Summary

This study shows that plain radiographs for non-traumatic shoulder pain have low impact on clinical decision-making for patients under 50 and suggests that healthcare spending can be greatly reduced by limiting the use of radiographs for those who are not likely to clinically benefit.

Abstract

Background

Diagnostic imaging is a fast-growing healthcare expenditure, yet research has shown that not all imaging is necessary. The purpose of this study is to evaluate the utility of shoulder screening radiographs for clinical decision-making in a sports medicine practice. This information could be used to limit the amount of radiation exposure to patients, reduce unnecessary healthcare spending, and support the use of telemedicine for patients who are unable to physically present to an imaging center or doctor’s office due to social distancing guidelines. It is hypothesized that screening radiographs will not significantly impact treatment plans for the younger patient population.

Methods

A questionnaire was completed by the principal investigating orthopaedic surgeon following the initial consultation of 91 shoulder complaints. The questionnaire documented the patient’s demographics, onset and duration of symptoms, history of trauma within two weeks of symptom onset, location of pain, pertinent findings on the plain radiographs, whether the plain radiographs altered the treatment plan, and the subsequent clinical diagnosis and patient treatment options.

Results

Screening plain radiographs were found to affect clinical decision-making in 15% of cases and in only 6% of patients under 50. Logistic regression analysis showed that age greater than or equal to 50 was a significant predictor of pertinent radiographic findings (p=0.04) and that shoulder pain for over a year was also strongly associated with useful radiographs (p=0.06). A population-based cost estimate was conducted, which deduced that up to $1.32 billion of yearly healthcare dollars are spent on shoulder radiographs that do not affect treatment plans.

Conclusions

The data from this study demonstrates that screening radiographs have a low impact on clinical decision-making in the initial evaluation of non-traumatic shoulder pain in patients under 50. Healthcare spending could be reduced by limiting the use of plain radiographs for younger patients presenting with non-traumatic shoulder injuries. The findings of our study also have broader implications for telemedicine visits and can help clinicians decide if it is necessary to have patients present for in-person radiographs.