MRI findings in atraumatic shoulder pain-patterns of disease correlated with age and gender

Reference values and influencing factors of the glenohumeral subluxation index: a study on 3004 participants

BACKGROUND

The primary objective of this study was to examine the glenohumeral subluxation index (GHSI) in a large general population cohort and to define reference values. Glenohumeral subluxation is important in the development and prediction of pathological states of the shoulder joint and in total shoulder arthroplasty. Therefore, another objective was to examine the influence of age, sex, body mass index, and body height and weight on GHSI.

METHODS

GHSI according to Walch was measured on bilateral magnetic resonance imaging of 3004 participants of the Study of Health in Pomerania (SHIP, aged 21-90 years). SHIP drew a sample of the adult general population of Pomerania (Northeastern Germany). Reference values for GHSI were assessed by quantile regression models. Associations of sex, age, and anthropometric markers with the GHSI were calculated by linear regression models.

RESULTS

A reference range between 42% and 55% for men with a mean of 49% ± 4% was defined, while the upper reference limit for women was 1% higher (mean, 50% ± 4%). Age was inversely associated with the GHSI in males (P < 0.001), while no significant association in females was observed (P = .625). Body weight and body mass index were positively associated (P < .001) without effect modification by sex. Heavy mechanical oscillations on the upper extremity showed no significant association with GHSI (P = .268).

CONCLUSION

The reference values for GHSI were expanded to a range of 42%-57% on magnetic resonance imaging. Several associations between GHSI and anthropometric properties are present. According to these associations, adjusted formulas are provided to enable individual, patient-specific diagnostics and therapy. Nevertheless, the clinical picture cannot be neglected.

Role of Magnetic Resonance Imaging (MRI) in the Diagnosis of Rotator Cuff Injuries and Correlation With Arthroscopy Findings

BACKGROUND AND AIM

The prevalent cause of shoulder pain is rotator cuff tears (RCT), which induce profound discomfort and morbidity. Hence, their detection and appropriate management become important to alleviate morbidity and enhance quality of life. Imaging has an important role in the diagnosis of such patients to guide for further management. A wide array of radiological approaches has been explored for the detection of RCT. The study aimed to assess the sensitivity (SN) and specificity (SP) of regular magnetic resonance imaging (MRI) in the diagnosis and characterization of RCT and furthermore to link the results of MRI with the arthroscopy findings. The limitations and pitfalls if any with MRI patients presenting were also addressed.

MATERIALS AND METHODS

The study was a diagnostic evaluation study conducted at the Department of Radiodiagnosis, Muslim Educational Society (MES) Medical College, Perinthalmanna, India, among individuals with RCT between December 1, 2015, and May 31, 2017. Patients who were referred for MRI and then taken up for arthroscopy were included. The findings for each tendon of rotator cuff on MRI were contrasted with that of arthroscopy, and the percentage of agreement was calculated. Additional findings relevant to the study were also noted. SN, SP, positive predictive value (PPV), and negative predictive value (NPV) of MRI were determined by taking arthroscopic findings as the gold standard.

RESULTS

The study was comprised of 36 patients assessed using MRI and arthroscopy for RCT. The study participants ranged in age from 31 to 70 years, with a mean of 52.69±8.86 years. The majority of the patients (69.4%) were between the ages of 41 and 60 years. MRI had 100% SN and SP for full-thickness supraspinatus (SS) tear, 50% SN and 100% SP for partial-thickness SS tear, 100% SN and 80% SP for full-thickness infraspinatus (IS) tear, 75% SN and 80% SP for partial-thickness IS tear, and 95% SN and 86.6% SP for subscapularis (SC) tear.

CONCLUSION

The MRI RCT investigation had a high SN, SP, and PPV compared to arthroscopy. The most frequently involved tendon reported in the present study was SS (n=35; 97.22%) followed by IS (n=32; 88.88%) and SC (n=22; 61.11%). The teres minor tendon was least commonly affected (n=0). Moreover, 61.11% (n=22) of the patients had joint effusion, 41.66% (n=15) had subacromial-subdeltoid bursal effusion, and 27.77% (n=10) had subcoracoid effusion, suggesting that RCT include joint effusion or bursal fluid. Acromioclavicular (AC) joint hypertrophy was found in 53% (n=19) of the patients, and 90% (n=17) were over 45 years old, indicating an association between age, AC joint hypertrophy, and RCT. Therefore, MRI has a good SN and SP for detecting various RCT. Therefore, it could be used to investigate a suspected RCT and should be considered a near-reference standard to arthroscopy for RCT diagnosis.