Linda J Probyn MD, Presenter: Nothing to Disclose

Lawrence M. White MD, Abstract Co-Author: Nothing to Disclose

David Charles Salonen MD, Abstract Co-Author: Nothing to Disclose

George Tomlinson, Abstract Co-Author: Nothing to Disclose

Erin Boynton MD, Abstract Co-Author: Nothing to Disclose

Tom Powell MD, Abstract Co-Author: Nothing to Disclose

To determine accuracy of direct MR arthrography (MRA) of the shoulder in the assessment of patients with recurrent signs or symptoms of instability following prior shoulder instability repair.

40 patients (32 males, 8 females, mean age 28) with signs and symptoms of recurrent instability post previous instability repair (24 patients 1 prior surgery, 16 patients ≥ 2 prior surgeries) who underwent direct MRA of the shoulder prior to repeat surgery were studied. The mean interval between most recent prior surgery and direct MRA was 4.3 years (range 6 months – 29 years). Direct MRA studies, imaged on a 1.5T system, were reviewed by two musculoskeletal radiologists using consensus agreement in a blinded fashion. MR assessment included evaluation of the labrum (overall, SLAP, Bankart), rotator cuff, biceps tendon, articular cartilage and presence or absence of a Hill-Sachs lesion. The mean interval between MR imaging and repeat surgery was 6 months (range 6 days – 36 months). Operative reports were compared with MR arthrogram results and statistical evaluation of MR imaging findings made using operative findings as a gold standard.

The accuracy, sensitivity and specificity of direct MRA in the diagnosis of; overall labral tears (n=27) was 94.2%, 96.2% and 88.9%, SLAP tears (n=17) was 93.3%, 93.8% and 92.9%, and Bankart injuries (n=17) was 93.3%, 100% and 84.6% respectively. The overall accuracy in detecting rotator cuff injury (n=17) was 85% (sensitivity 94.1%, specificity 70%), detecting biceps injury (n=6) was 95.8% (sensitivity 85.7%, specificity 100%) and detecting glenoid or humeral articular cartilage abnormality (n=14) was 75% (sensitivity 76.9% and specificity 71.4%). The accuracy for detecting a Hill-Sachs lesion (n=14) was 93.3%. The number of prior surgeries, side of injury, age or gender of the patient showed no significant correlation with the presence or absence of recurrent labral injury (p>0.1).

Direct MRA is highly accurate in the assessment of labral pathology and other internal derangement of the shoulder in patients with recurrent or residual symptoms following prior shoulder instability repair.

Probyn, L, White, L, Salonen, D, Tomlinson, G, Boynton, E, Powell, T, Direct MR Arthrographic Assessment of Recurrent Symptoms Post Shoulder Instability Repair: Correlation with Second Look Surgical Evaluation (in 40 Patients).  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4405097.html