Correlation of clinical examination, ultrasound, magnetic resonance imaging and arthroscopy as diagnostic tools in shoulder pathology
Keywords:Arthroscopy, MRI, Shoulder joint, USG
Background: Shoulder pathologies can cause significant pain, discomfort, and affect the activity of daily living. The aim of this study was to compare the efficacy of clinical examination, ultrasound, magnetic resonance imaging (MRI) with shoulder arthroscopy in diagnosing various shoulder pathologies, considering shoulder arthroscopy as the gold standard tool.
Methods: This was a prospective, comparative study conducted over 35 patients, between 18-75 years of age presenting with chronic shoulder pain or instability of more than 2 months duration. All patients were examined clinically, followed by high resolution ultrasound, MRI, arthroscopy of the affected shoulder.
Results: The sensitivity and specificity of ultrasonography (USG) for diagnosing full thickness tear was 100% each and for MRI was 88% and 100% respectively. For subacromial impingement USG had sensitivity of 66.67%, specificity of 94.12%, positive predictive value of 50% and negative predictive value of 88.89%. For rotator cuff tear USG had sensitivity of 92.86%, specificity of 50%, positive predictive value of 81.25% and negative predictive value of 75% considering shoulder arthroscopy as gold standard.
Conclusions: USG and MRI both are sensitive techniques for diagnosing of rotator cuff pathologies. USG has high accuracy in diagnosing partial thickness tears as compare to MRI. MRI proved to be superior in estimation of site and extent of tear. Considering shoulder arthroscopy as gold standard, it can be reserved for patients with suspicious of USG/MRI findings or those who may need surgical intervention simultaneously.
Dinnes J, Loveman E, McIntyre L, Waugh N. The effectiveness of diagnostic tests for the assessment of shoulder pain due to soft tissue disorders a systematic review. Health Technol Assess. 2003;7(29):1-3.
Martin-Hervas C, Romero J, Navas-Acien A, Reboiras JJ, Munuera L. Ultrasonographic and magnetic resonance images of rotator cuff lesions compared with arthroscopy or open surgery findings. J Shoulder Elbow Surg. 2001;10(4):410–5.
van Holsbeeck MT, Kolowich PA, Eyler WR, Craig JG, Shirazi KK, Habra GK, et al.US depiction of partial-thickness tear of the rotator cuff. Radiology. 1995;197(5):443–6.
Bianchi S, Martinoli C. Ultrasound. Muscloskeletal Syst. 2007;12:246–56.
Lewis JS. Rotator cuff tendinopathy. Br J Sports Med. 2009;43(4):236–41.
Hegedus EJ, Goode AP, Cook CE, Michener L, Myer CA, Myer DM, et al. Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med. 2012;46(14):964-78.
Al-Shawi A, Badge R, Bunker T. The detection of full thickness rotator cuff tears using ultrasound. J Bone Joint Surg Br Vol. 2008;90(7):889–92.
Iannotti JP, Zlatkin MB, Esterhai JL, Kressel HY, Dalinka MK, Spindler KP. Magnetic resonance imaging of the shoulder: sensitivity, specificity, and predictive value. J Bone Joint Surg Am. 1991;73(1):17–29.
Kneeland JB, Middleton WD, Carrera GF, Zeuge RC, Jesmanowicz A, Froncisz W, et al. MR imaging of the shoulder: diagnosis of rotator cuff tears. AJR Am J Roentgenol. 1987;149(2):333–7.
Singson RD, Hoang T, Dan S, Friedman M. MR evaluation of rotator cuff pathology using T2- weighted fast spin-echo technique with and without fat suppression. AJR Am J Roentgenol. 1996;166(5):1061–5.
Martinoli C. Musculoskeletal ultrasound: Technical guidelines. Insights Imaging. 2010;1(3):99–141.
Middleton WD. Ultrasonography of the shoulder. Radiolclin North Am. 1992;30:927-40.
Alasaarela E, Takalo R, Tervonen O, Hkala M, Suramo I. sonography and MRI in evaluation of painful arthritic shoulder. Br J Rheumatol 1997; 36:996-1000.
Lambert, Loffroy R, Guiu B, Mejean, Lerais JM, Coffin JP, Krause D. Rotator cuff tears. Radiol J. 2009;190(5):583-8.
Ravi Kiran HG, Adnan Siddique P, Adarsh T, Vijay C, Mruthyunjaya SN. Functional outcome of arthroscopic subacromial decompression in primary shoulder impingement syndrome due to extrinsic mechanical causes. Int J Orthop. 2017;3(2):110-6.
Burk DL, Karasick DM, Kurtz AB, Mitchell DG, Rifkin MD, Miller CL. Rotator cuff tears: prospective comparison of MR imaging with Arthrography, Sonography and surgeries. AJR AM J Rientgenol. 1989;153:87-92.
Read JW, Perko M. Shoulder ultrasound: diagnostic accuracy for impingement syndrome, rotator cuff tear, and biceps tendon pathology. J Shoulder Elbow Surg. 1998;7(3):264-71.
Norregaard J, Krogsgaard MR, Lorenzen T, Jensen EM. Diagnosisng patients with longstanding shoulder joint pain. Ann Rheum Dis. 2002;61:646–50.