Shoulder MRIs and anchor arthropathy

Magnetic resonance imaging (MRI) is a technology that is commonly used to assess the soft tissues of the shoulder. MRIs are so sensitive that radiologists report "findings" for virtually every examination in adult shoulders: very commonly reported are "tears of the labrum".  In the presence of such a report, the surgeon must determine and explain to the patient (1) whether the labral pathology is likely to be the cause of the symptoms and (2) whether addressing the findings with surgery is likely to improve the comfort and function of the shoulder.

Let's consider an instructive case. A man in his early thirties had right shoulder pain with exercise but a full range of motion and no pain at rest. An MRI was obtained showing a "posterior labral tear". This led to an arthroscopic posterior labral repair using four 2.4 mm polyether ether ketone anchors. His post-surgery recovery was difficult, marked by crunching and popping with motion.

Subsequent evaluation revealed a stiff shoulder with significant crepitus.

Plain radiographs demonstrate glenohumeral arthritis 

with a posterior humeral head defect as seen on the axillary "truth" view.

MRI showed prominence of a suture anchor

 

Comment: Suture anchors are an important advance in arthroscopic shoulder surgery. However, as this case and the cases below indicate, they can give rise to arthritis if they are prominent or become dislodged. For this reason, MRI findings of "labral tears" need to be interpreted with caution both with respect to their relation to the patient's symptoms and to the balance between risk and benefit of repair with suture anchors. 

The ream and run for severe anchor arthropathy in a young athletic man.

Ream and run for anchor arthropathy

The problem with suture anchors: anchor arthropathy

Suture anchors - never out of the woods

Total shoulder for anchor arthropathy

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Here are some videos that are of shoulder interest

Shoulder arthritis - what you need to know (see this link).

How to x-ray the shoulder (see this link).

The ream and run procedure (see this link).

The total shoulder arthroplasty (see this link).

The cuff tear arthropathy arthroplasty (see this link).

The reverse total shoulder arthroplasty (see this link).

The smooth and move procedure for irreparable rotator cuff tears (see this link).

Shoulder rehabilitation exercises (see this link).