Physical examination, magnetic resonance imaging and the arthroscopy of the shoulder: a correlation of diagnostic tests
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20241105Keywords:
Shoulder pathology, Arthroscopy, MRI, Clinical correlation, Clinical examinationAbstract
Background: Shoulder pathology is the third cause of consultation for musculoskeletal disorders; it is a cause of disability and economic losses. The gold standard for its diagnosis and treatment is arthroscopy. However, arthroscopy is an invasive diagnostic technique. Therefore, clinical and imaging methods may be useful as diagnostic techniques before considering arthroscopy. Nevertheless, these non-surgical diagnostic methods may present a poor correlation in diagnostic accuracy when compared to the arthroscopic diagnostic method in the context of shoulder pathology.
Methods: A retrospective study including 123 patients who presented shoulder complains, underwent physical examination and a shoulder magnetic resonance imaging (MRI) study prior to a shoulder arthroscopy. A clinical correlation was made using the kappa index, sensitivity and specificity of the clinical and imaging tests were also calculated.
Results: The correlation between arthroscopy and the clinical assessment showed a kappa index of 0.25 for rotator cuff injuries, 0.41 biceps pathology, 0.51 sub acromial impingement, 0.51 acromioclavicular arthrosis, 0.28 for SLAP injury. MRI diagnostic method showed a kappa correlation of 0.24 for rotator cuff injuries, 0.59 biceps pathology, 0.39 sub acromial impingement, 0.46 acromioclavicular arthrosis and 0.34 for superior labral anterior posterior (SLAP) injury.
Conclusions: After comparing arthroscopy with clinical assessment and the MRI diagnostic method we found that clinical assessment is useful to diagnose biceps pathologies, subacromial impingement, and acromioclavicular arthrosis. On the other hand, MRI studies and diagnosis made by a radiologist showed to be a valuable tool for the diagnosis of biceps pathology and acromioclavicular arthrosis.
References
Hodgetts C, Walker B. Epidemiology, common diagnoses, treatments and prognosis of shoulder pain: A narrative review. Int J Osteopathic Med. 2021;42:11-9.
Lucas J, van Doorn P, Hegedus E, Lewis J, van der Windt D. A systematic review of the global prevalence and incidence of shoulder pain. BMC Musculoskelet Disord. 2022;23(1):1073.
Cardiel MH, Rojas-Serrano J. Community based study to estimate prevalence, burden of illness and help seeking behavior in rheumatic diseases in Mexico City. A COPCORD study. Clin Exp Rheumatol. 2002;20(5):617-24.
Rodriguez-Amado J, Peláez-Ballestas I, Sanin LH, Esquivel-Valerio JA, Burgos-Vargas R, Pérez-Barbosa L, et al. Epidemiology of rheumatic diseases. A community-based study in urban and rural populations in the state of Nuevo Leon, Mexico. J Rheumatol Suppl. 2011;86:9-14.
Oh J, Lee MK. Shoulder pain, shoulder disability, and depression as serial mediators between stress and health-related quality of life among middle-aged women. Health Qual Life Outcomes. 2022;20(1):142.
Darryn M, Tracy C, Leanne B, Michael T, Paul SA. Shoulder pain cost-of-illness in patients referred for public orthopaedic care in Australia. Aust Health Rev. 2019;43:540-48.
Hind J, Sidhu GAS, Arealis G, Khadabadi NA, Ashwood N. An algorithmic approach to shoulder pathology. J Family Med Prim Care. 2022;11(9):5510-15.
Bakhsh W, Nicandri G. Anatomy and Physical Examination of the Shoulder. Sports Med Arthrosc Rev. 2018;26(3):e10-e22.
Gismervik SO, Drogset JO, Granviken F, Ro M, Leivseth G. Physical examination tests of the shoulder: a systematic review and meta-analysis of diagnostic test performance. BMC Musculoskelet Disord. 2017;18(1):41.
Apostolopoulos AP, Angelis S, Yallapragada RK, Khan S, Nadjafi J, Balfousias T, et al. The Sensitivity of Magnetic Resonance Imaging and Ultrasonography in Detecting Rotator Cuff Tears. Cureus. 2019;11(5):e4581.
Dong X, Wang L. The Imaging Diagnosis of Patients with Shoulder Pain Caused by Sports Injury. Appl Bionics Biomech. 2022;2022:5272446.
Halma JJ, Eshuis R, Krebbers YM, Weits T, De Gast A. Interdisciplinary inter-observer agreement and accuracy of MR imaging of the shoulder with arthroscopic correlation. Arch Orthop Trauma Surg. 2012;132(3):311-20.
Simon MJK, Regan WD. Utilization of MRI in surgical decision making in the shoulder. BMC Musculoskelet Disord. 2022;23(1):588.
Paxton ES, Backus J, Keener J, Brophy RH. Shoulder arthroscopy: basic principles of positioning, anesthesia, and portal anatomy. J Am Acad Orthop Surg. 2013;21(6):332-42.
Marecek GS, Saltzman MD. Complications in shoulder arthroscopy. Orthopedics. 2010;33(7):492-7.
McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb). 2012;22(3):276-82.
França FO, Godinho GG, Freitas JMA, Lang AS, Ammar CD, Martinelli F. Correlation of Physical Examination with Arthroscopic Findings in the Treatment of Rotator Cuff Tear. Rev Bras Ortop (Sao Paulo). 2022;57(3):467-71.
Bhatnagar A, Bhonsle S, Mehta S. Correlation between MRI and Arthroscopy in Diagnosis of Shoulder Pathology. J Clin Diagn Res. 2016;10(2):RC18-21.
Yang S, Kim TU, Kim DH, Chang MC. Understanding the physical examination of the shoulder: a narrative review. Ann Palliat Med. 2021;10(2):2293-303.
Momenzadeh OR, Gerami MH, Sefidbakht S, Dehghani S. Assessment of Correlation Between MRI and Arthroscopic Pathologic Findings in the Shoulder Joint. Arch Bone J Surg. 2015;3(4):286-90.
Malhi AM, Khan R. Correlation between clinical diagnosis and arthroscopic findings of the shoulder. Postgrad Med J. 2005;81(960):657-9.
Ohtadi NG, Vellet AD, Clark ML, Hollinshead RM, Sasyniuk TM, Fick GH, et al. A prospective, double-blind comparison of magnetic resonance imaging and arthroscopy in the evaluation of patients presenting with shoulder pain. J Shoulder Elbow Surg. 2004;13(3):258-65.
Thiagarajan A, Nagaraj R, Marathe K. Correlation Between Clinical Diagnosis, MRI, and Arthroscopy in Diagnosing Shoulder Pathology. Cureus. 2021;13(12):e20654.
Groarke P, Jagernauth S, Peters SE, Manzanero S, O'Connell P, Cowderoy G, et al. Correlation of magnetic resonance and arthroscopy in the diagnosis of shoulder injury. ANZ J Surg. 2021;91(10):2145-52.
