Correlation Between Clinical , MRI and MRA Diagnosis of Anterior Instability of Shoulder Joint

Abstract

Background: Anterior shoulder instability is caused by defect in soft tissue and bony structure around   shoulder joint. Thorough   history   and physical examinations are mandatory for clinical diagnosis. For confirmation of   instability by direct visualization of   structural defect   Magnetic resonance imaging (MRI) and Magnetic resonance Arthrogram (MRA) have emerged. Studies  on  diagnostic  evaluation of  essential clinical diagnosis for  shoulder  instability specially in terms of MRI and MRA are  lacking .Although it is paramount  for deciding  course  of management.

Aims  And  Objectives :   Correlating  and  comparing  clinical  diagnosis  of  anterior  shoulder instability  with  MRI and MRA diagnosis of the same  .

Methodology : 49 patients  clinically  examined  to diagnose  anterior  shoulder  instability  by  history and  physical  examination , then 49  underwent MRI  and  38 out of  49  underwent  MRA  to  detect  structural  defect  causing  shoulder   instability . Results were correlated.

Results : Young  (< 30 years ) ,male  with  recurrent  dislocation  resulting from  fall commonly   have  shoulder  instability  with  structural defect . Sensitivity, positive predictive values, accuracy of clinical diagnosis is highest when compared   MRI and MRA together as a single modality. Specificity   and agreement   is highest when compared   to MRI (K=0.573)

Conclusion: Clinical diagnosis   can be relied for shoulder instability. Clinically positive patients   have high chances of truly having instability (for satisfactory PPV values). Because of  slight  to moderate  agreement , MRI  and MRA confirmation  of  clinical diagnosis is  advisable before  planning for  management.