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Ni M, Gao L, Chen W, Zhao Q, Zhao Y, Jiang C, Yuan H. Preliminary exploration of deep learning-assisted recognition of superior labrum anterior and posterior lesions in shoulder MR arthrography. INTERNATIONAL ORTHOPAEDICS 2024; 48:183-191. [PMID: 37726561 PMCID: PMC10766676 DOI: 10.1007/s00264-023-05987-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/11/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE MR arthrography (MRA) is the most accurate method for preoperatively diagnosing superior labrum anterior-posterior (SLAP) lesions, but diagnostic results can vary considerably due to factors such as experience. In this study, deep learning was used to facilitate the preliminary identification of SLAP lesions and compared with radiologists of different seniority. METHODS MRA data from 636 patients were retrospectively collected, and all patients were classified as having/not having SLAP lesions according to shoulder arthroscopy. The SLAP-Net model was built and tested on 514 patients (dataset 1) and independently tested on data from two other MRI devices (122 patients, dataset 2). Manual diagnosis was performed by three radiologists with different seniority levels and compared with SLAP-Net outputs. Model performance was evaluated by the receiver operating characteristic (ROC) curve, area under the ROC curve (AUC), etc. McNemar's test was used to compare performance among models and between radiologists' models. The intraclass correlation coefficient (ICC) was used to assess the radiologists' reliability. p < 0.05 was considered statistically significant. RESULTS SLAP-Net had AUC = 0.98 and accuracy = 0.96 for classification in dataset 1 and AUC = 0.92 and accuracy = 0.85 in dataset 2. In dataset 1, SLAP-Net had diagnostic performance similar to that of senior radiologists (p = 0.055) but higher than that of early- and mid-career radiologists (p = 0.025 and 0.011). In dataset 2, SLAP-Net had similar diagnostic performance to radiologists of all three seniority levels (p = 0.468, 0.289, and 0.495, respectively). CONCLUSIONS Deep learning can be used to identify SLAP lesions upon initial MR arthrography examination. SLAP-Net performs comparably to senior radiologists.
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Affiliation(s)
- Ming Ni
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, People's Republic of China
| | - Lixiang Gao
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, People's Republic of China
| | - Wen Chen
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, People's Republic of China
| | - Qiang Zhao
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, People's Republic of China
| | - Yuqing Zhao
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, People's Republic of China
| | - Chenyu Jiang
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, People's Republic of China
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, People's Republic of China.
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Lalehzarian SP, Agarwalla A, Liu JN. Management of proximal biceps tendon pathology. World J Orthop 2022; 13:36-57. [PMID: 35096535 PMCID: PMC8771414 DOI: 10.5312/wjo.v13.i1.36] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/10/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
The long head of the biceps tendon is widely recognized as an important pain generator, especially in anterior shoulder pain and dysfunction with athletes and working individuals. The purpose of this review is to provide a current understanding of the long head of the biceps tendon anatomy and its surrounding structures, function, and relevant clinical information such as evaluation, treatment options, and complications in hopes of helping orthopaedic surgeons counsel their patients. An understanding of the long head of the biceps tendon anatomy and its surrounding structures is helpful to determine normal function as well as pathologic injuries that stem proximally. The biceps-labral complex has been identified and broken down into different regions that can further enhance a physician’s knowledge of common anterior shoulder pain etiologies. Although various physical examination maneuvers exist meant to localize the anterior shoulder pain, the lack of specificity requires orthopaedic surgeons to rely on patient history, advanced imaging, and diagnostic injections in order to determine the patient’s next steps. Nonsurgical treatment options such as anti-inflammatory medications, physical therapy, and ultrasound-guided corticosteroid injections should be utilized before entertaining surgical treatment options. If surgery is needed, the three options include biceps tenotomy, biceps tenodesis, or superior labrum anterior to posterior repair. Specifically for biceps tenodesis, recent studies have analyzed open vs arthroscopic techniques, the ideal location of tenodesis with intra-articular, suprapectoral, subpectoral, extra-articular top of groove, and extra-articular bottom of groove approaches, and the best method of fixation using interference screws, suture anchors, or cortical buttons. Orthopaedic surgeons should be aware of the complications of each procedure and respond accordingly for each patient. Once treated, patients often have good to excellent clinical outcomes and low rates of complications.
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Affiliation(s)
- Simon P Lalehzarian
- The Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, United States
| | - Avinesh Agarwalla
- Department of Orthopedic Surgery, Westchester Medical Center, Valhalla, NY 10595, United States
| | - Joseph N Liu
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, CA 90033, United States
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Liu F, Cheng X, Dong J, Zhou D, Sun Q, Bai X, Wang D. Imaging modality for measuring the presence and extent of the labral lesions of the shoulder: a systematic review and meta-analysis. BMC Musculoskelet Disord 2019; 20:487. [PMID: 31656171 PMCID: PMC6815459 DOI: 10.1186/s12891-019-2876-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 10/09/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Multiple published studies quantitatively analysing the diagnostic value of MRI, MR arthrography (MRA) and CT arthrography (CTA) for labral lesions of the shoulder have had inconsistent results. The aim of this meta-analysis was to systematically compare the diagnostic performance of MRI, MRA, CTA and CT. METHODS Two databases, PubMed and EMBASE, were used to retrieve studies targeting the accuracy of MRI, MRA, CTA and CT in detecting labral lesions of the shoulder. After carefully screening and excluding studies, the studies that met the inclusion criteria were used for a pooled analysis, including calculation of sensitivity and specificity with 95% confidence intervals (CIs) and the area under the hierarchical summary receiver operating characteristic (HSROC) curves. RESULTS The retrieval process identified 2633 studies, out of which two reviewers screened out all but 14 studies, involving a total of 1216 patients who were deemed eligible for inclusion in the meta-analysis. The results assessing the diagnostic performance of MRI vs. MRA for detecting labral lesions showed a pooled sensitivity of 0.77 (95% CI 0.70-0.84) vs. 0.92 (95% CI 0.84-0.96), a specificity of 0.95 (95% CI 0.85-0.98) vs. 0.98 (95% CI 0.91-0.99), and an area under the HSROC curve of 3.78 (95% CI 2.73-4.83) vs. 6.01 (95% CI 4.30-7.73), respectively. CONCLUSION MRA was suggested for use in patients with chronic shoulder symptoms or a pathologic abnormality. MRI is by far the first choice recommendation for the detection of acute labral lesions. CT should be a necessary supplemental imaging technique when there is highly suspected glenoid bone damage.
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Affiliation(s)
- Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Xiangyun Cheng
- Department of Orthopaedics, The 2nd Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jinlei Dong
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Dongsheng Zhou
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Qian Sun
- Department of General and Paediatric Surgery, Yantai Yuhuangding Hospital affiliated Qingdao University, Yuhuangding eastern road 20, Yantai, China
| | - Xiaohui Bai
- Department of Clinical Laboratory, Shandong Provincial Hospital affiliated to Shandong University, Jing Wu Road 324, Jinan, 250021, Shandong, China.
| | - Dawei Wang
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China.
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Value of MR arthrography findings for pain relief after glenohumeral corticosteroid injections in the short term. Eur Radiol 2019; 29:6416-6424. [DOI: 10.1007/s00330-019-06237-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/09/2019] [Accepted: 04/12/2019] [Indexed: 10/26/2022]
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Lansdown DA, Bendich I, Motamedi D, Feeley BT. Imaging-Based Prevalence of Superior Labral Anterior-Posterior Tears Significantly Increases in the Aging Shoulder. Orthop J Sports Med 2018; 6:2325967118797065. [PMID: 30238014 PMCID: PMC6141924 DOI: 10.1177/2325967118797065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Superior labral anterior-posterior (SLAP) tears can be associated with pain and shoulder dysfunction. Relatively little is known about the age-related prevalence of SLAP tears. Purpose To investigate the age-related prevalence of imaging-diagnosed SLAP tears in a heterogeneous grouping of shoulder conditions in a large cohort at a single institution with multiple blinded reviewers. Study Design Cross-sectional study; Level of evidence, 3. Methods A total of 281 shoulder magnetic resonance imaging (MRI) scans obtained over 8 months were reviewed by a musculoskeletal radiologist and an orthopaedic surgeon. The mean ± SD age of the group was 49.6 ± 15.5 years, and 107 of the patients were female (38.1%). Patients were divided into 4 age groups: 35 years or younger, 36 to 50 years, 51 to 65 years, and older than 65 years. Statistical analyses were completed by use of the Fisher exact test to compare proportions of SLAP tears between age groups, odds ratios to determine the likelihood of having a SLAP tear in each age group, and a logistic regression to control for associated abnormalities. Results There was a significant diffference in the proportion of SLAP tears found on the MRIs for each age group (P < .001). Patients were significantly more likely to have SLAP tears if aged 51 to 65 years (66.7%; odds ratio [OR], 2.00; 95% CI, 1.27-3.15) and if older than 65 years (81.2%; OR, 4.31; 95% CI, 2.36-7.88). No increased prevalence was observed in patients aged 35 years or younger (47.5%; OR, 0.91; 95% CI, 0.55-1.50) or 36 to 50 years (51.8%; OR, 1.08; 95% CI, 0.70-1.67). Logistic regression demonstrated that age was the only significant predictor for having a SLAP tear (P < .001). Kappa values were 0.46 to 0.65 between reviewers, indicating moderate to substantial agreement. Conclusion An increasing prevalence of MRI-based SLAP tears was observed with increasing patient age. Patients older than 50 years were significantly more likely to have superior labral abnormalities regardless of other shoulder injury or disease.
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Affiliation(s)
- Drew A Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Ilya Bendich
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Daria Motamedi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
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Magnetic Resonance Imaging and Arthroscopic Correlation in Shoulder Instability. Sports Med Arthrosc Rev 2017; 25:172-178. [DOI: 10.1097/jsa.0000000000000163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Somerville LE, Willits K, Johnson AM, Litchfield R, LeBel ME, Moro J, Bryant D. Clinical Assessment of Physical Examination Maneuvers for Superior Labral Anterior to Posterior Lesions. Surg J (N Y) 2017; 3:e154-e162. [PMID: 29018839 PMCID: PMC5629079 DOI: 10.1055/s-0037-1606829] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 08/08/2017] [Indexed: 01/02/2023] Open
Abstract
Purpose
Shoulder pain and disability pose a diagnostic challenge owing to the numerous etiologies and the potential for multiple disorders to exist simultaneously. The evidence to support the use of clinical tests for superior labral anterior to posterior complex (SLAP) is weak or absent. The purpose of this study is to determine the diagnostic validity of physical examination maneuvers for SLAP lesions by performing a methodologically rigorous, clinically applicable study.
Methods
We recruited consecutive new shoulder patients reporting pain and/or disability. The physician took a history and indicated their certainty about each possible diagnosis (“certain the diagnosis is absent/present,” or “uncertain requires further testing”). The clinician performed the physical tests for diagnoses where uncertainty remained. Magnetic resonance imaging arthrogram and arthroscopic examination were the gold standards. We calculated sensitivity, specificity, and likelihood ratios (LRs) and investigated whether combinations of the top tests provided stronger predictions.
Results
Ninety-three patients underwent physical examination for SLAP lesions. When using the presence of a SLAP lesion (Types I–V) as disease positive, none of the tests was sensitive (10.3–33.3) although they were moderately specific (61.3–92.6). When disease positive was defined as repaired SLAP lesion (including biceps tenodesis or tenotomy), the sensitivity (10.5–38.7) and specificity (70.6–93.8) of tests improved although not by a substantial amount. None of the tests was found to be clinically useful for predicting repairable SLAP lesions with all LRs close to one. The compression rotation test had the best LR for both definitions of disease (SLAP tear present = 1.8 and SLAP repaired = 1.67). There was no optimal combination of tests for diagnosing repairable SLAP lesions, with at least two tests positive providing the best combination of measurement properties (sensitivity 46.1% and specificity 64.7%).
Conclusion
Our study demonstrates that the physical examination tests for SLAP lesions are poor diagnostic indicators of disease. Performing a combination of tests will likely help, although the magnitude of the improvement is minimal. These authors caution clinicians placing confidence in the physical examination tests for SLAP lesions rather we suggest that clinicians rely on diagnostic imaging to confirm this diagnosis.
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Affiliation(s)
- Lyndsay E Somerville
- Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Kevin Willits
- Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Andrew M Johnson
- School of Health Studies, Faculty of Health Sciences, The University of Western Ontario, London, Ontario, Canada
| | - Robert Litchfield
- Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Marie-Eve LeBel
- Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Jaydeep Moro
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Dianne Bryant
- Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.,School of Health Studies, Faculty of Health Sciences, The University of Western Ontario, London, Ontario, Canada.,Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Somerville LE, Willits K, Johnson AM, Litchfield R, LeBel ME, Moro J, Bryant D. Diagnostic Validity of Patient-Reported History for Shoulder Pathology. Surg J (N Y) 2017; 3:e79-e87. [PMID: 28825026 PMCID: PMC5553515 DOI: 10.1055/s-0037-1601878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 02/28/2017] [Indexed: 12/26/2022] Open
Abstract
Objective The purpose of this article is to determine whether patient-reported history items are predictive of shoulder pathology and have the potential for use in triaging patients with shoulder pathology to orthopaedic outpatient clinics. Setting It is set at two tertiary orthopaedic clinics. Patients All new patients reporting pain and/or disability of the shoulder joint were prospectively recruited. A total of 193 patients were enrolled, 15 of whom withdrew, leaving 178 patients composing the study sample. Design Patients completed a questionnaire on the history of their pathology, then the surgeon took a thorough history indicating the most likely diagnosis. The clinician then performed appropriate physical examination. Arthroscopy was the reference standard for those undergoing surgery and magnetic resonance imaging (MRI) with arthrogram for all others. We calculated the sensitivity, specificity, and likelihood ratios (LRs) of history items alone and in combination. We used the LRs to generate a clinical decision algorithm. Main Outcome Measures Diagnosis was determined through arthroscopy or MRI arthrogram. Reporting was standardized to ensure review of all structures. Results The physical examination and history agreed in 75% of cases. Of those that did not agree, the physical examination misdirected the diagnosis in 47% of our cases. In particular, history items were strong predictors of anterior and posterior instability and subscapularis tears and were combined in a tool to be utilized for screening patients. Conclusion The patient-reported history items were effective for diagnosing shoulder pathology and should be considered for use in a triaging instrument.
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Affiliation(s)
- Lyndsay E Somerville
- Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Kevin Willits
- Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Andrew M Johnson
- School of Health Studies, Faculty of Health Sciences, The University of Western Ontario, London, Ontario, Canada
| | - Robert Litchfield
- Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Marie-Eve LeBel
- Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Jaydeep Moro
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Dianne Bryant
- Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.,School of Health Studies, Faculty of Health Sciences, The University of Western Ontario, London, Ontario, Canada.,Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Yıldız F, Bilsel K, Pulatkan A, Uzer G, Aralaşmak A, Atay M. Reliability of magnetic resonance imaging versus arthroscopy for the diagnosis and classification of superior glenoid labrum anterior to posterior lesions. Arch Orthop Trauma Surg 2017; 137:241-247. [PMID: 27904970 DOI: 10.1007/s00402-016-2605-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Indexed: 01/03/2023]
Abstract
PURPOSE The physical examination of the shoulder is usually not reliable for the true diagnosis of superior glenoid labrum anterior to posterior (SLAP) lesions. Magnetic resonance imaging (MRI) has been routinely used for the diagnosis. This prospective study investigates the radiological diagnosis of the SLAP lesions and compares accuracy of arthroscopic and MRI classifications. METHODS One hundred thirty-two patients with positive physical examination signs using O'Brien, Yergason, resistance supination external rotation and Krank tests and MRI findings are included in the study. Shoulder MRIs were obtained for all patients within three months prior to the surgeries. SLAP lesion is detected in 90 and 102 patients according to MRI and arthroscopy, respectively. Arthroscopic and MRI classifications of the patients were performed according to modified Snyder classification. RESULTS Sensitivity and specificity of the MRI were found as 70.59 and 40%, respectively. No difference was detected between MRI and arthroscopy classifications in 52 (39%) patients. Although the diagnosis was compatible with arthroscopy in 34 (25%) patients, the classification was incompatible. In 46 (34%) of patients the diagnosis was incompatible with the MRI. CONCLUSION Although MRI is a good diagnostic tool for SLAP lesions, its use for the classification is limited. Level of evidence Level III, Diagnostic study.
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Affiliation(s)
- Fatih Yıldız
- Department of Orthopaedics and Traumatology, School of Medicine, Bezmialem Vakif University, Vatan Cd, Fatih, 34093, Istanbul, Turkey.
| | - Kerem Bilsel
- Department of Orthopaedics and Traumatology, School of Medicine, Bezmialem Vakif University, Vatan Cd, Fatih, 34093, Istanbul, Turkey
| | - Anıl Pulatkan
- Department of Orthopaedics and Traumatology, School of Medicine, Bezmialem Vakif University, Vatan Cd, Fatih, 34093, Istanbul, Turkey
| | - Gökçer Uzer
- Department of Orthopaedics and Traumatology, School of Medicine, Bezmialem Vakif University, Vatan Cd, Fatih, 34093, Istanbul, Turkey
| | - Ayşe Aralaşmak
- Department of Radiology, School of Medicine, Bezmialem Vakif University, Vatan Cd, Fatih, 34093, Istanbul, Turkey
| | - Musa Atay
- Department of Radiology, School of Medicine, Bezmialem Vakif University, Vatan Cd, Fatih, 34093, Istanbul, Turkey
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Thorsness RJ, Erickson BJ, Hamamoto JT, Cole BJ, Verma NN. Management of the Biceps Tendon. OPER TECHN SPORT MED 2016. [DOI: 10.1053/j.otsm.2016.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Banerjee M, Müller-Hübenthal J, Grimme S, Balke M, Bouillon B, Lefering R, Goßmann A, Shafizadeh S. Moderate value of non-contrast magnetic resonance imaging after non-dislocating shoulder trauma. Knee Surg Sports Traumatol Arthrosc 2016; 24:1888-95. [PMID: 24923686 DOI: 10.1007/s00167-014-3102-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 05/27/2014] [Indexed: 01/02/2023]
Abstract
PURPOSE The purpose of the present study was to determine the value of shoulder magnetic resonance imaging (MRI) obtained in the community setting interpreted by musculoskeletal radiologists in patients with shoulder pain initiated by a single non-dislocating shoulder trauma. METHODS In 56 of 61 consecutive patients who underwent shoulder arthroscopy due to pain after a single non-dislocating shoulder trauma, the data sets of non-contrast MRI were complete. These were retrospectively interpreted by three radiologists specialized on musculoskeletal MRI who were blinded for patients' history and who did not have access to the reports of arthroscopy. Standard evaluation forms were used to assess the MRIs for superior labrum anterior and posterior (SLAP) lesions, anterior or posterior labrum lesions, lesions of the long head of biceps tendon (LHB) and for partial tears of the supraspinatus tendon and the upper quarter of the subscapularis tendon. Quality of the MRI was assessed by each radiologist on a four-point scale. RESULTS The pooled sensitivity for the three radiologists for the detection of SLAP lesions was 45.0 %, for anterior or posterior labrum tears 77.8 and 66.7 %, for lesions of the LHB 63.2 % and for partial tears of the supraspinatus or subscapularis tendon tears 84.8 and 33.3 %. Corresponding inter-rater reliabilities were poor (SLAP lesions) to substantial (anterior labrum tears). Quality of MRI only influenced the accuracy for the detection of posterior labrum tears. CONCLUSION A non-contrast shoulder MRI obtained in the community setting after non-dislocating shoulder trauma has a moderate sensitivity for most intraarticular pathologies when interpreted by musculoskeletal radiologists. Accuracy is dependent on the observer and not on the assessed quality. LEVEL OF EVIDENCE Case series, Level IV.
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Affiliation(s)
- Marc Banerjee
- Department of Orthopedic and Trauma Surgery, Faculty of Health - School of Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, Ostmerheimerstr. 200, 51109, Cologne, Germany.
| | | | | | - Maurice Balke
- Department of Orthopedic and Trauma Surgery, Faculty of Health - School of Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, Ostmerheimerstr. 200, 51109, Cologne, Germany
| | - Bertil Bouillon
- Department of Orthopedic and Trauma Surgery, Faculty of Health - School of Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, Ostmerheimerstr. 200, 51109, Cologne, Germany
| | - Rolf Lefering
- Cologne Merheim Medical Center, IFOM, Institute for Research in Operative Medicine, University of Witten/Herdecke, Cologne, Germany
| | - Axel Goßmann
- Department of Radiology, Cologne Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany
| | - Sven Shafizadeh
- Department of Orthopedic and Trauma Surgery, Faculty of Health - School of Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, Ostmerheimerstr. 200, 51109, Cologne, Germany
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Bhatnagar A, Bhonsle S, Mehta S. Correlation between MRI and Arthroscopy in Diagnosis of Shoulder Pathology. J Clin Diagn Res 2016; 10:RC18-21. [PMID: 27042543 DOI: 10.7860/jcdr/2016/14867.7309] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 11/26/2015] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Shoulder pain can cause significant pain, discomfort and reduce the ability to perform activities of daily living, thus making it the third most common cause of musculoskeletal consultation. The current gold standard diagnostic investigation is arthroscopy. MRI is a proved sensitive and accurate non-invasive tool in investigating shoulder pathology, but false and misleading results are equally reported. AIM The aim of the study is to compare the efficacy of MRI in diagnosing shoulder pathologies in comparison to arthroscopy, considering arthroscopy as the gold standard. MATERIALS AND METHODS Thirty nine consecutive patients, between 18-80 years of age, presenting with chronic shoulder pain or instability of more than 6 weeks, or with clinical signs of impingement or tear were included in the study. MRI of the shoulder joint was done followed by shoulder arthroscopy. The data collected was analysed for the significant correlation between MRI of shoulder and arthroscopic findings by kappa statistics. RESULTS Out of 39 patients, Rotator cuff (RC) tear was the most common pathology. MRI showed excellent sensitivity in the diagnosis of rotator cuff tears (0.91) and osteochondral defects (OCD), very good sensitivity for Bankart's lesion (0.8) and had poor sensitivity to detect SLAP tear (0.15). MRI was specific for all shoulder pathologies. MRI detected RC tears with kappa score of 0.73, Bankart's tear and OCD's with kappa score of 0.83 and 1.0 respectively and SLAP lesion with kappa score of 0.14. The accuracy of MRI was highest in diagnosing OCD's (1.0), followed by RC tear (0.9), Bankart's tear (0.9) and accuracy was least in diagnosing SLAP lesion (0.7). False negative results were more than false positives. CONCLUSION The present study supports that MRI is effective in diagnosing rotator cuff tears, Bankart's tear and ostechondral defects but was not found to be helpful in diagnosing SLAP lesions. MRI and arthroscopy have complimentary roles in the diagnosis of shoulder pathology.
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Affiliation(s)
- Abhinav Bhatnagar
- Registrar, Department of Orthopaedics, Fortis Hospital , Mumbai, India
| | - Sachin Bhonsle
- Consultant, Department of Orthopaedics, Fortis Hospital , Mumbai, India
| | - Sonu Mehta
- Registrar, Department of Orthopaedics, Fortis Hospital , Mumbai, India
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Taylor SA, Newman AM, Nguyen J, Fabricant PD, Baret NJ, Shorey M, Ramkumar P, O'Brien SJ. Magnetic Resonance Imaging Currently Fails to Fully Evaluate the Biceps-Labrum Complex and Bicipital Tunnel. Arthroscopy 2016; 32:238-44. [PMID: 26440371 DOI: 10.1016/j.arthro.2015.08.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 07/14/2015] [Accepted: 08/06/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine the diagnostic accuracy of magnetic resonance imaging (MRI) for biceps-labrum complex (BLC) lesions, including the extra-articular bicipital tunnel. METHODS A retrospective review of 277 shoulders with chronic refractory BLC symptoms that underwent arthroscopic subdeltoid transfer of the long head of the biceps tendon (LHBT) to the conjoint tendon was conducted. Intraoperative lesions were categorized as "inside" (labral tears and dynamic LHBT incarceration), "junctional" (LHBT partial tears, LHBT subluxation, and biceps chondromalacia), or "bicipital tunnel" (extra-articular bicipital tunnel scar/stenosis, loose bodies, LHBT instability, and LHBT partial tears) based on anatomic location. Attending radiologist-generated MRI reports were graded dichotomously as positive or negative for biceps and labral damage and then compared with intraoperative findings. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for MRI with respect to intraoperative findings. RESULTS With regard to inside lesions, MRI had an overall sensitivity, specificity, PPV, and NPV for labrum lesions of 77.3%, 68.2%, 57.3%, and 84.5% respectively. The sensitivity, specificity, PPV, and NPV of MRI for junctional lesions were 43.3%, 55.6%, 73.1%, and 26.0%, respectively. For the bicipital tunnel, MRI had a sensitivity, specificity, PPV, and NPV of 50.4%, 61.4%, 48.7%, and 63.0%, respectively. CONCLUSIONS MRI was unreliable for ruling out BLC lesions among chronically symptomatic patients, including when the bicipital tunnel was affected.
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Affiliation(s)
| | | | - Joseph Nguyen
- Hospital for Special Surgery, New York, New York, U.S.A
| | | | | | - Mary Shorey
- Hospital for Special Surgery, New York, New York, U.S.A
| | - Prem Ramkumar
- Hospital for Special Surgery, New York, New York, U.S.A
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Schwartzberg R, Reuss BL, Burkhart BG, Butterfield M, Wu JY, McLean KW. High Prevalence of Superior Labral Tears Diagnosed by MRI in Middle-Aged Patients With Asymptomatic Shoulders. Orthop J Sports Med 2016; 4:2325967115623212. [PMID: 26779556 PMCID: PMC4710128 DOI: 10.1177/2325967115623212] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background: The incidence of superior labral surgery has increased in the past decade in the United States, and a contributing factor could be an increased rate of superior labral tears diagnosed with magnetic resonance imaging (MRI). Prior MRI studies of the asymptomatic shoulder have focused on rotator cuff pathology or pathology in a narrow and specific group of athletes. Labral abnormalities have not previously been thoroughly evaluated in asymptomatic middle-aged individuals. Purpose: To evaluate the prevalence of superior labral tears diagnosed by MRI in the asymptomatic shoulders of middle-aged people (age range, 45-60 years). Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 53 asymptomatic adults (age range, 45-60 years) with no history of surgery or injury to either shoulder were included in the study. Physical examinations of all shoulders were performed. Noncontrast MRI (1.5 T) was performed in 1 randomly determined shoulder of each subject. Two fellowship-trained musculoskeletal radiologists who were blinded to the purpose of the study and ages of the subjects evaluated each MRI. Results: Radiologists interpreted the MRIs as consistent with superior labral tears in 55% and 72% of the cohort. Comparison of the radiological evaluations of the superior labra were moderate (κ = 0.410, P = .033). There were no differences in readings for superior labral tear regarding age (P = .87), sex (P = .41), whether the dominant shoulder underwent MRI (P = .99), whether the subject worked a physical job (P = .08), or whether the subject participated in overhead sports for a period of 1 year (P = .62). Conclusion: Superior labral tears are diagnosed with high frequency using MRI in 45- to 60-year-old individuals with asymptomatic shoulders. These shoulder MRI findings in middle-aged populations emphasize the need for supporting clinical judgment when making treatment decisions for this patient population. Clinical Relevance: To avoid overtreatment, physicians should realize that superior labral tears diagnosed by MRI in individuals between the ages of 45 and 60 years may be normal age-related findings.
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Affiliation(s)
| | | | | | | | - James Y Wu
- Center for Diagnostic Imaging, Winter Park, Florida, USA
| | - Kevin W McLean
- Center for Diagnostic Imaging, Winter Park, Florida, USA
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van Grinsven S, van Loon C, van Gorp M, van Kints M, Konings P, van Kampen A. A feedback protocol improves the diagnostic performance of MR arthrography by experienced musculoskeletal radiologists in patients with traumatic anterior shoulder instability. Eur J Radiol 2015; 84:2242-9. [DOI: 10.1016/j.ejrad.2015.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 07/08/2015] [Accepted: 07/09/2015] [Indexed: 01/27/2023]
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van Grinsven S, Nijenhuis TA, Konings PC, van Kampen A, van Loon CJM. Are radiologists superior to orthopaedic surgeons in diagnosing instability-related shoulder lesions on magnetic resonance arthrography? A multicenter reproducibility and accuracy study. J Shoulder Elbow Surg 2015; 24:1405-12. [PMID: 26175312 DOI: 10.1016/j.jse.2015.05.050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 04/22/2015] [Accepted: 05/04/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND We compared the diagnostic reproducibility and accuracy of musculoskeletal radiologists with orthopaedic shoulder surgeons in 2 large medical centers in assessing magnetic resonance arthrograms (MRAs) of patients with traumatic anterior shoulder instability. METHODS Forty-five surgically confirmed MRAs were assessed by 4 radiologists, 4 orthopaedic surgeons, 2 radiologic teams, and 2 orthopaedic teams. During MRA assessment and surgery, the same 7-lesion scoring form was used. κ Coefficients, sensitivity, specificity, and differences in percentage of agreement or correct diagnosis (P < .05, McNemar test) were calculated per lesion and overall per the 7 lesion types. RESULTS The overall κ between the individual radiologists (κ = 0.51, κ = 0.46) and orthopaedic surgeons (κ = 0.46, κ = 0.41) was moderate. Although the overall percentage of agreement between the radiologists was slightly higher than that between the orthopaedic surgeons in both centers (80.0% vs 77.5% and 75.2% vs 73.7%), there was no significant difference. In each medical center, however, the most experienced orthopaedic surgeon was exceedingly more accurate than both radiologists per the 7 lesion types (81.9% vs 72.4%/74.6% and 76.5% vs 67.3%/73.7%). In 3 of 4 cases, this difference was significant. Overall accuracy improvement through consensus assessment was merely established for the weakest member of each team. CONCLUSION Experienced orthopaedic surgeons are more accurate than radiologists in assessing traumatic anterior shoulder instability-related lesions on MRA. In case of diagnosis disagreement, these orthopaedic surgeons should base their treatment decision on their own MRA interpretation.
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Affiliation(s)
- Susan van Grinsven
- Department of Orthopaedics, Rijnstate Hospital, Arnhem, The Netherlands.
| | - Thijs A Nijenhuis
- Department of Orthopaedics, Rijnstate Hospital, Arnhem, The Netherlands
| | - Peer C Konings
- Department of Orthopaedics, Rijnstate Hospital, Arnhem, The Netherlands
| | - Albert van Kampen
- Department of Orthopaedics, Radboud University Medical Centre, Nijmegen, The Netherlands
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Sheridan K, Kreulen C, Kim S, Mak W, Lewis K, Marder R. Accuracy of magnetic resonance imaging to diagnose superior labrum anterior-posterior tears. Knee Surg Sports Traumatol Arthrosc 2015; 23:2645-50. [PMID: 24985524 DOI: 10.1007/s00167-014-3109-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 05/29/2014] [Indexed: 01/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the accuracy of magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) in diagnosing superior labral anterior-posterior (SLAP) lesions. We hypothesized that the accuracy of MRI and MRA was lower than previously reported. METHODS Between 2006 and 2008, 444 patients who had both shoulder arthroscopy and an MRI (non-contrast or MR arthrography) for shoulder pain at our institution prior to surgery were identified and included in the study. The radiologic diagnosis and surgical evaluation were compared to determine the accuracy of diagnosing a SLAP lesion by MRI. Using arthroscopy as the standard, sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated for all MRIs, as well as separately for the non-intra-articular contrast MRI group and the MR arthrography group. RESULTS Of the 444 patients having an MRI and arthroscopy for shoulder pain, 121 had a SLAP diagnosis by MRI and 44 had a SLAP diagnosis by arthroscopy. Overall, MRI had an accuracy of 76 %, a PPV of 24 %, and a NPV of 95 %. Sensitivity was 66 %, and specificity was 77 %. MR arthrography had an accuracy of 69 %, sensitivity of 80 %, and a PPV of 29 %. Non-contrast MRI had an accuracy of 85 %, sensitivity of 36 %, and a PPV of 13 %. CONCLUSIONS In our retrospective study of 444 patients, sensitivity, specificity, and accuracy were all lower than previously reported in the literature for diagnosing SLAP lesions. Our data indicated that while MRI could exclude a SLAP lesion (NPV = 95 %), MRI alone was not an accurate clinical tool. MR arthrography had a large number of false-positive readings in this study. We concluded that even with intra-articular contrast, MRI had limitations in the ability to diagnose surgically proven SLAP lesions.
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Affiliation(s)
- Kent Sheridan
- Department of Orthopaedic Surgery, Davis Medical Center, University of California, 4860 Y Street, Suite 3800, Sacramento, CA, 95817, USA,
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Trantalis JN, Sohmer S, More KD, Nelson AA, Wong B, Dyke CH, Thornton GM, Boorman RS, Lo IKY. Arthroscopic repair of type II SLAP lesions: Clinical and anatomic follow-up. INTERNATIONAL JOURNAL OF SHOULDER SURGERY 2015; 9:74-80. [PMID: 26288536 PMCID: PMC4528287 DOI: 10.4103/0973-6042.161434] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Aims: The aim was to evaluate the clinical and anatomic outcome of arthroscopic repair of type II SLAP lesions. Materials and Methods: The senior author performed isolated repairs of 25 type II SLAP lesions in 25 patients with a mean age of 40.0 ± 12 years. All tears were repaired using standard arthroscopic suture anchor repair to bone. All patients were reviewed using a standardized clinical examination by a blinded, independent observer, and using several shoulder outcome measures. Patients were evaluated by magnetic resonance imaging arthrogram at a minimum of 1-year postoperatively. Statistical Analysis Used: Two-tailed paired t-test were used to determine significant differences in preoperative and postoperative clinical outcomes scores. In addition, a Fisher's exact test was used. Results: At a mean follow-up of 54-month, the mean American Shoulder and Elbow Surgeons Shoulder Index (ASES) scores improved from 52.1 preoperatively to 86.1 postoperatively (P < 0.0001) and the Simple Shoulder Test (SST) scores from 7.7 to 10.6 (P < 0.0002). Twenty-two out of the 25 patients (88%) stated that they would have surgery again. Of the 21 patients who had postoperative magnetic resonance imaging arthrographys (MRAs), 9 patients (43%) demonstrated dye tracking between the labrum bone interface suggestive of a recurrent tear and 12 patients (57%) had a completely intact repair. There was no significant difference in ASES, SST, and patient satisfaction scores in patients with recurrent or intact repairs. Conclusions: Arthroscopic repair of type II SLAP lesions demonstrated improvements in clinical outcomes. However, MRA imaging demonstrated 43% of patients with recurrent tears. MRA results do not necessarily correlate with clinical outcome.
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Affiliation(s)
- John N Trantalis
- Department of Orthopaedics, Concord Public Hospital, Concord, NSW 2137, Australia
| | - Stephen Sohmer
- Department of Surgery, Campbell River Hospital, 375 2nd Avenue, Campbell River, BC V9W 3V1, Canada
| | - Kristie D More
- Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute of Bone and Joint Health, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 1N4, Canada
| | - Atiba A Nelson
- Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute of Bone and Joint Health, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 1N4, Canada
| | - Ben Wong
- Department of Radiology, Foothills Medical Centre, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - Corinne H Dyke
- Department of Radiology, Foothills Medical Centre, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - Gail M Thornton
- Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute of Bone and Joint Health, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 1N4, Canada
| | - Richard S Boorman
- Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute of Bone and Joint Health, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 1N4, Canada
| | - Ian K Y Lo
- Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute of Bone and Joint Health, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 1N4, Canada
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Jordan RW, Naeem R, Srinivas K, Shyamalan G. A comparison of magnetic resonance arthrography and arthroscopic findings in the assessment of anterior shoulder dislocations. Skeletal Radiol 2015; 44:653-7. [PMID: 25532474 DOI: 10.1007/s00256-014-2080-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 12/03/2014] [Accepted: 12/04/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study is to establish the sensitivity and specificity of MRA in the investigation of patients with traumatic anterior shoulder dislocations. MATERIALS AND METHODS A retrospective analysis of consecutive patients undergoing both magnetic resonance arthrography and arthroscopic assessment after a traumatic anterior shoulder dislocation between January 2011 and 2014 was performed. Demographic data were collected from electronic records. Images were interpreted by 8 musculoskeletal radiologists and patients were treated by 8 consultant orthopaedic surgeons. Arthroscopic findings were obtained from surgical notes and these findings were used as a reference for MRA. The sensitivity, specificity, and positive predictive value were calculated for the different injuries. RESULTS Sixty-nine patients underwent both an MRA and shoulder arthroscopy during the study period; however, clinical notes were unavailable in 9 patients. Fifty-three patients (88 %) were male, the mean age was 28 years (range 18 to 50) and 16 subjects (27 %) had suffered a primary dislocation. The overall sensitivity and specificity of MRA to all associated injuries was 0.9 (CI 0.83-0.95) and 0.94 (CI 0.9-0.96) retrospectively. The lowest sensitivity was seen in osseous Bankart 0.8 (CI 0.44-0.96) and superior labral tear (SLAP) lesions 0.5 (CI 0.14-0.86). The overall positive predictive value was 0.88 (CI 0.76-0.91) with the lowest values found in rotator cuff 0.4 (CI 0.07-0.83) and glenohumeral ligament (GHL) lesions 0.29 (CI 0.05-0.7). CONCLUSION Magnetic resonance angiography has a high sensitivity when used to identify associated injuries in shoulder dislocation, although in 8 patients (13 %) arthroscopy identified an additional injury. The overall agreement between MRA and arthroscopic findings was good, but the identification of GHL and rotator cuff injuries was poor.
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Affiliation(s)
- R W Jordan
- Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK,
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20
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van Grinsven S, Hagenmaier F, van Loon CJM, van Gorp MJ, van Kints MJ, van Kampen A. Does the experience level of the radiologist, assessment in consensus, or the addition of the abduction and external rotation view improve the diagnostic reproducibility and accuracy of MRA of the shoulder? Clin Radiol 2014; 69:1157-64. [PMID: 25218253 DOI: 10.1016/j.crad.2014.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 07/05/2014] [Accepted: 07/09/2014] [Indexed: 12/21/2022]
Abstract
AIM To prospectively evaluate the influence of observer experience, consensus assessment, and abduction and external rotation (ABER) view on the diagnostic performance of magnetic resonance arthrography (MRA) in patients with traumatic anterior-shoulder instability (TASI). MATERIALS AND METHODS Fifty-eight MRA examinations (of which 51 had additional ABER views) were assessed by six radiologists (R1-R6) and three teams (T1-T3) with different experience levels, using a seven-lesion standardized scoring form. Forty-five out of 58 MRA examination findings were surgically confirmed. Kappa coefficients, sensitivity, specificity, and differences in percent agreement or correct diagnosis (p-value, McNemar's test) were calculated per lesion and overall per seven lesion types to assess diagnostic reproducibility and accuracy. RESULTS Overall kappa ranged from poor (k = 0.17) to moderate (k = 0.53), sensitivity from 30.6-63.5%, and specificity from 73.6-89.9%. Overall, the most experienced radiologists (R1-R2) and teams (T2-T3) agreed significantly more than the lesser experienced radiologists (R3-R4: p = 0.014, R5-R6; p = 0.018) and teams (T2-T3: p = 0.007). The most experienced radiologist (R1, R2, R3) and teams (T1, T2) were also consistently more accurate than the lesser experienced radiologists (R4, R5, R6) and team (T3). Significant differences were found between R1-R4 (p = 0.012), R3-R4 (p = 0.03), and T2-T3 (p = 0.014). The overall performance of consensus assessment was systematically higher than individual assessment. Significant differences were established between T1-T2 and radiologists R3-R4 (p<0.001, p = 0.001) and between T2 and R3 (p<0.001/p = 0.001) or R4 (p = 0.050). No overall significant differences were found between the radiologists' assessments with and without ABER. CONCLUSION The addition of ABER does not significantly improve overall diagnostic performance. The radiologist's experience level and consensus assessment do contribute to higher reproducibility and accuracy.
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Affiliation(s)
- S van Grinsven
- Department of Orthopaedics, Rijnstate Hospital, PO Box 9555, 6800 TA, Arnhem, The Netherlands.
| | - F Hagenmaier
- Department of Orthopaedics, Rijnstate Hospital, PO Box 9555, 6800 TA, Arnhem, The Netherlands
| | - C J M van Loon
- Department of Orthopaedics, Rijnstate Hospital, PO Box 9555, 6800 TA, Arnhem, The Netherlands
| | - M J van Gorp
- Department of Radiology, Rijnstate Hospital, PO Box 9555, 6800 TA, Arnhem, The Netherlands
| | - M J van Kints
- Department of Radiology, Rijnstate Hospital, PO Box 9555, 6800 TA, Arnhem, The Netherlands
| | - A van Kampen
- Department of Orthopaedics, Radboud University Medical Centre, PO Box 9101, 6501 HB, Nijmegen, The Netherlands
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Voigt JD, Mosier M, Huber B. In-office diagnostic arthroscopy for knee and shoulder intra-articular injuries its potential impact on cost savings in the United States. BMC Health Serv Res 2014; 14:203. [PMID: 24885678 PMCID: PMC4101857 DOI: 10.1186/1472-6963-14-203] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 04/24/2014] [Indexed: 02/04/2023] Open
Abstract
Background The purpose of this analysis was to determine whether in office diagnostic needle arthroscopy (Visionscope Imaging System [VSI]) can provide for improved diagnostic assessment and; more cost effective care. Methods Data on arthroscopy procedures in the US for deep seated pathology in the knee and shoulder were used (Calendar Year 2012). These procedures represent approximately 25-30% of all arthroscopic procedures performed annually. Sensitivities, specificities, positive predictive, and negative predictive values for MRI analysis of this deep seated pathology from systematic reviews and meta-analyses were used in assessing for false positive and false negative MRI findings. The costs of performing diagnostic and surgical arthroscopy procedures (using 2013 Medicare reimbursement amounts); costs associated with false negative findings; and the costs for treating associated complications arising from diagnostic and therapeutic arthroscopy procedures were then assessed. Results In patients presenting with medial meniscal pathology (ICD9CM diagnosis 836.0 over 540,000 procedures in CY 2012); use of the VSI system in place of MRI assessment (standard of care) resulted in a net cost savings to the system of $151 million. In patients presenting with rotator cuff pathology (ICD9CM 840.4 over 165,000 procedures in CY2012); use of VSI in place of MRI similarly saved $59 million. These savings were realized along with more appropriate care as; fewer patients were exposed to higher risk surgical arthroscopic procedures. Conclusions The use of an in-office arthroscopy system can: possibly save the US healthcare system money; shorten the diagnostic odyssey for patients; potentially better prepare clinicians for arthroscopic surgery (when needed) and; eliminate unnecessary outpatient arthroscopy procedures, which commonly result in surgical intervention.
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Somerville L, Bryant D, Willits K, Johnson A. Protocol for determining the diagnostic validity of physical examination maneuvers for shoulder pathology. BMC Musculoskelet Disord 2013; 14:60. [PMID: 23394210 PMCID: PMC3579687 DOI: 10.1186/1471-2474-14-60] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 01/15/2013] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Shoulder complaints are the third most common musculoskeletal problem in the general population. There are an abundance of physical examination maneuvers for diagnosing shoulder pathology. The validity of these maneuvers has not been adequately addressed. We propose a large Phase III study to investigate the accuracy of these tests in an orthopaedic setting. METHODS We will recruit consecutive new shoulder patients who are referred to two tertiary orthopaedic clinics. We will select which physical examination tests to include using a modified Delphi process. The physician will take a thorough history from the patient and indicate their certainty about each possible diagnosis (certain the diagnosis is absent, present or requires further testing). The clinician will only perform the physical examination maneuvers for diagnoses where uncertainty remains. We will consider arthroscopy the reference standard for patients who undergo surgery within 8 months of physical examination and magnetic resonance imaging with arthrogram for patients who do not. We will calculate the sensitivity, specificity and positive and negative likelihood ratios and investigate whether combinations of the top tests provide stronger predictions of the presence or absence of disease. DISCUSSION There are several considerations when performing a diagnostic study to ensure that the results are applicable in a clinical setting. These include, 1) including a representative sample, 2) selecting an appropriate reference standard, 3) avoiding verification bias, 4) blinding the interpreters of the physical examination tests to the interpretation of the gold standard and, 5) blinding the interpreters of the gold standard to the interpretation of the physical examination tests. The results of this study will inform clinicians of which tests, or combination of tests, successfully reduce diagnostic uncertainty, which tests are misleading and how physical examination may affect the magnitude of the confidence the clinician feels about their diagnosis. The results of this study may reduce the number of costly and invasive imaging studies (MRI, CT or arthrography) that are requisitioned when uncertainty about diagnosis remains following history and physical exam. We also hope to reduce the variability between specialists in which maneuvers are used during physical examination and how they are used, all of which will assist in improving consistency of care between centres.
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Affiliation(s)
- Lyndsay Somerville
- Health and Rehabilitation Sciences, Faculty of Health Science, Western University, London, Canada
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A meta-analysis of the diagnostic test accuracy of MRA and MRI for the detection of glenoid labral injury. Arch Orthop Trauma Surg 2012; 132:905-19. [PMID: 22395821 DOI: 10.1007/s00402-012-1493-8] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Indexed: 12/17/2022]
Abstract
PURPOSE Magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) have gained increasing favour in the assessment of patients with suspected glenoid labral injuries. The purpose of this study was to determine the diagnostic accuracy of MRI or MRA in the detection of gleniod labral lesions. MATERIALS AND METHODS A systematic review was undertaken of the electronic databases Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, AMED and CINAHL, in addition to a search of unpublished literature databases. All studies which compared the ability of MRI or MRA (index test) to assess gleniod labral tears or lesions, when verified with a surgical procedure (arthroscopy or open surgery-reference test) were included. Data extraction and methodological appraisal using the QUADAS tool were both conducted by two reviewers independently. Data were analysed through a summary receiver operator characteristic curve and pooled sensitivity and specificity analysis were calculated with 95% confidence intervals. RESULTS Sixty studies including 4,667 shoulders from 4,574 patients were reviewed. There appeared slightly greater diagnostic test accuracy for MRA over MRI for the detection of overall gleniod labral lesions (MRA-sensitivity 88%, specificity 93% vs. MRI sensitivity 76% vs. specificity 87%). Methodologically, studies recruited and identified their samples appropriately and clearly defined the radiological procedures. In general, it was not clearly defined why patients were lost during the study, and studies were poor at recording whether the same clinical data were available to the radiologist interpreting the MRI or MRA as would be available in clinical practice. Most studies did not state whether the surgeon interpreting the arthroscopic procedure was blinded to the results of the MR or MRA imaging. CONCLUSIONS Based on the available literature, overall MRA appeared marginally superior to MRI for the detection of glenohumeral labral lesions. LEVEL OF EVIDENCE Level 2a.
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Value of magnetic resonance arthrography in post-traumatic anterior shoulder instability prior to arthroscopy: a prospective evaluation of MRA versus arthroscopy. Arch Orthop Trauma Surg 2012; 132:371-5. [PMID: 22065145 DOI: 10.1007/s00402-011-1423-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2010] [Indexed: 02/09/2023]
Abstract
PURPOSE This prospective study was designed to evaluate the value of magnetic resonance arthrography (MRA) after traumatic anterior shoulder instability prior to arthroscopy. METHODS Patients included had two or more shoulder dislocations, at least the first being traumatic. MRA images were scored for Hill Sachs lesions, superior labral anterior posterior (SLAP) lesions, rotator cuff tears, glenohumeral ligament (GHL) lesions and Bankart lesions. Consequently, a standardized shoulder arthroscopy was performed. Five surgeons were involved in the study, initially blinded to the MRA results. MRA and arthroscopic findings were compared. Interobserver agreement was calculated by using Cohen's Kappa coefficients (κ). RESULTS Eighteen patients (13 male, 5 female) were included (mean age 26.1 years). Hill Sachs lesions demonstrated fair agreement (κ = 0.33) whereas for SLAP lesions moderate agreement was calculated (κ = 0.43). On MRA, four partial thickness rotator cuff lesions were seen, not being stated by arthroscopy. GHL lesions were described on MRA in 15 patients; only two patients turned out to have GHL lesions at arthroscopy. Two arthroscopically diagnosed Bankart lesions which needed surgical treatment were not detected by MRA (moderate agreement, κ = 0.47). CONCLUSIONS In patients with post-traumatic anterior glenohumeral instability MRA shows many lesions that can not be confirmed by arthroscopy and therefore do not have therapeutical consequences. On the other hand some labral lesions which do need surgical treatment are not detected on MRA. At least from this study, it can be concluded that MRA has limited value prior to the arthroscopic treatment of post-traumatic shoulder instability.
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Houtz CG, Schwartzberg RS, Barry JA, Reuss BL, Papa L. Shoulder MRI accuracy in the community setting. J Shoulder Elbow Surg 2011; 20:537-42. [PMID: 21440460 DOI: 10.1016/j.jse.2011.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 12/22/2010] [Accepted: 01/01/2011] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS/BACKGROUND Evaluate the accuracy for shoulder magnetic resonance imaging (MRI) interpretations of typical community radiologists and compare this to selected fellowship trained musculoskeletal radiologists. METHODS The MRIs of 104 shoulders of 100 consecutive different patients who had undergone shoulder arthroscopy by a single surgeon were included in this prospective study. The 104 typed MRI reports of community radiologists were examined, and the positive or negative findings were recorded for the anterior, superior, and posterior labra, and the long head biceps tendon and rotator cuff. The 104 MRIs were then interpreted by 2 fellowship trained musculoskeletal radiologists who were blinded to the nature of this study. They were asked to specifically comment on the same shoulder pathologies and to subjectively rate the quality of each MRI study using a visual analogue score (VAS). RESULTS The shoulder pathologies documented by arthroscopy included rotator cuff tears (55 full, 10 partial), labral tears (12 anterior, 17 posterior, 29 superior), and 31 biceps abnormalities. There were 69 noncontrast MRIs and 35 MRI arthrograms. Comparing the community radiologists' accuracies with the 2 selected musculoskeletal radiologists' accuracies, there were no significant differences for any of the shoulder pathologies studied. There was a significant positive correlation between VAS and accuracies for both musculoskeletal radiologists in diagnosing posterior labral tears only. The use of contrast in these MRIs only significantly improved both of the musculoskeletal radiologists' accuracies in diagnosing biceps lesions. CONCLUSION The accuracies for shoulder MRI in this community setting were not improved by having the MRIs interpreted by selected fellowship trained musculoskeletal radiologists.
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Superior labral tears: repair versus biceps tenodesis. J Shoulder Elbow Surg 2011; 20:S2-8. [PMID: 21281918 DOI: 10.1016/j.jse.2010.11.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 11/18/2010] [Accepted: 11/20/2010] [Indexed: 02/01/2023]
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Edwards SL, Lee JA, Bell JE, Packer JD, Ahmad CS, Levine WN, Bigliani LU, Blaine TA. Nonoperative treatment of superior labrum anterior posterior tears: improvements in pain, function, and quality of life. Am J Sports Med 2010; 38:1456-61. [PMID: 20522835 DOI: 10.1177/0363546510370937] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although there are multiple reports documenting successful outcomes with operative treatment of superior labrum anterior posterior (SLAP) tears, there are few reports on the results of nonoperative treatment. HYPOTHESIS Nonoperative treatment of SLAP tears will result in improved outcomes over pretreatment values using validated, patient-derived outcome instruments. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 371 patients with a diagnosis of labral tear at our institution were mailed a questionnaire that included the following validated, patient-derived outcome assessment instruments: Short Form 36 (SF-36), European Quality of Life measure (EuroQol), visual analog pain scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, and simple shoulder test (SST). Sixty-six surveys did not reach the patients because of incorrect addresses, and 50 surveys were returned, for a 16.4% (50 of 305) response rate. Of the patients with a clinically documented SLAP lesion (positive O'Brien test, pain at the bicipital groove, and positive magnetic resonance imaging) and sufficient follow-up data (minimum 1 year), 39 patients who met the criteria returned the survey and 19 had nonoperative treatment. Twenty patients (51%) from the overall surveyed group were considered nonoperative treatment failures and had arthroscopic surgical reconstruction. Nonoperative treatment consisted of nonsteroidal anti-inflammatory drugs and a physical therapy protocol focused on scapular stabilization exercises and posterior capsular stretching. Statistical analysis was performed using the paired t test; values of P < .05 were considered significant. RESULTS At an average follow-up of 3.1 years, function improved significantly (ASES function 30.8 to 45.0 [P < .001]; ASES total 58.5 to 84.7 [P = .001], SST 8.3 to 11.0 [P = .02]) in those patients with successful nonoperative treatment. Quality of life also improved after treatment (EuroQol 0.76 to 0.89, P = .009). Pain relief was significant, as VAS pain scores decreased from 4.5 to 2.1 (P = .043). All patients with successful nonoperative treatment returned to sports. Seventy-one percent of all athletes were able to return to preparticipation levels, but only 66% of overhead athletes returned to their sport at the same or higher level. CONCLUSION Using validated, patient-derived outcome instruments, the present study shows that successful nonoperative treatment of superior labral tears results in improved pain relief and functional outcomes compared with pretreatment assessments. Although 20 patients (51%) in this group elected surgery and may be considered nonoperative treatment failures, those patients with successful nonoperative treatment had significant improvements in pain, function, and quality of life. Return to sports was comparable with patients with successful surgical treatment, although return to overhead sports at the same level was difficult to achieve (66%). Based on these findings, a trial of nonoperative treatment may be considered in patients with the diagnosis of isolated superior labral tear. In overhead athletes and in those patients where pain relief and functional improvement is not achieved, surgical treatment should be considered.
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Theodoropoulos JS, Andreisek G, Harvey EJ, Wolin P. Magnetic resonance imaging and magnetic resonance arthrography of the shoulder: dependence on the level of training of the performing radiologist for diagnostic accuracy. Skeletal Radiol 2010; 39:661-7. [PMID: 19826811 DOI: 10.1007/s00256-009-0811-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Revised: 09/23/2009] [Accepted: 09/24/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE Discrepancies were identified between magnetic resonance (MR) imaging and clinical findings in patients who had MR imaging examinations evaluated by community-based general radiologists. The purpose of this study was to evaluate the diagnostic performance of MR imaging examinations of the shoulder with regard to the training level of the performing radiologist. METHODS A review of patient charts identified 238 patients (male/female, 175/63; mean age, 40.4 years) in whom 250 arthroscopies were performed and who underwent MR imaging or direct MR arthrography in either a community-based or hospital-based institution prior to surgery. All MR imaging and surgical reports were reviewed and the diagnostic performance for the detection of labral, rotator cuff, biceps, and Hill-Sachs lesions was determined. Kappa and Student's t test analyses were performed in a subset of cases in which initial community-based MR images were re-evaluated by hospital-based musculoskeletal radiologists, to determine the interobserver agreement and any differences in image interpretation. RESULTS The diagnostic performance of community-based general radiologists was lower than that of hospital-based sub-specialized musculoskeletal radiologists. A sub-analysis of re-evaluated cases showed that musculoskeletal radiologists performed better. kappa values were 0.208, 0.396, 0.376, and 0.788 for labral, rotator cuff, biceps, and Hill-Sachs lesions (t test statistics: p = <0.001, 0.004, 0.019, and 0.235). CONCLUSIONS Our results indicate that the diagnostic performance of MR imaging and MR arthrography of the shoulder depends on the training level of the performing radiologist, with sub-specialized musculoskeletal radiologists having a better diagnostic performance than general radiologists.
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Affiliation(s)
- John S Theodoropoulos
- Division of Orthopaedics, Mount Sinai Hospital and the University Health Network, University of Toronto, Room 476c, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
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McFarland EG, Tanaka MJ, Garzon-Muvdi J, Jia X, Petersen SA. Clinical and imaging assessment for superior labrum anterior and posterior lesions. Curr Sports Med Rep 2009; 8:234-9. [PMID: 19741350 DOI: 10.1249/jsr.0b013e3181b7f042] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In the evaluation of the painful shoulder, especially in the overhead athlete, diagnosing superior labrum anterior and posterior (SLAP) lesions continues to challenge the clinician because of 1) the lack of specificity of examination tests for SLAP; 2) a paucity of well-controlled studies of those tests; and 3) the presence of coexisting confounding abnormalities. Some evidence indicates that multiple positive tests increase the likelihood that a SLAP lesion is present, but no one physical examination finding conclusively makes that diagnosis. The goals of this article were to review the physical examination techniques for making the diagnosis of SLAP lesions, to evaluate the clinical usefulness of those examinations, and to review the role of magnetic resonance imaging in making the diagnosis.
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Affiliation(s)
- Edward G McFarland
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA.
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Gates ME, Kou JX, Demetropoulos CK, Jurist KA, Guettler JH. Effects of zone-specific superior labral detachment on biceps anchor stability. Am J Sports Med 2009; 37:2445-50. [PMID: 19776338 DOI: 10.1177/0363546509343468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE This study aimed to elucidate the degree of biceps anchor displacement that occurs when specific zones of the superior labrum are detached from the glenoid. STUDY DESIGN Descriptive laboratory study. METHODS Twelve cadaveric scapulae with intact labrums were prepared by removing the surrounding musculature with the labrum, biceps anchor, and biceps tendon carefully preserved. Pulleys were used to apply traction in 3 different directions- superior, lateral, and combined posterior/superior/lateral, to simulate the "peel-back" mechanism-while a continuous 1.13 kg of traction was applied to the biceps tendon. Labral tears were created by sharp incisions in isolation and in combinations of 3 zones defined relative to the glenoid fossa: anterior, posterior, or superior. The displacement of the biceps anchor (position of the marker after the simulated lesion relative to the marker position with the labrum intact) was measured relative to a rigid reference frame. RESULTS The greatest degree of displacement occurred with the sectioning of all 3 zones, followed by the sectioning of 2 adjacent zones. Superior traction created the least displacement in all combinations, while lateral traction created maximal displacement, with one exception: in the setting of anterosuperior/superior lesions, maximal displacement was observed using the peel-back mechanism. CONCLUSION Biceps anchor displacement, particularly the degree and direction of displacement, is affected by the labral detachment pattern. All 3 labral zones assessed in this study have important biomechanical contributions to biceps anchor displacement. CLINICAL SIGNIFICANCE These findings have important implications relating to the clinician's arthroscopic assessment of superior labrum anterior and posterior (SLAP) tears, as well as the determination of need for stabilization. This information is particularly useful when treating SLAP tears in certain laborers and athletes, whose activities may cause specific biceps anchor displacement patterns.
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Affiliation(s)
- Megan E Gates
- Harold W. Gehring Center for Biomechanics and Implant Analysis, William Beaumont Hospital, Research Institute, Royal Oak, Michigan, USA
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Lin E. Magnetic Resonance Arthrography of Superior Labrum Anterior-Posterior Lesions: A Practical Approach to Interpretation. Curr Probl Diagn Radiol 2009; 38:91-7. [DOI: 10.1067/j.cpradiol.2008.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Superior labral anterior-posterior (SLAP) tears: recent advances and outcomes. CURRENT ORTHOPAEDIC PRACTICE 2008. [DOI: 10.1097/bco.0b013e3282ff8b5b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Park JH, Lee YS, Wang JH, Noh HK, Kim JG. Outcome of the isolated SLAP lesions and analysis of the results according to the injury mechanisms. Knee Surg Sports Traumatol Arthrosc 2008; 16:511-5. [PMID: 18193193 DOI: 10.1007/s00167-007-0482-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Accepted: 12/04/2007] [Indexed: 01/02/2023]
Abstract
Superior labral anterior posterior (SLAP) lesions of the shoulder arise from various causes and have some controversies in their treatment. The purpose of this study is to evaluate the outcomes of arthroscopic SLAP repair and the relationship between injury mechanisms and outcomes. We evaluated the clinical results of 24 patients (mean 33 months follow-up) who had an arthroscopic isolated SLAP (type II: 21, type III: 1, type IV: 2 patients) repair with suture anchors. These labral tears were arthroscopically repaired with 1-4 anchors (mean 1.8). All patients were evaluated with University of California, Los Angeles (UCLA) and Visual Analogue Scale (VAS) scores. There were the following injury mechanisms: compression-type, 10; traction-type, 9; combined or other-type, 5 patients. We also compared the clinical results according to the injury mechanisms. Preoperatively, the mean of UCLA and VAS scores were 22.7 and 6.4 points, respectively. At an average of 33 months postoperatively, the mean of UCLA and VAS scores were 29.9 and 2.1 points, respectively. There was statistical improvement in the subjective scores from the pre- to post-operation. UCLA and VAS scores of the pre- and post-operation were not statistically different according to the injury mechanisms. Arthroscopic repair is effective in the treatment of isolated SLAP lesion and injury mechanisms do not affect the clinical outcomes.
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Affiliation(s)
- Jung Ho Park
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 516 Gozan-1-dong, Danwon-gu, Ansan 425-707, Republic of Korea
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Pandya NK, Colton A, Webner D, Sennett B, Huffman GR. Physical examination and magnetic resonance imaging in the diagnosis of superior labrum anterior-posterior lesions of the shoulder: a sensitivity analysis. Arthroscopy 2008; 24:311-7. [PMID: 18308183 DOI: 10.1016/j.arthro.2007.09.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2007] [Revised: 08/31/2007] [Accepted: 09/06/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE The overall purpose of our study was to examine the sensitivity of physical examination, magnetic resonance imaging (MRI), and magnetic resonance (MR) arthrogram for the identification of arthroscopically confirmed SLAP lesions of the shoulder. METHODS An analysis of 51 consecutive patients with arthroscopically confirmed SLAP lesions and no history of shoulder dislocation was performed. Before undergoing surgery, all patients underwent a standardized physical examination and had either an MRI and/or MR arthrogram performed. Sensitivity analysis was then performed on the results of both the physical examination maneuvers and the radiologic imaging compared to the arthroscopic findings at surgery. RESULTS The sensitivity of O'Brien's (active compression) test was 90%, whereas the Mayo (dynamic) shear was 80% and Jobe's relocation test was 76%. The sensitivity of a physical examination with any 1 of these 3 SLAP provocative tests being positive was 100%. Neer's sign (41%) and Hawkin's impingement tests (31%) each had low sensitivity for SLAP lesions. The sensitivity of MRI for SLAP lesions was 67% when interpreted by the performing surgeon, 53% when read by a radiologist. When the MR arthrograms were analyzed alone, the sensitivity was 72% (surgeon) and 50% (radiologist), respectively. CONCLUSIONS All 3 physical examination maneuvers traditionally considered provocative for SLAP pathology (O'Brien's, Mayo shear, and Jobe's relocation) were sensitive for the diagnosis of SLAP lesions. MRI and MR arthrogram imaging had lower sensitivity than these physical examination tests in diagnosing SLAP lesions. Patient history, demographics, and the surgeon's physical examination should remain central to the diagnosis of SLAP lesions. LEVEL OF EVIDENCE Level II, development of diagnostic criteria on basis of consecutive patients with universally applied gold standard.
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Affiliation(s)
- Nirav K Pandya
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA
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