Magnetic resonance imaging of the shoulder: assessment of effectiveness

To quantify how magnetic resonance imaging (MRI) influences clinicians' diagnosis, diagnostic confidence and management plans in patients with shoulder problems. To investigate whether such changes are associated with an improvement in health.

A prospective observational study on all patients referred to a regional centre for MRI of the shoulder over a 6-month period. Data on diagnosis, diagnostic confidence and proposed management before MRI were compared with diagnoses and actual management after MRI. In addition, short form 36 item (SF-36) health survey data were collected at referral and again 6 months later.

In 86 of 99 MRI referrals there was sufficient clinical data for the patient to enter the study. MRI led to previously unsuspected diagnoses in 20 of 59 patients where the clinicians had provided full diagnostic information before and after the examination. When MRI confirmed the clinical diagnosis, significant improvements in clinicians' diagnostic confidence were found (P < 0.001). MRI led to a change in management (P < 0.05) in 44 (62%) of the 71 patients where full management plans were available. Health survey results were available in 62 patients; although there were some improvements in SF-36 scores, these did not reach statistical significance.

Magnetic resonance imaging of the shoulder significantly influences clinicians' diagnoses and management plans. However, patients do not record a statistically significant improvement in health-related quality of life over 6 months.