DIAGNOSTIC ACCURACY OF ULTRASOUND-GUIDED PHYSIOTHERAPY ASSESSMENT IN SHOULDER IMPINGEMENT: DIAGNOSTIC ACCURACY STUDY

Abstract

Background:
Shoulder impingement is a common musculoskeletal condition associated with pain, functional limitation, and reduced quality of life. Accurate diagnosis remains challenging due to overlapping clinical presentations and variable reliability of physical examination tests. Musculoskeletal ultrasound has emerged as a practical, accessible imaging modality that allows real-time and dynamic assessment of shoulder structures. Its integration into physiotherapy practice may enhance diagnostic accuracy, particularly in resource-limited healthcare settings.

Objective:
To determine the diagnostic accuracy of ultrasound-guided physiotherapy assessment in identifying shoulder impingement among patients presenting with shoulder pain.

Methods:
A diagnostic accuracy study was conducted across public and private physiotherapy settings in Rawalpindi, Pakistan, over an eight-month period. A total of 130 participants with unilateral shoulder pain were assessed using standardized clinical examination and ultrasound-guided physiotherapy assessment. Ultrasound findings were compared against a reference standard diagnosis established by an independent orthopedic consultant supported by conventional imaging where required. Diagnostic accuracy parameters including sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were calculated. Pain and functional status were assessed using the Numeric Pain Rating Scale and Shoulder Pain and Disability Index.

Results:
Ultrasound-guided physiotherapy assessment demonstrated a sensitivity of 88.5% and specificity of 82.1%, with an overall diagnostic accuracy of 86.9%. Positive predictive value was 93.5%, while negative predictive value was 70.3%. Participants with positive ultrasound findings reported significantly higher pain intensity and disability scores compared to ultrasound-negative participants (p < 0.001).

Conclusion:
Ultrasound-guided physiotherapy assessment showed high diagnostic accuracy for shoulder impingement and demonstrated strong clinical relevance. Its integration into routine physiotherapy evaluation may improve diagnostic confidence, support early targeted management, and enhance musculoskeletal care delivery.

Keywords:

Diagnostic Imaging; Musculoskeletal Ultrasound; Physical Therapy Modalities; Shoulder Impingement Syndrome; Shoulder Joint; Sensitivity and Specificity; Ultrasonography