Friday, May 25, 2018

Is imaging the rotator cuff prior to shoulder arthroplasty worth the cost?

Do magnetic resonance imaging and computed tomography provide equivalent measures of rotator cuff muscle size in glenohumeral osteoarthritis?

These authors assert that rotator cuff muscle volume is associated with outcomes after total shoulder
arthroplasty. They sought to determine whether computed tomography(CT) provides an equivalent measurement of cuff muscle area to a previously validated MRI measurement in 30 patients prior to total shoulder arthroplasty.

The found that the result were similar: the mean intraclass correlation coefficients were 0.989 (95% confidence interval [CI], 0.976-0.995) for the supraspinatus, 0.978 (95% CI, 0.954-0.989) for the infraspinatus–teres minor, and 0.977 (95% CI, 0.952-0.989) for the subscapularis. The mean differences were 0.2 cm2 (95% CI, 0.0-0.4 cm2) for the supraspinatus (P = .052), 0.8 cm2 (95% CI, 0.1-1.4 cm2) for the infraspinatus–teres minor (P = .029), and –0.3 cm2 (95% CI, –1.2 to 0.5 cm2) for the subscapularis (P = .407). They concluded that CT provides nearly equivalent measures of cuff muscle area to MRI technique.

Comment: While the authors state that measurements of rotator cuff muscle volume are clinically useful and that "the information provided in this study may decrease the need for redundant testing and may lower the cost of health care," it is not clear how these measurements would benefit patient care or that their cost would be justified by the benefit to the patient.

In our practice we avoid the costs of routine MRI and CT scans prior to shoulder arthroplasty in that they do not alter the care of the patient.

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