Kevin Rowan MD, Presenter: Nothing to Disclose

Gordon Andrews, Abstract Co-Author: Nothing to Disclose

Audrey Spielman, Abstract Co-Author: Nothing to Disclose

Jordan Leith, Abstract Co-Author: Nothing to Disclose

Anthony Gerard Ryan MBBCh, MSc, Abstract Co-Author: Nothing to Disclose

Bruce Forster, Abstract Co-Author: Nothing to Disclose

The purpose of this study is to compare the frequency of rotator cuff pathology versus labroligamentous pathology in patients under age 40 and determine if routine MR arthrography is justified in all patients in this age group.

Shoulder pain and instability are common complaints among patients of all ages. In younger patients, symptoms are commonly related to the labroligamentous structures, whereas rotator cuff pathology is much more common in older patients. The difference in etiology within different age groups becomes important when choosing the technique used to image the shoulder--visualization of labroligamentous structures requires MR arthrography, with intra-articular gadolinium, whereas rotator cuff pathology is sufficiently visualized without intra-articular contrast. At our institution, we routinely perform MR arthrography on all patients 40 years of age and under who are referred for MR imaging of the shoulder, regardless of the clinical indication. MR arthrography was performed on 332 patients 40 years of age and under, over four years from 2000 to 2004. 243 of these studies were performed for clinical history of instability and assessment of labroligamentous structures. The remaining 89 patients had no history of instability and the referral was for reasons other than labroligamentous pathology, such as assessment for rotator cuff tear. Assessment of labroligamentous and rotator cuff pathology were based on well-recognized criteria. A computer database was assessed and radiology reports were retrospectively evaluated in all 332 patients.

In the 243 patients under age 40 with clinical history of potential labral pathology, 39% (94/243) demonstrated a labral tear and 2.1% (5/243) had a full thickness rotator cuff tendon tear. In the 89 patients with no history indicative of labral pathology, 19% (17/89) showed an unsuspected labral tear whereas only 4.5% (4/89) had a full thickness rotator cuff tear.

Our findings support the use of MR arthography in the evaluation of the shoulder in patients aged 40 years and younger, due to the significant risk that symptoms are related to labral pathology even when this is unsuspected clinically.

Rowan, K, Andrews, G, Spielman, A, Leith, J, Ryan, A, Forster, B, MR Shoulder Arthrography in Patients under 40 Years of Age: Frequency of Rotator Cuff Tear versus Labroligamentous Pathology.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4406812.html