Incidence of False Positive Rotator Cuff Pathology in MRIs of Patients with Adhesive Capsulitis
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Rat Model of Adhesive Capsulitis of the Shoulder
Published on: September 28, 2018
Bryan J Loeffler1, Stephen L Brown, Donald F D'Alessandro
1Department of Orthopedic Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA.
Abstract:
The purpose of this study was to compare the incidence of presumed rotator cuff pathology based on radiologist and surgeon interpretation of preoperative magnetic resonance images (MRIs) with actual rotator cuff pathology found intraoperatively in patients undergoing arthroscopic capsular release for adhesive capsulitis.The medical records of 38 consecutive patients who underwent arthroscopic glenohumeral capsular release for adhesive capsulitis between September 2001 and May 2007 were retrospectively reviewed. Radiologist and surgeon predicted status of the rotator cuff by prospective MRI interpretation was compared to the actual status of the rotator cuff intraoperatively. Radiologists' preoperative MRI interpretations predicted a 57.9% incidence of rotator cuff pathology, while operative findings revealed a true incidence of only 13.2% (P<.0001). Radiologists accurately predicted the absence or presence of a rotator cuff tear in 19 of 38 cases (50%), compared to the surgeon, who correctly interpreted 29 of 38 MRIs (76.3%).Interpretations of shoulder MRIs in patients with adhesive capsulitis may provide misleading information regarding rotator cuff pathology. The actual findings of shoulder MRI scans may lead to the appearance of false rotator cuff pathology in this population, and a high percentage of false positive MRI reports of rotator cuff tears was observed in these patients. If MRI is chosen as a diagnostic adjunct in this patient population, careful consideration should be given to its interpretation to avoid unnecessary or possibly aggravating surgical intervention.
Insights
Magnetic resonance imaging (MRI) may overestimate rotator cuff pathology in patients with adhesive capsulitis. Surgeons
Area of Science:
- Orthopedic Surgery
- Musculoskeletal Imaging
Background:
- Adhesive capsulitis, or frozen shoulder, is a common condition causing shoulder stiffness and pain.
- Magnetic resonance imaging (MRI) is frequently used to assess rotator cuff integrity preoperatively.
Purpose of the Study:
- To compare the accuracy of preoperative MRI interpretations of rotator cuff pathology with intraoperative findings in patients undergoing arthroscopic capsular release for adhesive capsulitis.
- To evaluate the diagnostic performance of radiologists versus surgeons in interpreting shoulder MRIs for rotator cuff pathology in this specific patient group.
Main Methods:
- Retrospective review of 38 patients who underwent arthroscopic glenohumeral capsular release for adhesive capsulitis.
- Comparison of preoperative MRI interpretations (radiologist and surgeon) with intraoperative findings regarding rotator cuff pathology.
Main Results:
- Radiologists predicted a 57.9% incidence of rotator cuff pathology on MRI, but intraoperative findings confirmed only 13.2% (P<.0001).
- Surgeons correctly interpreted rotator cuff status on MRI in 76.3% of cases, significantly outperforming radiologists (50% accuracy).
- A high rate of false-positive rotator cuff tears was observed in MRI interpretations for patients with adhesive capsulitis.
Conclusions:
- Preoperative MRI interpretations for adhesive capsulitis can be misleading, potentially indicating false rotator cuff pathology.
- Surgeons demonstrated higher accuracy than radiologists in interpreting shoulder MRIs for rotator cuff pathology in this population.
- Careful consideration of MRI interpretation is crucial in patients with adhesive capsulitis to prevent unnecessary or potentially harmful surgical interventions.
