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Mardani-Kivi M, Alizadeh A, Asadi K, Izadi A, Leili EK, arzpeyma SF. Can indirect magnetic resonance arthrography be a good alternative to magnetic resonance imaging in diagnosing glenoid labrum lesions?: a prospective study. Clin Shoulder Elb 2022; 25:182-187. [PMID: 35791684 PMCID: PMC9471823 DOI: 10.5397/cise.2021.00598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/07/2021] [Indexed: 12/02/2022] Open
Abstract
Background This study was designed to evaluate and compare the diagnostic value of magnetic resonance imaging (MRI) and indirect magnetic resonance arthrography (I-MRA) imaging with those of arthroscopy and each other. Methods This descriptive-analytical study was conducted in 2020. All patients who tested positive for labrum lesions during that year were included in the study. The patients underwent conservative treatment for 6 weeks. In the event of no response to conservative treatment, MRI and I-MRA imaging were conducted, and the patients underwent arthroscopy to determine their ultimate diagnosis and treatment plan. Imaging results were assessed at a 1-week interval by an experienced musculoskeletal radiologist. Image interpretation results and arthroscopy were recorded in the data collection form. Results Overall, 35 patients comprised the study. Based on the kappa coefficient, the results indicate that the results of both imaging methods are in agreement with the arthroscopic findings, but the I-MRA consensus rate is higher than that of MRI (0.612±0.157 and 0.749±0.101 vs. 0.449±0.160 and 0.603±0.113). The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of MRI in detecting labrum tears were77.77%, 75.00%, 91.30%, 50.00%, and 77.14%, respectively, and those of I-MRA were 88.88%, 75.00%, 92.30%, 66.66%, and 85.71%. Conclusions Here, I-MRA showed higher diagnostic value than MRI for labral tears. Therefore, it is recommended that I-MRA be used instead of MRI if there is an indication for potential labrum lesions.
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Rotem G, Haziza S, Tenenbaum S, Thein R. MRA for SLAP - Is the threshold for referral too low? J Orthop 2020; 19:199-202. [PMID: 32055147 DOI: 10.1016/j.jor.2019.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/30/2019] [Indexed: 11/16/2022] Open
Affiliation(s)
- Gilad Rotem
- Department of Orthopedic Surgery, Chaim Sheba Medical Center at Tel Hashomer, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Sagie Haziza
- Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Shay Tenenbaum
- Department of Orthopedic Surgery, Chaim Sheba Medical Center at Tel Hashomer, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Ran Thein
- Department of Orthopedic Surgery, Chaim Sheba Medical Center at Tel Hashomer, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel
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Davis C, Immormino J, Higgins BM, Clark K, Engebose S, Garcia AN, Cook CE. Diagnostic utility of the Active Compression Test for the superior labrum anterior posterior tear: A systematic review. Shoulder Elbow 2019; 11:321-331. [PMID: 31534482 PMCID: PMC6739753 DOI: 10.1177/1758573218811656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/02/2018] [Accepted: 10/10/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND The Active Compression Test has been proposed to have high diagnostic accuracy for superior labrum anterior to posterior tears. The aim of this systematic review was to compile the available evidence for this test and evaluate its diagnostic accuracy. METHODS The databases PubMed, Embase, Cochrane, CINAHL, and SCOPUS were searched for case control, diagnostic studies that evaluated the Active Compression Test between 1999 (date of test introduction) and February 2018. Two independent review authors screened the search results, assessed the risk of bias using QUADAS-2, and extracted the data. RESULTS Eighteen studies (pooled sample = 3091) were included in this review. Twelve out of 18 studies either had high or unclear risk of bias (66.6%). Results from the pooled analysis of all 18 studies provided that the Active Compression Test is more sensitive (71.5: 95% CI = 68.8, 74.0) than specific (51.9: 95% CI = 50.7, 53.1) and only marginally influenced posttest probability from a pretest probability of 31.7-40.72% with a positive finding and a pretest probability of 31.7-20.33% with a negative finding. DISCUSSION The Active Compression Test has both limited screening and confirmation ability; therefore, we do not advocate for its use in clinical decision making.
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Affiliation(s)
- Cody Davis
- Division of Physical Therapy, Duke
University, Durham, USA
| | | | | | - Kyle Clark
- Division of Physical Therapy, Duke
University, Durham, USA
| | | | - Alessandra N Garcia
- Division of Physical Therapy, Duke
University, Durham, USA,Department of Orthopaedic Surgery,
Division of Physical Therapy, Duke University, Durham, USA,Alessandra N Garcia, PT 2200 W. Main St.,
Suite A210, Durham, NC 27705, USA.
| | - Chad E Cook
- Division of Physical Therapy, Duke
University, Durham, USA,Duke Clinical Research Institute, Duke
University, Durham, USA
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Magnetic resonance-guided direct shoulder arthrography for the detection of superior labrum anterior-posterior lesions using an open 1.0-T MRI scanner. Pol J Radiol 2019; 84:e251-e257. [PMID: 31481997 PMCID: PMC6717947 DOI: 10.5114/pjr.2019.86894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 04/23/2019] [Indexed: 11/26/2022] Open
Abstract
Purpose Direct magnetic resonance arthrography (MRA) offers increased diagnostic accuracy compared to conventional magnetic resonance imaging (MRI) in the detection of superior labrum anterior-posterior (SLAP) lesions. The aim of the present study was to present the technique of magnetic resonance-guided direct shoulder arthrography (MDSA), to evaluate the diagnostic value of this novel MRA procedure to detect SLAP lesions in comparison to the currently practiced MRI, and to correlate the radiological findings to the respective arthroscopic findings. Material and methods Fifty-six patients with clinical signs of a SLAP lesion underwent both MRI examination and MDSA prior to arthroscopic surgery. The MRI of both interventions were compared with the arthroscopic findings. Statistical analysis was performed using the McNemar test. Results Sensitivity, specificity, and accuracy for detecting SLAP lesions were 23%, 88%, and 54% on MRI and 80%, 81%, and 80% on MDSA, respectively. Sensitivity (p < 0.001) and accuracy (p = 0.001) in detection of SLAP lesions were significantly higher by MDSA whereas accuracy showed no significant differences (p = 0.625). Conclusions The MDSA can be performed in an open 1.0-T MRI scanner with a high level of technical success and a reasonable methodical effort. The modification of MRA provides the requirements as a practicable routine shoulder magnetic resonance examination including arthrography to detect SLAP lesions. The diagnostic value is significantly better than MRI examinations without included arthrography, which currently predominates the clinical practice to investigate shoulder pathology.
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Abstract
Background: SLAP lesions of the shoulder are challenging to diagnose by clinical means alone. Interpretation of MR images requires knowledge of the normal appearance of the labrum, its anatomical variants, and the characteristic patterns of SLAP lesions. In general, high signal extending anterior and posterior to the biceps anchor is the hallmark of SLAP lesions. Common diagnostic criteria for a SLAP lesion by MR or MR arthrography include the following: presence of a laterally curved, high signal intensity in the labrum on a coronal image, multiple or branching lines of high signal intensity in the superior labrum on a coronal image, full-thickness detachment with irregularly marginated high signal intensity and/or separation >2 mm on conventional MRI or 3 mm on MR arthrography between the labrum and glenoid on a coronal image, and a paralabral cyst extending from the superior labrum. Methods: MR diagnosis of SLAP tears may be improved with provocative maneuvers, such as longitudinal traction of the arm or positioning of the shoulder in abduction and external rotation during imaging. The use of intra-articular contrast distends the joint similar to what occurs during arthroscopy and forced diffusion under the labrum may improve the ability to detect SLAP lesions that might not be seen with standard MR. Improved diagnostic accuracy for SLAP tears is seen with 3-T compared with 1.5-T MR imaging, with or without intra-articular contrast material. Conclusion: Regardless of MR findings, however, physicians should be cautious when recommending surgery in the patient with a vague clinical picture. The patient’s history, physical exam, and imaging evaluation all should be considered together in making the decision to proceed with surgery.
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Affiliation(s)
- Robert D Boutin
- Department of Radiology, UC Davis School of Medicine, 4860 Y St., Suite 3100, Sacramento, CA 95817, USA
| | - Richard A Marder
- Department of Orthopaedic Surgery, UC Davis School of Medicine, 4860 Y St., Suite 3800, Sacramento, CA 95817, USA
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6
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Validity of radial magnetic resonance imaging to determine the extent of Bankart lesions. Clin Imaging 2018; 48:131-138. [DOI: 10.1016/j.clinimag.2017.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 09/21/2017] [Accepted: 10/13/2017] [Indexed: 11/23/2022]
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Razmjou H, Christakis M, Kennedy D, Robarts S, Holtby R. Impact of Radiographic Imaging of the Shoulder Joint on Patient Management: An Advanced-Practice Physical Therapist's Approach. Physiother Can 2017; 69:351-360. [PMID: 30369703 DOI: 10.3138/ptc.2016-41pc] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: Recent care innovations using advanced-practice physical therapists (APPs) as alternative health care providers are promising. However, information related to the clinical decision making of APPs is limited with respect to ordering shoulder-imaging investigations and the impact of these investigations on patient management. The purpose of this study was twofold: (1) to explore the clinical decision making of the APP providing care in a shoulder clinic by examining the relationship between clinical examination findings and reasons for ordering imaging investigations and (2) to examine the impact on patient management of ordered investigations such as plain radiographs, ultrasound (US), magnetic resonance imaging (MRI), and magnetic resonance arthrogram (MRA). Method: This was a prospective study of consecutive patients with shoulder complaints. Results: A total of 300 patients were seen over a period of 12 months. Plain radiographs were ordered for 241 patients (80%); 39 (13%) received MRI, 27 (9%) US, and 7 (2%) MRA. There was a relationship between clinical examination findings and ordering plain radiographs and US (ps=0.047 to <0.0001). Plain radiographs ordered to examine the biomechanics of the glenohumeral joint affected management (χ2 1=8.66, p=0.003). Finding a new diagnosis was strongly correlated with change in management for all imaging investigations (ps=0.001 to <0.0001). Conclusion: Skilled, extended-role physical therapists rely on history and clinical examination without overusing costly imaging. The most important indicator of change in management was finding a new diagnosis, regardless of the type of investigation ordered.
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Affiliation(s)
- Helen Razmjou
- Department of Rehabilitation.,Sunnybrook Research Institute.,Department of Physical Therapy
| | - Monique Christakis
- Department of Medical Imaging, Sunnybrook Health Sciences Centre.,Department of Medical Imaging, Faculty of Medicine, University of Toronto, Toronto
| | - Deborah Kennedy
- Department of Rehabilitation.,Department of Physical Therapy.,School of Rehabilitation Science, McMaster University, Hamilton, Ont
| | | | - Richard Holtby
- Department of Orthopaedic Surgery, Holland Orthopaedic & Arthritic Centre
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Seo JB, Yoo JS, Lee JY, Han KH. What are the anatomical predictive factors of degenerative superior labrum anterior to posterior lesion in rotator cuff tear? J Orthop 2017; 14:425-429. [PMID: 28794582 DOI: 10.1016/j.jor.2017.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 07/21/2017] [Indexed: 10/19/2022] Open
Abstract
The purpose of this study was to evaluate the influence of anatomical factors degenerative superior labrum anterior to posterior lesion in rotator cuff tear. The study included 421 middle-aged patients treated using arthroscopic surgery for rotator cuff tears. Patients were divided into two groups based on the superior labrum anterior-to-posterior (SLAP). Glenoid inclination, glenoid length, humeral head diameter, acromio-humeral distance (AHD) head-glenoid difference (HGD), head glenoid angle (HGA), size and retraction of rotator cuff tears were evaluated in both groups. In conclusion, a HGD exceeding 10 mm could be anatomically predictive of degenerative SLAP. LEVEL OF EVIDENCE Case series, Level IV.
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Affiliation(s)
- Joong-Bae Seo
- Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Jae-Sung Yoo
- Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Joon-Yeul Lee
- Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Kyoo-Hong Han
- Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Republic of Korea
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Symanski JS, Subhas N, Babb J, Nicholson J, Gyftopoulos S. Diagnosis of Superior Labrum Anterior-to-Posterior Tears by Using MR Imaging and MR Arthrography: A Systematic Review and Meta-Analysis. Radiology 2017; 285:101-113. [PMID: 28604236 DOI: 10.1148/radiol.2017162681] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Purpose To evaluate the diagnostic accuracies of nonenhanced magnetic resonance (MR) imaging and MR arthrography for diagnosis of superior labrum anterior-to-posterior (SLAP) tears by using a systematic review and meta-analysis. Materials and Methods A comprehensive literature search was performed on the two main concepts of MR imaging (MR imaging, and direct and indirect MR arthrography) and SLAP tears. Inclusion criteria consisted of original studies that assessed the diagnostic accuracy of MR imaging, direct MR arthrography, and/or indirect MR arthrography for the detection of SLAP tears, by using surgical findings as the reference standard. The Quality Assessment of Diagnostic Accuracy Studies 2, or QUADAS-2 Quality Assessment of Diagnostic Accuracy Studies 2 Quality Assessment of Diagnostic Accuracy Studies 2 , tool was used to assess methodologic quality. Meta-analyses were performed that compared MR imaging studies to direct MR arthrography studies and indirect MR arthrography studies, 3-T studies to 1.5-T studies, and low-bias MR imaging studies to low-bias direct MR arthrography studies. Study variation was analyzed by using the Cochran Q test of heterogeneity and the I2 statistic. Results Thirty-two studies met inclusion and exclusion criteria, including 3524 imaging examinations: 1963 direct MR arthrography examinations (23 studies), 1402 MR examinations (14 studies), and 159 indirect MR arthrography examinations (three studies). Twelve studies had low risk for bias, two had questionable risk, and 18 had high risk. Mean sensitivities of direct MR arthrography, MR imaging, and indirect MR arthrography for SLAP tear diagnosis were 80.4%, 63.0%, and 74.2%, respectively. Mean specificities of direct MR arthrography, MR imaging, and indirect MR arthrography were 90.7%, 87.2%, and 66.5%, respectively. Summary receiver operator characteristic (ROC) curve demonstrated superior accuracy of direct MR arthrography compared with those of MR imaging and indirect MR arthrography. Similar findings were observed in the low-bias subanalysis. Summary ROC curve demonstrated overall superiority of 3-T imaging, with or without intra-articular contrast material compared with 1.5-T imaging, with or without intra-articular contrast material. Significant variance was observed for MR imaging and direct MR arthrography (P < .001) studies for both mean sensitivity and specificity. Conclusion Direct MR arthrography appears to be more accurate than nonenhanced MR imaging for diagnosis of SLAP tears, whereas 3-T MR imaging with or without intra-articular contrast material appears to improve diagnostic accuracy compared with 1.5-T MR imaging with or without intra-articular contrast material. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- John S Symanski
- From the Department of Radiology, NYU Langone Medical Center/Hospital for Joint Diseases, 660 First Ave, New York, NY 10016 (J.S.S., J.B., S.G.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (N.S.); and NYU Health Sciences Library, NYU School of Medicine, New York, NY (J.N.)
| | - Naveen Subhas
- From the Department of Radiology, NYU Langone Medical Center/Hospital for Joint Diseases, 660 First Ave, New York, NY 10016 (J.S.S., J.B., S.G.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (N.S.); and NYU Health Sciences Library, NYU School of Medicine, New York, NY (J.N.)
| | - James Babb
- From the Department of Radiology, NYU Langone Medical Center/Hospital for Joint Diseases, 660 First Ave, New York, NY 10016 (J.S.S., J.B., S.G.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (N.S.); and NYU Health Sciences Library, NYU School of Medicine, New York, NY (J.N.)
| | - Joseph Nicholson
- From the Department of Radiology, NYU Langone Medical Center/Hospital for Joint Diseases, 660 First Ave, New York, NY 10016 (J.S.S., J.B., S.G.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (N.S.); and NYU Health Sciences Library, NYU School of Medicine, New York, NY (J.N.)
| | - Soterios Gyftopoulos
- From the Department of Radiology, NYU Langone Medical Center/Hospital for Joint Diseases, 660 First Ave, New York, NY 10016 (J.S.S., J.B., S.G.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (N.S.); and NYU Health Sciences Library, NYU School of Medicine, New York, NY (J.N.)
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A systematic review and meta-analysis of diagnostic test of MRA versus MRI for detection superior labrum anterior to posterior lesions type II-VII. Skeletal Radiol 2017; 46:149-160. [PMID: 27826700 DOI: 10.1007/s00256-016-2525-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 10/26/2016] [Accepted: 10/27/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the diagnostic performance of magnetic resonance arthrography (MRA) and magnetic resonance imaging (MRI) in superior labrum anterior to posterior lesions (type II-VII) of the shoulder. MATERIAL AND METHODS PubMed and Scopus search engines, an electronic search of articles was performed from inception to February 19, 2016. Diagnostic performance of index tests was compared by the summary area under receiver operator characteristic curve (AUROC). RESULTS AND CONCLUSIONS In all, 117 of 493 studies were eligible and 32 studies (2,013 shoulders) and 11 studies (1,498 shoulders) were evaluated with MRA and MRI. The summary sensitivity, specificity, likelihood ratio (positive and negative) and AUROC were 0.87 (95 % confidence interval, CI: 0.82, 0.91), 0.92 (95 %CI: 0.85, 0.95), 10.28 (95 %CI: 5.84, 18.08), 0.14 (95 %CI: 0.10, 0.20) and 0.94 (95 %CI: 0.92, 0.96) respectively for MRA, and 0.76 (95 %CI: 0.61, 0.86), 0.87 (95 %CI: 0.71, 0.95), 5.89 (95 %CI: 2.5, 13.86), 0.28 (95 %CI: 0.17, 0.47) and 0.94 (95 %CI: 0.92, 0.96) respectively for MRI. The diagnostic performance of MRA was superior to MRI by both direct and indirect comparisons for the detection of SLAP lesions.
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11
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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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Bartolomé A, Pirogova T, Bartolomé M, Sánchez R, García de Lucas F. Glenohumeral instability: Validity of low-field MRI for diagnosis of labral tears. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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13
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Simão MN, Vinson EN, Spritzer CE. Magnetic resonance imaging evaluation of meniscoid superior labrum: normal variant or superior labral tear. Radiol Bras 2016; 49:220-224. [PMID: 27777474 PMCID: PMC5073387 DOI: 10.1590/0100-3984.2015.0083] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Objective The objective of this study was to determine the incidence of a "meniscoid"
superior labrum. Materials and Methods This was a retrospective analysis of 582 magnetic resonance imaging
examinations of shoulders. Of those 582 examinations, 110 were excluded, for
a variety of reasons, and the final analysis therefore included 472 cases.
Consensus readings were performed by three musculoskeletal radiologists
using specific criteria to diagnose meniscoid labra. Results A meniscoid superior labrum was identified in 48 (10.2%) of the 472 cases
evaluated. Arthroscopic proof was available in 21 cases (43.8%). In 10
(47.6%) of those 21 cases, the operative report did not include the mention
a superior labral tear, thus suggesting the presence of a meniscoid labrum.
In only one of those cases were there specific comments about a mobile
superior labrum (i.e., meniscoid labrum). In the remaining 11 (52.4%),
surgical correlation demonstrated superior labral tears. Conclusion A meniscoid superior labrum is not an infrequent finding. Depending upon
assumptions and the requirement of surgical proof, the prevalence of a
meniscoid superior labrum in this study was between 2.1% (surgically proven)
and 4.8% (projected). However, superior labral tears are just as common and
are often confused with meniscoid labra.
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Affiliation(s)
- Marcelo Novelino Simão
- MD, PhD, Radiologist at the Central de Diagnóstico Ribeirão Preto (Cedirp), Attending Physician in the Musculoskeletal Division of the Center for Imaging at the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Emily N Vinson
- MD, Assistant Professor of Radiology, Duke University, Durham, NC, USA
| | - Charles E Spritzer
- MD, Chief of the Musculoskeletal Imaging Division, Duke University, Durham, NC, USA
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The Snyder Classification of Superior Labrum Anterior and Posterior (SLAP) Lesions. Clin Orthop Relat Res 2016; 474:2075-8. [PMID: 27075334 PMCID: PMC4965366 DOI: 10.1007/s11999-016-4826-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 04/04/2016] [Indexed: 01/31/2023]
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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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Abstract
The following guideline covers a wide array of shoulder conditions seen in the workers' compensation, as well as the nonworkers' compensation, population. The guideline is intended to help establish work relatedness and aid in making the diagnosis of shoulder injuries and degenerative conditions. It also provides a nonoperative and operative guideline for the treatment of several shoulder conditions, not limited to rotator cuff tears, subacromial impingement syndrome, acromioclavicular arthritis and dislocations, as well as glenohumeral arthritis.
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Affiliation(s)
- Michael Codsi
- EvergreeenHealth Medical Center, 12040 NE 128th st, Kirklnad, WA 98034, USA
| | - Chris R Howe
- Proliance Orthopedic Associates, 4011 Talbot Road South, Suite #300, Renton, WA 98055, USA.
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17
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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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18
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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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19
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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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20
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Abstract
The physical examination of the shoulder has been studied extensively, but the quality and statistical power of the published research often is lacking. The initial reports of new shoulder examination techniques commonly describe impressive performance. However recent meta-analyses have found that when the majority of these tests are used in isolation, they lack the ability to rule in or rule out the pathology in question, with few exceptions. The diagnostic accuracy of the physical examination improves when the shoulder tests are evaluated in combination, such as positive passive distraction and active compression identifying a superior labral anterior to posterior (SLAP) lesion. The accuracy also can be improved when the shoulder tests are evaluated in conjunction with specific historical findings, such as age greater than 39 years, history of popping or clicking, and a positive painful arc (pain experienced between 60° and 120° of abduction) identifying rotator cuff tendinopathy. The literature on shoulder imaging demonstrates that rotator cuff tears can be ruled in or ruled out by both ultrasound and magnetic resonance imaging. For SLAP lesions, magnetic resonance arthrography can be used to rule out a tear but may not be as accurate as combined physical examinations to rule in a tear.
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Affiliation(s)
- John W O'Kane
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA
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21
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Soft tissue injury of the shoulder after single non-dislocating trauma: prevalence and spectrum of intraoperative findings during shoulder arthroscopy and treatment results. Arch Orthop Trauma Surg 2015; 135:103-9. [PMID: 25394541 DOI: 10.1007/s00402-014-2114-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE The purpose of our study was to present the spectrum and prevalence of intraarticular lesions in patients with shoulder pain after a single non-dislocating shoulder trauma and to evaluate the clinical results according to pathology and workers' compensation status. METHODS Sixty consecutive patients (61 shoulders) with shoulder pain following a single non-dislocating shoulder trauma had shoulder arthroscopy. The indication for surgery was either persistent pain for 3 months or longer after trauma and/or an intraarticular lesion on MRI. Patients with history of shoulder complaints, previous shoulder surgery, a complete rotator cuff tear or a fracture of the shoulder girdle were excluded. Intraarticular findings during shoulder arthroscopy were retrospectively analyzed. After a minimum follow-up of 1 year patients were contacted by telephone interview and ASES score, Simple Shoulder Test, Subjective Shoulder Value and residual pain were assessed for the entire population and for patients with and without workers' compensation. RESULTS The most common intraarticular findings were SLAP (44.3 %) and Pulley (19.7 %) lesions followed by lesions of the anterior or posterior labrum (14.8 %). The mean age of the 13 women and 47 men was 41.9 years (SD 10.9). Patients with workers' compensation had significantly lower scores than patients without and had a significantly lower return to work rate than patients without. INTERPRETATION In patients with persistent shoulder pain after sprain or contusion arthroscopy revealed a broad spectrum of intraarticular findings. Patients with workers' compensation claims had worse results than those without. LEVEL OF EVIDENCE Case series (Level IV).
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22
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Moore-Reed SD, Kibler WB, Sciascia AD, Uhl T. Preliminary development of a clinical prediction rule for treatment of patients with suspected SLAP tears. Arthroscopy 2014; 30:1540-9. [PMID: 25129864 DOI: 10.1016/j.arthro.2014.06.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 06/11/2014] [Accepted: 06/13/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To use the clinical prediction rule process to identify patient variables, measured on initial clinical presentation, that would be predictive of failure to achieve satisfactory improvement, while following a rehabilitation program, in the modification of SLAP injury symptoms and dysfunction. METHODS A cohort of patients received the clinical diagnosis of a SLAP lesion based on specific history and examination findings and/or magnetic resonance imaging. They underwent a physical examination of the kinetic chain and shoulder, including tests for labral injury. Patients followed a standardized physical therapy program emphasizing restoration of demonstrated strength, flexibility, and strength-balance deficits. At 6 weeks' follow-up, patients were re-evaluated and divided into those recommended for surgery (RS) and those not recommended for surgery (NRS). Bivariate logistic regression was performed to identify the best combination of predictive factors. RESULTS Fifty-eight patients (aged 39 ± 11 years, 45 men) were included. Of these, 31 (53%) were categorized as NRS and 27 (47%) as RS. The presence of a painful arc of motion (odds ratio, 3.95; P = .024) and the presence of increased forward scapular posture (odds ratio, 1.27; P = .094) on the injured side were predictive of being in the RS group. This finding indicates that the odds of being in the RS group increased 4 times when a positive painful arc was present and increased 27% with every 1-cm increase in involved anterior shoulder posture. CONCLUSIONS A structured rehabilitation program resulted in modification of symptoms and improved function at 6 weeks' follow-up in over half of patients in the study group. On initial evaluation, the presence of a painful arc of overhead motion, indicating loss of normal glenohumeral kinematics, and the presence of forward shoulder posture, indicating an altered scapular position, represent negative predictive factors for success of rehabilitation. Future validation of the model in a larger population is necessary. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
| | - W Ben Kibler
- Shoulder Center of Kentucky, Lexington, Kentucky, U.S.A
| | - Aaron D Sciascia
- Shoulder Center of Kentucky, Lexington, Kentucky, U.S.A.; Division of Athletic Training, University of Kentucky, Lexington, Kentucky, U.S.A..
| | - Tim Uhl
- Division of Athletic Training, University of Kentucky, Lexington, Kentucky, U.S.A
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23
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Abstract
In general, favorable outcomes have been achieved with arthroscopic repair of superior labral anterior-posterior (SLAP) tears. However, some patients remain dissatisfied or suffer further injury after SLAP repair and may seek additional treatment to alleviate their symptoms. The cause of persistent pain or recurrent symptoms after repair is likely multifactorial; therefore, careful preoperative workup is required to elucidate the cause of pain. Review of the details of previous surgical procedures is crucial because certain fixation methods are prone to failure or can cause additional injury. Failed SLAP repair can be managed with nonsurgical or surgical options. Nonsurgical modalities include physical therapy and strengthening programs, anti-inflammatory agents, and activity modification. Surgical options include revision SLAP repair and biceps tenotomy or tenodesis with or without revision SLAP repair. Outcomes after surgical management of failed SLAP repair are inferior to those of primary repair. Select patients may be better served by primary biceps tenodesis rather than SLAP repair.
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24
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Aliprandi A, Sdao S, Cannaò PM, Khattak YJ, Longo S, Sconfienza LM, Sardanelli F. Imaging of shoulder pain in overhead throwing athletes. SPORT SCIENCES FOR HEALTH 2013. [DOI: 10.1007/s11332-013-0151-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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26
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Indirect magnetic resonance arthrography of the shoulder; a reliable diagnostic tool for investigation of suspected labral pathology. Skeletal Radiol 2013; 42:1225-33. [PMID: 23715887 PMCID: PMC3720992 DOI: 10.1007/s00256-013-1644-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 04/22/2013] [Accepted: 04/30/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE Indirect magnetic resonance arthrography (I-MRA) confers significant logistical advantages over direct MRA and does not require articular injection. In this study, we determined the diagnostic performance of I-MRA in relation to conventional MRI and arthroscopy or surgery in detecting tears of the glenoid labrum, including Bankart lesions and superior labral antero-posterior (SLAP) tears in a standard clinical setting. PATIENTS AND METHODS Ninety-one symptomatic patients underwent conventional MRI and I-MRA of the affected shoulder, followed by either arthroscopy or open surgery. The scans were interpreted independently by two experienced radiology consultants with a special interest in musculoskeletal radiology. Using the surgical findings as the standard of reference, sensitivity, specificity, and diagnostic accuracy of conventional non-contrast MRI and I-MRA in the detection of labral tears were calculated. RESULTS The sensitivity of I-MRA was 95 and 97 %, respectively, for two radiologists as opposed to 79 and 83 % for conventional MRI. For both radiologists, the specificity of I-MRA, as well as MRI, was 91 % for detection of labral tears of all types. Accuracy of diagnosis was 93 and 95 %, respectively, for two radiologists with indirect MRA, compared to 84 and 86 % with non-contrast MRI. CONCLUSIONS This retrospective study shows that I-MRA is a highly accurate and sensitive method for the detection of labral tears. The data obtained supports the use of I-MRA as standard practice in patients with shoulder instability due to suspected labral pathology where further investigative imaging is indicated.
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