Thursday, July 20, 2017

How bad is the shoulder arthritis on x-ray?

Reliability of radiologic glenohumeral osteoarthritis classifications

These authors sought to determine the intraobserver and interobserver reliability of glenohumeral osteoarthritis classification schemes based on plain anteroposterior radiographs of 108 shoulder joints from 96 consecutive patients with glenohumeral osteoarthritis. On two occasions each of two observers graded the film into 6 classification systems. The intraobserver and interobserver reliabilities were 0.907 (observer 1), 0.965 (observer 2), and 0.851 (interobserver) for the Samilson-Prieto grading system;
0.954, 0.948, and 0.869 for the Allain modification;
0.936, 0.830, and 0.791 for the Gerbermodification;
0.887, 0.892, and 0.744 for theKellgren and Lawrence classification;
0.873, 0.964, and 0.935 for theWeinstein; and
0.854, 0.934, and 0.797 for the Guyette grading system.

Comment: Some surgeons and clinical investigators are interested using radiographic classification systems for demographic and outcomes studies.  However, radiographic evaluation is incomplete if it is based on the AP view only.

This is demonstrated by the films of a man in his mid 40s who presented to us with shoulder pain and limited motion. His anteroposterior x-ray suggested mild to moderate arthritis.

However, the 'truth' view (a standardized axillary taken with the arm in the functional position of elevation in the plane of the scapula - see this link), revealed a retroverted, biconcave glenoid with posterior humeral decentering = the bad arthritic triad (BAT - see this link), a much greater degree of pathology than what was suggested on the AP view.

Here are some other cases in which the 'truth' view demonstrated substantially greater pathoanatomy than what could be seen on the AP view

We find that the standardized AP and 'truth' axillary view taken as described in this link usually provide all the necessary imaging information to characterize the arthritic pathoanatomy and plan treatment.

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