID: RIN39068)

,

Gerd Balser

²Rudolf-Frey Teaching Department, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (Ringgold ID: RIN39068)

,

Kay Stankov

⁵Corporate Finance, Technical University of Darmstadt, Darmstadt, Germany (Ringgold ID: RIN26536)

,

Mirco Sgroi

⁶Department of Orthopaedic Surgery, Ulm University Medical Center, Ulm, Germany (Ringgold ID: RIN27197)

,

Gerhard Schmidmaier

¹Clinic for Trauma and Reconstructive Surgery, University Hospital Heidelberg, Heidelberg, Germany (Ringgold ID: RIN27178)

,

Roman Kloeckner ^*

⁷Institute of Interventional Radiology, University Medical Center Schleswig Holstein Campus Lübeck, Lübeck, Germany (Ringgold ID: RIN54360)

,

Christian Schamberger^*

¹Clinic for Trauma and Reconstructive Surgery, University Hospital Heidelberg, Heidelberg, Germany (Ringgold ID: RIN27178)

› Institutsangaben

Abstract

Purpose Arthroscopy is one of the most common interventions in orthopedics. Hence it is important to train users early in order to ensure the safest possible identification of access portals (AP). This prospective study aimed to compare a palpatory (PalpMethod) with a sonographic (SonoMethod) method for AP location in the shoulder and knee joints.

Materials and Methods The study included trainee doctors (n=68) attending workshops (lasting approx. 90 minutes). In these workshops a teaching video initially demonstrated the PalpMethod and SonoMethod of AP identification. An experienced operator first marked the access portals on the test subject with a UV pen (determined ideal point [DIP]). Adhesive film was then affixed to the puncture regions. Subsequently participants marked on shoulders and knees first the point determined by palpation, then the point determined by sonography. Analysis involved DIP visualization with a UV lamp and employed a coordinate system around the central DIP. In addition, participants completed an evaluation before and after the workshop.

Results The analysis included 324 measurements (n=163 shoulders and n= 161 knees). The majority of participants had not previously attended any courses on manual examination (87.9%) or musculoskeletal ultrasound (93.9%). Overall, the markings participants made on the shoulder using the SonoMethod were significantly closer to the DIP than those made by the PalpMethod (Palp 18.8mm ± 14.5mm vs. Sono 11.2mm ± 7.2mm; p<0.001). On the knee, however, the markings made by the PalpMethod were significantly closer to the DIP overall (Palp 8.0mm ± 3.2mm vs. Sono 12.8mm ± 5.2mm; p<0.001). Conclusion The results show that the SonoMethod produces more accurate markings on the shoulder, while the PalpMethod is superior for the knee.

Keywords

musculoskeletal ultrasound - arthroscopy - ultrasound-guided procedure - knee joint - shoulder joint

Bibliographical Record
Andreas Michael Weimer, Johannes M. Weimer, Svenja Berthold, Stephan Stein, Lukas Müller, Holger Buggenhagen, Gerd Balser, Kay Stankov, Mirco Sgroi, Gerhard Schmidmaier, Roman Kloeckner, Christian Schamberger. Shoulder and Knee Arthroscopy Access Point: Prospective Comparison of Sonographic and Palpatory Detection – Which Method is Better for Novices?. Ultrasound Int Open 2024; 10: a22710098.
DOI: 10.1055/a-2271-0098

Volltext

Referenzen

References
1 Kouk S. The Evolution of Arthroscopy A Historical Perspective. Bull Hosp Jt Dis (2013) 2021; 79: 23-29
2 Bundesamt S. Die 20 häufigsten Operationen insgesamt 2022 [cited 2023 06.04]. Available from: https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Gesundheit/Krankenhaeuser/Tabellen/drg-operationen-insgesamt.html
3 Martin KD, Patterson DP, Cameron KL. Arthroscopic Training Courses Improve Trainee Arthroscopy Skills: A Simulation-Based Prospective Trial. Arthroscopy. 2016; 32: 2228-2232
4 Paxton ES, Backus J, Keener J, Brophy RH. Shoulder arthroscopy: basic principles of positioning, anesthesia, and portal anatomy. J Am Acad Orthop Surg 2013; 21: 332-342
5 Mayr HO, Stoehr A. [Complications of knee arthroscopy]. Orthopade. 2016; 45: 4-12
6 Moen TC, Rudolph GH, Caswell K, Espinoza C, Burkhead WZ, Krishnan SG. Complications of shoulder arthroscopy. J Am Acad Orthop Surg 2014; 22: 410-419
7 Mehta P, Rand EB, Visco CJ, Wyss J. Resident Accuracy of Musculoskeletal Palpation With Ultrasound Verification. J Ultrasound Med 2018; 37: 1719-1724
8 Rho ME, Chu SK, Yang A, Hameed F, Lin CY, Hurh PJ. Resident accuracy of joint line palpation using ultrasound verification. Pm r 2014; 6: 920-925
9 Claessen F, Kachooei AR, Kolovich GP, Buijze GA, Oh LS, van den Bekerom MPJ. et al. Portal placement in elbow arthroscopy by novice surgeons: cadaver study. Knee Surg Sports Traumatol Arthrosc 2017; 25: 2247-2254
10 Weinrauch P, Kermeci S. Ultrasound-assisted hip arthroscopy. Arthrosc Tech 2014; 3: e255-e259
11 Prenaud C, Loubeyre J, Soubeyrand M. Decompression of the suprascapular nerve at the suprascapular notch under combined arthroscopic and ultrasound guidance. Scientific Reports 2021; 11: 18906
12 Hua Y, Yang Y, Chen S, Wang Y, Li Y, Chen J. et al. Ultrasound-guided establishment of hip arthroscopy portals. Arthroscopy 2009; 25: 1491-1495
13 Mhaskar VA, Agrahari H, Maheshwari J. Ultrasound guided arthroscopic meniscus surgery. J Ultrasound 2023; 26: 577-581
14 van Loon FHJ, Buise MP, Claassen JJF, Dierick-van Daele ATM, Bouwman ARA. Comparison of ultrasound guidance with palpation and direct visualisation for peripheral vein cannulation in adult patients: a systematic review and meta-analysis. Br J Anaesth 2018; 121: 358-366
15 Sage W, Pickup L, Smith TO, Denton ER, Toms AP. The clinical and functional outcomes of ultrasound-guided vs landmark-guided injections for adults with shoulder pathology – a systematic review and meta-analysis. Rheumatology (Oxford) 2013; 52: 743-751
16 Patel DN, Nayyar S, Hasan S, Khatib O, Sidash S, Jazrawi LM. Comparison of ultrasound-guided versus blind glenohumeral injections: a cadaveric study. J Shoulder Elbow Surg 2012; 21: 1664-1668
17 Kumar V, Rajnish RK. Knee Examination. In: Dhatt SS, Prabhakar S, editors. Handbook of Clinical Examination in Orthopedics: An Illustrated Guide. Singapore: Springer Singapore; 2019. p 247-254
18 Prabhakar S, Syam K. Shoulder Examination. In: Dhatt SS, Prabhakar S, editors. Handbook of Clinical Examination in Orthopedics: An Illustrated Guide. Singapore: Springer Singapore; 2019. p 53-132
19 Dienst M, Kohn D. Grundlagen der Kniearthroskopie. In: Pfeil J, Siebert W, Janousek A, Josten C, editors. Minimal-invasive Verfahren in der Orthopädie und Traumatologie. Berlin, Heidelberg: Springer Berlin Heidelberg; 2000. p 179-184
20 Bachmann CE, Gruber G, Konermann W, Arnold A, Gruber GM, Ueberle F. et al. Ultrasound Examination — Standard Ultrasound Cross Sectional Planes (DEGUM Recommendations). In: Bachmann CE, Gruber G, Konermann W, Arnold A, Gruber GM, Ueberle F, et al., editors. ESWT and Ultrasound Imaging of the Musculoskeletal System. Heidelberg: Steinkopff; 2001. p 37-55
21 Cicak N, Matasović T, Bajraktarević T. Ultrasonographic guidance of needle placement for shoulder arthrography. J Ultrasound Med 1992; 11: 135-137
22 Konermann W, Gruber G. Ultraschalldiagnostik der Bewegungsorgane: Kursbuch nach den Richtlinien der DEGUM und der DGOU. Georg Thieme Verlag; 2011
23 Walrod BJ, Schroeder A, Conroy MJ, Boucher LC, Bockbrader M, Way DP. et al. Does Ultrasound-Enhanced Instruction of Musculoskeletal Anatomy Improve Physical Examination Skills of First-Year Medical Students?. J Ultrasound Med 2018; 37: 225-232
24 Gazzillo GP, Finnoff JT, Hall MM, Sayeed YA, Smith J. Accuracy of palpating the long head of the biceps tendon: an ultrasonographic study. Pm r 2011; 3: 1035-1040
25 Gaudreault N, Lebel K, Bédard S, Daigle F, Venne G, Balg F. Using ultrasound imaging to assess novice physiotherapy students' ability to locate musculoskeletal structures with palpation. Physiotherapy. 2021; 113: 53-60
26 Meyer M, Graveleau N, Hardy P, Landreau P. Anatomic risks of shoulder arthroscopy portals: anatomic cadaveric study of 12 portals. Arthroscopy. 2007; 23: 529-536
27 Lin JS, Gimarc DC, Adler RS, Beltran LS, Merkle AN. Ultrasound-Guided Musculoskeletal Injections. Semin Musculoskelet Radiol 2021; 25: 769-784
28 Amoo-Achampong K, Nwachukwu BU, McCormick F. An orthopedist’s guide to shoulder ultrasound: a systematic review of examination protocols. The Physician and Sportsmedicine 2016; 44: 407-416
29 Gillman LM, Kirkpatrick AW. Portable bedside ultrasound: the visual stethoscope of the 21st century. Scand J Trauma Resusc Emerg Med 2012; 20: 18
30 AGA. Ausbildung www.aga-online.ch: Gesellschaft für Arthroskopie und Gelenkchirurgie; 2023 [cited 2023 02.06]. Available from: https://www.aga-online.ch/ausbildung/
31 Alomar AZ. Undergraduate Medical Students' Perceptions of an Online Audio-Visual-Based Module for Teaching Musculoskeletal Physical Examination Skills. J Med Educ Curric Dev 2022; 9 23821205221078794
32 Blechschmidt V, Recker F. Representation of sonographic learning objectives in the NKLM 2.0. Ultraschall Med 2022; 43: 30
33 Weimer JM, Rink M, Müller L, Dirks K, Ille C, Bozzato A. et al. Development and Integration of DOPS as Formative Tests in Head and Neck Ultrasound Education: Proof of Concept Study for Exploration of Perceptions. Diagnostics. 2023; 13: 661
34 Murphy RF, LaPorte DM, Wadey VM. Musculoskeletal education in medical school: deficits in knowledge and strategies for improvement. J Bone Joint Surg Am 2014; 96: 2009-2014

Zusatzmaterial

Zusatzmaterial