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Value of shoulder US compared to MRI in infants with obstetric brachial plexus paralysis
Altan Gunes1, Ekim Gumeler2, Ayca Akgoz2
1Department of Radiology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey.
Insights
Ultrasonography (US) accurately detects glenohumeral instability in infants with brachial plexus birth injury (BPBI), serving as a reliable alternative to MRI. This dynamic US evaluation is valuable for screening and assessing instability in affected infants.
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
- Musculoskeletal Ultrasound
Background:
- Brachial plexus birth injury (BPBI) can lead to glenohumeral instability due to muscle imbalances.
- Early and accurate diagnosis of instability is crucial for timely intervention in infants.
Purpose of the Study:
- To compare the diagnostic accuracy of physical examination and ultrasonography (US) against magnetic resonance imaging (MRI) for glenohumeral instability in infants with BPBI.
- To evaluate the utility of US as a screening tool for this condition.
Main Methods:
- Prospective study of 42 infants with BPBI, assessed via physical exam and dynamic US at intervals.
- MRI was performed on 21 patients identified with instability by physical exam or US.
- Glenohumeral instability defined by specific alpha angle and posterior humeral head displacement criteria.
Main Results:
- MRI confirmed glenohumeral instability in 15 of 21 evaluated patients.
- US demonstrated 100% accuracy and sensitivity in detecting glenohumeral instability.
- Significant differences were noted in posterior humeral head displacement measurements between US and MRI (p=0.028).
Conclusions:
- Dynamic ultrasonography is a highly accurate and specific alternative to MRI for assessing glenohumeral instability in infants with BPBI.
- US measurements of instability parameters are comparable to MRI, supporting its use.
- US is a valuable screening modality for identifying glenohumeral instability in this pediatric population.
Purpose:
Children with brachial plexus birth injury (BPBI) may eventually develop glenohumeral instability due to development of unbalanced muscular strength. Our major goal in this study is to compare the accuracy of physical examination and ultrasonography (US) in determination of glenohumeral instability in infants with BPBI compared with magnetic resonance imaging (MRI) as a gold standard, and to investigate the role and value of US as a screening modality for assessing glenohumeral instability.
Methods:
Forty-two consecutive patients (mean age, 2.3±0.8 months) with BPBI were enrolled into this prospective study. Patients were followed up with physical examination and US with dynamic evaluation in 4-6 weeks intervals. Patients who developed glenohumeral instability based on physical examination and/or US (n=21) underwent MRI. Glenohumeral instability was defined as alpha angle >30° and percentage of posterior humeral head displacement >50%. Diagnostic accuracy of physical examination and US was calculated and quantitative parameters were compared with Wilcoxon test.
Results:
Glenohumeral instability was confirmed with MRI in 15 of 21 patients. Accuracy and sensitivity of physical examination and US were 47%, 66% and 100%, 100%, respectively in determination of glenohumeral instability. No significant difference was found for the alpha angle (p = 0.173) but the percentage of posterior humeral head displacement was statistically significant between US and MRI (p = 0.028).
Conclusion:
Our results indicate that US with dynamic evaluation is a good alternative for MRI in assessment of glenohumeral instability in infants with BPBI, since it is highly accurate and specific, and quantitative measurements used for glenohumeral instability were comparable to MRI. US can be used as a screening method to assess glenohumeral instability in infants with BPBI.
