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Shoulder arthroscopy remains superior to direct MR arthrography for diagnosis of subtle rotator interval lesions

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

To assess the sensitivity, specificity and accuracy of MR arthrography, as opposed to shoulder arthroscopy, in diagnosing individual rotator interval (RI) structures lesions at different levels of severity.

Materials and methods

Seventy-five patients were enrolled in a prospective study. All the patients were diagnosed with full-thickness rotator cuff tendon tears on unenhanced MRI and had complimentary MR arthrography to search for obscure RI lesions. All the patients then underwent shoulder arthroscopy. The arthroscopist was blinded about the MR arthrography results.

Results

At arthroscopy, 42 patients (56 %) were found to have RI lesion(s) and represented the study group. The remaining 33 patients represented the control group. The sensitivity, specificity and accuracy of MR arthrography for detecting individual RI lesions varied widely depending on the location and severity of the lesions. MR arthrography showed intermediate sensitivity of 67–80 %, specificity of 83–89 % and accuracy of 89–92 % for diagnosing subtle RI lesions; and perfect (100 %) sensitivity, specificity and accuracy for diagnosing biceps long head tendon dislocation. For the rest of RI lesions, MR arthrography showed high sensitivity, specificity and accuracy. Inter-observer agreement was found to be almost perfect (K = 0.81–1.0).

Conclusion

Shoulder arthroscopy remains the gold standard for diagnosing subtle RI lesions. Although MR arthrography has proved to be a valuable tool for diagnosing established RI lesions, it is of intermediate sensitivity for diagnosing subtle RI lesions resulting in early insufficiency of the biceps pulley system.

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Conflict of interest

All the authors responsible for this work declare no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt

    Ashraf Anbar

  2. Department of Orthopedic Surgery, Dr. Erfan and Bagedo General Hospital, Jidda, KSA

    Ashraf Anbar

  3. Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt

    Yasser Emad

  4. Rheumatology and Rehabilitation Department, Dr. Erfan and Bagedo General Hospital, Jidda, KSA

    Yasser Emad

  5. Radiology Department, Faculty of Medicine, Cairo University, Cairo, Egypt

    Fatma Zeinhom & Yasser Ragab

  6. Radiology Department, Dr. Erfan and Bagedo General Hospital, Jidda, KSA

    Fatma Zeinhom & Yasser Ragab

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  1. Ashraf Anbar
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  2. Yasser Emad
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  3. Fatma Zeinhom
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  4. Yasser Ragab
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Correspondence to Ashraf Anbar.

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Anbar, A., Emad, Y., Zeinhom, F. et al. Shoulder arthroscopy remains superior to direct MR arthrography for diagnosis of subtle rotator interval lesions. Eur J Orthop Surg Traumatol 25, 689–697 (2015). https://doi.org/10.1007/s00590-014-1545-6

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  • DOI: https://doi.org/10.1007/s00590-014-1545-6

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