1
|
Christopher HW, Grainger AJ. Anterior Shoulder Instability. Semin Musculoskelet Radiol 2022; 26:546-557. [DOI: 10.1055/s-0042-1756168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AbstractThe anatomy of the glenohumeral joint prioritizes mobility at the expense of stability and thus predisposes it to injury through dislocation. This article discusses the anatomical basis for instability and how it translates into patterns of injury, focusing on anterior instability. We suggest an approach to imaging the unstable shoulder and examine the imaging features seen in the context of anterior instability, along with consideration of postoperative appearances.
Collapse
Affiliation(s)
- Holly W. Christopher
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Andrew J. Grainger
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| |
Collapse
|
2
|
Ugas MA, Huynh BH, Fox MG, Patrie JT, Gaskin CM. MR Arthrography: Impact of Steroids, Local Anesthetics, and Iodinated Contrast Material on Gadolinium Signal Intensity in Phantoms at 1.5 and 3.0 T. Radiology 2014; 272:475-83. [DOI: 10.1148/radiol.14132352] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
3
|
Anterior Glenohumeral Instability: Classification of Pathologies of Anteroinferior Labroligamentous Structures Using MR Arthrography. Adv Orthop 2013; 2013:473194. [PMID: 24198968 PMCID: PMC3807713 DOI: 10.1155/2013/473194] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 09/13/2013] [Indexed: 11/18/2022] Open
Abstract
We examined labroligamentous structures in unstable anteroinferior glenohumeral joints using MR arthrography (MRA) to demonstrate that not all instabilities are Bankart lesions. We aimed to show that other surgical protocols besides classic Bankart repair are appropriate for labroligamentous lesions. The study included 35 patients (33 males and 2 females; mean age: 30.2; range: 18 to 57 years). MRA was performed in all patients. The lesions underlying patients' instability such as Bankart, anterior labral periosteal sleeve avulsion (ALPSA), and Perthes lesions were diagnosed by two radiologists. MRA yielded 16 diagnoses of Bankart lesions, 5 of ALPSA lesions, and 14 of Perthes lesions. Albeit invasive, MRA seems to be a more reliable and accurate diagnostic imaging modality for the classification and treatment of instabilities compared to standard MRI.
Collapse
|
4
|
MDCT arthrography of the shoulder with datasets of isotropic resolution: indications, technique, and applications. AJR Am J Roentgenol 2012; 198:635-46. [PMID: 22358004 DOI: 10.2214/ajr.11.7078] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The purposes of this review are to summarize the indications for MDCT arthrography of the shoulder, highlight the features of MDCT acquisition, and describe the normal and abnormal MDCT arthrographic appearances of the shoulder. CONCLUSION MDCT arthrography is a valid alternative for shoulder imaging of patients with contraindications to MRI or after failed MRI. MDCT arthrography is accurate for assessment of a variety of shoulder abnormalities and, with further validation, may become the imaging test of choice for evaluation of the postoperative shoulder.
Collapse
|
5
|
|
6
|
Domenech E, Berná-Serna JDD, Polo L, Reus M, Berná-Mestre JDD, Canteras M. Effect of SonoVue on the synovial membrane in rabbit knees. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:1241-1246. [PMID: 21876095 DOI: 10.7863/jum.2011.30.9.1241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the effect of intra-articular injection of SonoVue (sulfur hexafluoride with a phospholipid shell; Bracco SpA, Milan, Italy) on the synovial membrane in an animal model. METHODS Twenty-one New Zealand White rabbits (42 knees) were used in this study. We injected the knees with normal saline (saline group; n = 21) and SonoVue (SonoVue group; n = 21). A histologic examination of the knees was performed out at 3 and 12 hours and 3, 7, 15, 30, and 45 days after injection. Four histologic parameters (synovial hyperplasia, synovial stroma, vascular dilatation, and inflammatory infiltrates) were graded separately. RESULTS We found no significant differences in this study for synovial hyperplasia, vascular dilatation, or inflammatory infiltrates between the saline and SonoVue groups. A significant difference was only observed for synovial stroma (P < .05), and most of the histologic changes were mild in the saline group and moderate in the SonoVue group. The histologic changes observed in this study are considered transitory and reversible. CONCLUSIONS The results suggest that intra-articular injection of SonoVue is a safe procedure.
Collapse
Affiliation(s)
- Ernesto Domenech
- Department of Radiology, Virgen de la Arrixaca University Hospital, 30120 El Palmar, Murcia, Spain
| | | | | | | | | | | |
Collapse
|
7
|
Shang Y, Zheng ZZ, Li X. Direct MR arthrography of the shoulder at 3 tesla: Optimization of gadolinium concentration. J Magn Reson Imaging 2009; 30:229-35. [DOI: 10.1002/jmri.21828] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
8
|
MR Arthrography of the Shoulder Using an Anterior Approach: Optimal Injection Site. AJR Am J Roentgenol 2008; 191:1397-400. [DOI: 10.2214/ajr.08.1014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
9
|
AGNELLO KIMBERLYA, PUCHALSKI SARAHM, WISNER ERIKR, SCHULZ KURTS, KAPATKIN AMYS. EFFECT OF POSITIONING, SCAN PLANE, AND ARTHROGRAPHY ON VISIBILITY OF PERIARTICULAR CANINE SHOULDER SOFT TISSUE STRUCTURES ON MAGNETIC RESONANCE IMAGES. Vet Radiol Ultrasound 2008; 49:529-39. [DOI: 10.1111/j.1740-8261.2008.00429.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
10
|
Andreisek G, Froehlich JM, Hodler J, Weishaupt D, Beutler V, Pfirrmann CWA, Boesch C, Nanz D. Direct MR arthrography at 1.5 and 3.0 T: signal dependence on gadolinium and iodine concentrations--phantom study. Radiology 2008; 247:706-16. [PMID: 18403628 DOI: 10.1148/radiol.2473071013] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively quantify in vitro the influence of gadopentetate dimeglumine and ioversol on the magnetic resonance (MR) imaging signal observed with a variety of musculoskeletal pulse sequences to predict optimum gadolinium concentrations for direct MR arthrography at 1.5 and 3.0 T. MATERIALS AND METHODS In an in vitro study, T1 and T2 relaxation times of three dilution series of gadopentetate dimeglumine (concentration, 0-20.0 mmol gadolinium per liter) at ioversol concentrations with iodine concentration of 0, 236.4, and 1182 mmol iodine per liter (corresponding to 0, 30, and 150 mg of iodine per milliliter) were measured at 1.5 and 3.0 T. The relaxation rate dependence on concentrations of gadolinium and iodine was analytically modeled, and continuous profiles of signal versus gadolinium concentration were calculated for 10 pulse sequences used in current musculoskeletal imaging. After fitting to experimental discrete profiles, maximum signal-to-noise ratio (SNR), gadolinium concentration with maximum SNR, and range of gadolinium concentration with 90% of maximum SNR were derived. The overall influence of field strength and iodine concentration on these parameters was assessed by using t tests. The deviation of simulated from experimental signal-response profiles was assessed with the autocorrelation of the residuals. RESULTS The model reproduced relaxation rates of 0.37-38.24 sec(-1), with a mean error of 4.5%. Calculated SNR profiles matched the discrete experimental profiles, with autocorrelation of the residuals divided by the mean of less than 5.0. Admixture of ioversol consistently reduced T1 and T2, narrowed optimum gadolinium concentration ranges (P = .004-.006), and reduced maximum SNR (P < .001 to not significant). Optimum gadolinium concentration was 0.7-3.4 mmol/L at both field strengths. At 3.0 T, maximum SNR was up to 75% higher than at 1.5 T. CONCLUSION Admixture of ioversol to gadopentetate dimeglumine solutions results in a consistent additional relaxation enhancement, which can be analytically modeled to allow a near-quantitative a priori optimized match of contrast media concentrations and imaging protocol for a broad variety of pulse sequences.
Collapse
Affiliation(s)
- Gustav Andreisek
- Institute for Diagnostic Radiology and Department of Medical Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Noël C, Campagna R, Minoui A, Thévenin F, Richarme D, Feydy A, Guérini H, Drapé JL, Chevrot A. Fissures du labrum glénoïdal postérieur et lésions associées de l’épaule : une étude en arthroscanner. ACTA ACUST UNITED AC 2008; 89:487-93. [DOI: 10.1016/s0221-0363(08)71452-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
12
|
Andreisek G, Duc SR, Froehlich JM, Hodler J, Weishaupt D. MR arthrography of the shoulder, hip, and wrist: evaluation of contrast dynamics and image quality with increasing injection-to-imaging time. AJR Am J Roentgenol 2007; 188:1081-8. [PMID: 17377051 DOI: 10.2214/ajr.06.0719] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to investigate the contrast dynamics and the relationship between visualization of intraarticular structures and time elapsed between intraarticular injection of contrast agent and MRI in symptomatic patients referred for MR arthrography of the shoulder, hip, and wrist. SUBJECTS AND METHODS Our local ethics committees and the national drug administration approved this multicentric study. We prospectively studied 11 shoulders, 11 hips, and 10 wrists. After the intraarticular gadolinium injection, patients underwent a baseline MR arthrography protocol (time point [TP] 1) and subsequent MRI at another four time points (TP 2-TP 5) up to 240 minutes. The course of contrast-to-noise ratio (CNR) over time was calculated. Three observers assessed the degree of visualization of different intraarticular structures and the overall image quality at each time point using a 3-point scale and a 5-point scale, respectively. RESULTS For all joints, CNR measurements showed peak CNR at TP 1 (21 minutes) and TP 2 (45 minutes) with a subsequent, near-logarithmic decline of CNR values over time. Visualization of different anatomic structures decreased over time. Overall image quality was insufficient for diagnostic purposes at TP 3 (96 minutes) in three (27%) of 11 shoulders and in three (27%) of 11 hips. In two (20%) of 10 wrists, image quality was insufficient at TP 2 (45 minutes). CONCLUSION For MR arthrography, the degree of visualization of intraarticular structures depends on the time elapsed between contrast injection and MRI. MR arthrography of the shoulder and hip should be performed within 90 minutes, and MR arthrography of the wrist should be performed within 45 minutes, after intraarticular injection.
Collapse
Affiliation(s)
- Gustav Andreisek
- Institute for Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | | | | | | | | |
Collapse
|
13
|
Ganguly A, Gold GE, Butts Pauly K, Mayer D, Moseley MM, Pelc NJ, Fahrig R. Quantitative evaluation of the relaxivity effects of iodine on GD-DTPA enhanced MR arthrography. J Magn Reson Imaging 2007; 25:1219-25. [PMID: 17520728 DOI: 10.1002/jmri.20934] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To quantify the effect of iodine on the gadolinium (Gd) contrast-enhanced signal in MR arthrography. MATERIALS AND METHODS Saline solutions of Gd contrast agent (0-1 mmol/liter) were mixed with iodinated contrast agent (0-185 mmol/liter). The T1 and T2 relaxation constants of these solutions were measured at 1.5T. Different types of commonly used iodinated contrast agents as well as sodium iodide (NaI) solutions were also analyzed. RESULTS Iodine caused significant T2 shortening and some T1 shortening in Gd contrast solutions. Both contrast agents independently obeyed the standard relaxation relation, and their mixture obeyed a modified version of this relation. The side chains in various iodine molecules and their viscosities affected the relaxation properties differently. For various spin-echo (SE) sequences, the signal from synovial fluid containing different concentrations of the two contrast agents was calculated. The T2-weighted signal appeared to be most affected by the increase in iodine concentrations. In the absence of Gd contrast, all SE sequences showed an initial increase in signal from iodine contrast. CONCLUSION A generalized relation for the relaxivities of Gd contrast in the presence of iodine was established. The side chains of iodine contrast were found to alter the relaxivities of Gd contrast. Imaging with proton density (PD)-weighted SE with only iodine contrast agent was found to be feasible.
Collapse
Affiliation(s)
- Arundhuti Ganguly
- Lucas MRS Center, Department of Radiology, Stanford University, 1201 Welch Road, Stanford, CA 94305, USA.
| | | | | | | | | | | | | |
Collapse
|
14
|
Provencher MT, King S, Solomon DJ, Bell SJ, Mologne TS. Recurrent Posterior Shoulder Instability: Diagnosis and Management. OPER TECHN SPORT MED 2005. [DOI: 10.1053/j.otsm.2006.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
15
|
Masi JN, Newitt D, Sell CA, Daldrup-Link H, Steinbach L, Majumdar S, Link TM. Optimization of gadodiamide concentration for MR arthrography at 3 T. AJR Am J Roentgenol 2005; 184:1754-61. [PMID: 15908526 DOI: 10.2214/ajr.184.6.01841754] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to determine the optimal concentration of a gadolinium-based contrast agent (gadodiamide) for direct MR arthrography at 3 T compared with 1.5 T in an in vitro study. CONCLUSION Optimized concentrations of gadolinium-based contrast agents for MR arthrography are similar at 3 and 1.5 T, although a slightly greater dilution may be useful at 3 T. Signal-to-noise ratio peak levels are significantly reduced by adding an iodinated contrast agent, relatively significantly more at 3 T than at 1.5 T.
Collapse
Affiliation(s)
- Jeffrey N Masi
- Department of Radiology, University of California, San Francisco, 400 Parnassus Ave., A 367, Box 0628, San Francisco, CA 94143-0628, USA
| | | | | | | | | | | | | |
Collapse
|
16
|
Chung CB, Isaza IL, Angulo M, Boucher R, Hughes T. MR Arthrography of the Knee: How, Why, When. Radiol Clin North Am 2005; 43:733-46, viii-ix. [PMID: 15893534 DOI: 10.1016/j.rcl.2005.02.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
MR arthrography combines the techniques of arthrography with MR imaging to benefit from the added imaging information afforded by intra-articular distention. This article reviews technical considerations for MR arthrography, potential complications, indications, pitfalls in imaging diagnosis, and commonly encountered pathology. It is an elegant study that can offer precise diagnostic information in the appropriate clinical setting.
Collapse
Affiliation(s)
- Christine B Chung
- Department of Radiology, University of California San Diego and Veterans Affairs Healthcare System, 3350 La Jolla Village Drive, La Jolla, CA 92161, USA.
| | | | | | | | | |
Collapse
|
17
|
Affiliation(s)
- Christine B Chung
- University of California-San Diego and Veterans Affairs Health Care Services-San Diego, 3350 La Jolla Village Drive, La Jolla, CA 92161, USA.
| | | | | |
Collapse
|
18
|
Abstract
Lesions leading to glenohumeral instability may result from acute trauma, atraumatic laxity, or repetitive microtrauma. Athletic activities, especially overhead throwing, may lead to a series of lesions involving the stabilizing structures of the shoulder. The resultant injuries and pathomechanics leading to shoulder symptoms can be classified as primary disease, primary instability, acute traumatic instability, and posterosuperior impingment syndrome. MR imaging with or without intrarticular or intravenous injection of contrast material, along with clinical examination and stress testing, provides valuable preoperative assessment.
Collapse
Affiliation(s)
- Javier Beltran
- Department of Radiology, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219, USA.
| | | |
Collapse
|
19
|
Montgomery DD, Morrison WB, Schweitzer ME, Weishaupt D, Dougherty L. Effects of iodinated contrast and field strength on gadolinium enhancement: implications for direct MR arthrography. J Magn Reson Imaging 2002; 15:334-43. [PMID: 11891980 DOI: 10.1002/jmri.10065] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To optimize direct magnetic resonance (MR) arthrography by determining the effect of dilution of gadolinium in iodinated contrast, saline, or albumin on T1-weighted, T2-weighted, and gradient-recalled echo (GRE) images, and the effect of scanner field strength. MATERIALS AND METHODS Gadopentetate dimeglumine was diluted into normal saline, albumin, or iodinated contrast (0.625 mmol/liter to 40 mmol/liter). Samples were scanned at 1.5T and 0.2T. Signal intensity was measured using T1-weighted spin-echo (SE), T2-weighted SE, and two- and three-dimensional GRE (20 degrees-75 degrees flip angle) sequences. Graphical analysis of signal intensity vs. gadolinium concentration was performed. RESULTS Albumin had no effect on gadolinium contrast. Dilution of gadolinium in iodinated contrast decreased signal intensity on all sequences compared to samples of identical concentration diluted in saline at both 1.5T and 0.2T: with a 2 mmol/liter gadolinium solution at 1.5T, signal was decreased by 26.1% on T1-weighted images, 31.7% on GRE20 images, and 28.9% on GRE45 images, and the T2 value decreased by 71.1%; at 0.2T, signal was decreased by 23.5% on T1-weighted images. On all sequences, the peak signal shifted to the left (lower gadolinium concentration) when diluted in iodinated contrast. Peak signal was also seen at different gadolinium concentrations on different sequences and field strength: at 1.5T, peak in saline/iodine was 2.5/0.625 mmol/liter on T1-weighted images, and 2.5/1.25 mmol/liter on GRE20 and GRE45 sequences. At 0.2T, peak in saline/iodine was 0.625-2.5/1.25 mmol/liter on T1-weighted images, 0.625-2.5/1.25 on GRE45 images, 2.5-10.0/1.25-5.0 mmol/liter on GRE65 images, and 1.25-5.0/0.625-1.25 mmol/liter on GRE75 images. CONCLUSION Dilution of gadolinium in iodinated contrast results in decreased signal on T1-weighted, T2-weighted, and GRE images compared to dilution in saline or albuminfor both 1.5-T and 0.2-T scanners; if gadolinium is diluted in iodinated contrast for MR arthrography, a lower concentration should be used because the peak is shifted to the left. The use of iodinated contrast should be minimized, as it may diminish enhancement and lower the sensitivity and specificity of MR arthrography. Optimal gadolinium concentration for MR arthrography is dependent on scanner field strength and a broader range of gadolinium concentration can be used to provide maximal signal at low field strength.
Collapse
Affiliation(s)
- Douglas D Montgomery
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | | | | | | |
Collapse
|
20
|
Karantanas A. Comments on Zanetti et al.: MR arthrographic variability of the arthroscopically normal glenoid labrum: qualitative and quantitative assessment. Eur Radiol 2002; 12:491. [PMID: 11870455 DOI: 10.1007/s003300101133] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
21
|
Abstract
PURPOSE As imaging delays during MR arthrography can result in suboptimal studies and potential pitfalls in diagnosis, we sought to evaluate the temporal behavior of intraarticular Gd-DTPA. METHOD We prospectively studied four shoulders, four knees, and four hips. Two of each group received either an intraarticular injection of 3 mmol/L Gd-DTPA and iodinated contrast medium or 2 mmol/L Gd-DTPA and 0.9% saline. We measured contrast-to-noise ratio (CNR) and joint distention on serial T1-weighted sequences. Retrospectively, we measured CNR and imaging delays in 31 MR arthrography patients (20 shoulders, 7 knees, and 4 hips). RESULTS In the shoulder, maximal CNR and joint distention occurred at 15 min. CNR decreased 53% by 1 h. In the knee, maximal distention occurred at 1 h, whereas CNR peaked at 2.75 h and then declined 20 and 86% by 3.5 and 6.25 h, respectively. In the hip, peak CNR and distention occurred at 0.5 h. CNR declined 53% by 2 h. Both contrast mixtures yielded similar results. CONCLUSION MR arthrography may tolerate imaging delays of 1 h for the shoulder, 2 h for the hip, and 3.5 h for the knee.
Collapse
Affiliation(s)
- S C Wagner
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
| | | | | |
Collapse
|
22
|
Abstract
The important role played by the rotator cuff in the stability and movement of the glenohumeral joint make it susceptible to damage and injury in patients of all age groups. A number of extrinsic and intrinsic mechanisms have been described for the development of rotator cuff disease, although it is more likely that the actual etiology in any one individual is multifactorial. The key to successful management in a particular patient is an accurate diagnosis of the underlying cause by thorough clinical examination and the use of appropriate investigations. The mainstay of treatment of patients with rotator cuff disease is nonoperative. Surgical intervention is usually considered only after failure of at least 6 months of conservative therapy. However, there are a few situations where early surgical intervention is indicated.
Collapse
Affiliation(s)
- G Tytherleigh-Strong
- Sports Medicine Program, Division of Orthopaedics, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | | |
Collapse
|
23
|
Brenner ML, Morrison WB, Carrino JA, Nusser CA, Sanders TG, Howard RF, Meier P. Direct MR arthrography of the shoulder: is exercise prior to imaging beneficial or detrimental? Radiology 2000; 215:491-6. [PMID: 10796930 DOI: 10.1148/radiology.215.2.r00ma14491] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To define the beneficial and detrimental effects of adding exercise to direct magnetic resonance (MR) shoulder arthrography. MATERIALS AND METHODS Direct, intraarticular, gadolinium arthrography of the shoulder was performed in 41 patients, who underwent 1.5-T MR imaging before and after 1 minute of arm swinging. Fourteen milliliters of dilute gadolinium solution was injected. Two readers blinded to exercise independently graded the randomly distributed images with a five-point scale for capsular contrast material resorption; extraarticular contrast material leakage; rotator cuff, glenoid labrum, and anterior capsule conspicuity; and partial-thickness or full-thickness rotator cuff tear and labral tear detectability. The sign test was performed to evaluate the significance of differences between preexercise and postexercise grading for each reader. A second review was performed, with direct side-by-side comparison of preexercise and postexercise images. RESULTS There was evidence of increased capsular resorption after exercise but no alteration in the depiction of the rotator cuff tendons or glenoid labrum. There was no significant extraarticular contrast material leakage after exercise and no alteration in depiction of the anterior capsule. There was no difference in the detectability of rotator cuff or labral tears. CONCLUSION Exercise with direct shoulder MR arthrography has no beneficial or detrimental effect on image quality or on the depiction of rotator cuff or labral tears.
Collapse
Affiliation(s)
- M L Brenner
- Department of Radiology, Orthopedic Surgery, Wilford Hall Medical Center, 759th MDTS/MTRD, 2200 Bergquist Dr, Suite 1, Lackland AFB, TX 78236-5300, USA
| | | | | | | | | | | | | |
Collapse
|