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Magnetic resonance arthrography in recurrent anterior shoulder instability as compared to arthroscopy: a prospective
H Parmar1, B Jhankaria, M Maheshwari
1Department of Radiology, Seth G. S. Medical College and K. E. M. Hospital, and Jhankaria Imaging Center, Mumbai, India.
Aim:
To evaluate the accuracy of magnetic resonance (MR) arthrographic imaging in the diagnosis of glenoid labral and ligament tears in recurrent shoulder instability.
Settings And Design:
Prospective, comparative study at a tertiary care centre.
Material And Methods:
Patients with three or more episodes of anterior shoulder dislocation were enrolled in the study. They were subjected to magnetic resonance arthrography (MRA) for delineation of abnormalities. The findings obtained at MRA were compared with those found at arthroscopy and surgical exploration.
Results:
MRA detected glenoid tears in all 22 patients with 20 (90%) patients having antero-inferior tears, 3 (14%) patients had superior labral involvement and 2 (10%) patients had posterior labral abnormality. On arthroscopy, antero-inferior, superior and posterior labral tear were found in 21 (95%), 5 (22%) and 7 (32%) patients respectively. MRA showed a sensitivity of 95%, and a specificity of 100% for the detection of the antero-inferior labral tears. The sensitivity of MRA for the detection of superior, middle and inferior glenohumeral ligament tear was 83%, 80% and 86% with a specificity of 100%, 71% and 93% respectively. MRA was 100% sensitive for the detection of rotator cuff injuries and detection of bony lesions like Hill-Sach's and bony Bankart's lesion.
Conclusions:
MRA is a sensitive and specific modality for evaluation of anterior shoulder instability.