Margit Kooijman

58 Background Musculoskeletal ultrasound (MSU) in secondary care has become a patient friendly, accurate and cost-effective method for diagnosing shoulder complaints 1 . In recent years, it also gained popularity amongst GPs and physiotherapists. However, basic data on MSU in primary care is scarce. For example, the uptake, the targeted patient population and reimbursement is largely unknown 2-4 . For patients, the possibility of accurate additional imagery in combination with physical examination at one place close to their homes is attractive. For policy makers, it is of importance in the discussion of substitution from secondary to primary care. Scholten-Peeters (2014) investigated the opinions and experiences of Dutch radiologists and orthopedic surgeons about the use of MSU in primary care 3 . It shows that they had little confidence in its use in primary care and believed that diagnostic MSU belongs in secondary care. The discussion on the desirability of MSU in primary care, calls for a further investigation on actual prevalence and experiences of MSU physiotherapists. It is suspected by the authors that for a large part, MSU is used to diagnose shoulder complaints. Therefore, this paper focuses mainly on patients with shoulder problems. Except for back and neck problems, shoulder pain is the most frequent complaint in physiotherapy practice 5 . Despite its frequent occurrence, studies report unfavourable outcome in many patients. In physiotherapy practice, the percentage of patients recovering after treatment varies from 20% to 79% and it is known that the treatment duration is relatively long 6 . This is frustrating for patients and clinicians and leads to high costs both for secondary care and sick leave 7-9 . Since long-lasting complaints contribute to an unfavourable prognosis, an adequate and quick diagnosis is important 10,11 . This is the starting point for choosing the right treatment with the appropriate clinician, most frequently the GP or physiotherapist. However, the shoulder is one of the most complex joints to diagnose complaints correctly. In clinical practice and in research, history and physical tests are relied on for this purpose. Yet, many studies show that these physical tests, even when combined, have limited diagnostic value 12 . In search for an alternative, MSU as a diagnostic aid is on the rise in primary care 13 . The important question being how physical tests and MSU relate to one another and whether MSU is considered valuable by clinicians in improving the management of shoulder conditions. As a starting point, the current study explores the use of MSU in the clinical practice of the physical therapist. As such, it addresses two research questions. Firstly, what is the current prevalence of MSU in Dutch physiotherapy practices? Secondly, what are the experiences of MSU physiotherapists with MSU in a primary care setting in patients with shoulder complaints?