Wednesday, July 29, 2015

MRI versus Ultrasound in the assessment of the rotator cuff prior to shoulder arthroplasty - are either necessary?

Ultrasound vs. MRI in the assessment of rotator cuff structure prior to shoulder arthroplasty.

These authors suggest that prior to implantation of shoulder prostheses,  imaging techniques
routinely include plain X-rays and computed tomography (CT) for the assessment of the osseous structure whereby magnetic resonance imaging (MRI) is used to evaluate the soft tissues, especially the integrity of the rotator cuff and its degree of fatty degeneration.

In this study, they compared the accuracy of ultrasound to 3 T Tesla MRI for the detection of rotator cuff and long biceps tendon pathologies before joint replacement in 45 patients.

Using MRI as a reference the accuracy of ultrasound was
91% for the supraspinatus tendon
84% for the infraspinatus tendon
78% for the subscapularis
87% for the long biceps tendon

Comment: As pointed out in a prior post, there seems to be a tendency to overimage shoulders prior to arthroplasty resulting in the expenditure of time and money and radiation without changing the surgery or the outcome. In our practice history, physical examination, and standardized x-rays are sufficient to provide the necessary preoperative information necessary to plan surgery in almost all cases.

With respect to the use of sonography to evaluate the rotator cuff, we presented this method back in 1988, long before the current high quality instruments became available. We compared our findings to the surgical findings in 90 shoulders, finding the overall accuracy to be 95%. In our hands, sonography is best performed by the surgeon because only the surgeon can (1) include sonography as a part of the physical examination, (2) direct the examination to the elements of importance, (3) interpret the findings in light of the other information regarding the shoulder and (4) use the sonographic images to inform the patient of the shoulder pathology.


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