Achilles tendon diagnostic ultrasound examination: A locally designed protocol and audit

Abstract Background Diagnostic ultrasound is regarded as the gold standard for imaging tendinopathies for diagnosis, focusing rehabilitation, and guided intervention. However, there are no published diagnostic ultrasound protocols for the Achilles tendon which represent best practice. In the Felixstowe Community Hospital Physiotherapy Department a protocol for diagnostic ultrasound examination of the Achilles tendon was implemented in January 2013 and acts as a local guideline. Objectives To determine whether a local Achilles tendon image protocol is being adhered to in diagnostic ultrasound examinations of mid-portion Achilles tendinopathy. A pre-determined 75% adherence to the protocol was set as the standard representing best practice in diagnostic ultrasound examination of the Achilles tendon. A target of 100% of diagnostic ultrasound examinations should meet this standard. Methods Data collection of acquired and archived diagnostic ultrasound examinations with a subsequent diagnosis of mid-portion Achilles tendinopathy was included. A proforma was developed to collect data to determine whether diagnostic ultrasound examinations met the protocol standard. Results The sample included all patients from 1 January to 31 May 2013 (n = 30). The study population included 16 females and 14 males with a mean age of 54.2 (SD ± 15.01) years and mostly represented by the age category 36–65 years (76.7%). This audit demonstrated that 73% (22 patients from 30) of diagnostic ultrasound examinations adhered to the standard set. This audit demonstrated inconsistencies in performing components of the diagnostic ultrasound examination procedure including the region of interest power Doppler, contra-lateral grey-scale, contra-lateral power Doppler, split screen images and annotation. Conclusions The audit has highlighted the need to enhance Achilles tendon diagnostic ultrasound examinations; a number of recommendations have been made in improving the service for Achilles tendon examinations. It is envisaged that by adoption of these recommendations the musculo-skeletal service for these patients at the Felixstowe Community Hospital Physiotherapy Department will be enhanced before commencement of the second Clinical Audit Cycle is undertaken.