ACCURACY OF PREOPERATIVE MRI IN DIAGNOSIS OF SUBSCAPULARIS TENDON TEAR
Main Article Content
Keywords
MRI-Magnetic Resonance Imaging, FTT-Full thickness tear, PTT- Partial thickness tear, 1.5 T-1.5 Tesla
Abstract
Background : MRI is widely used to evaluate the rotator cuff pathologies of shoulder joint. The study was done to find the effectiveness of MRI in detecting subscapularis tendon tears in comparison with arthroscopy/surgery in a tertiary care hospital .
Methods : It was a prospective study done in MES academy of medical science in 83 patients who underwent MRI of the shoulder joint and subsequent surgery/ arthroscopy over a period of 12 months for suspected rotator cuff pathologies. The inclusion criteria included: (1) absence of prior surgery of the subscapularis tendon; (2) preoperative MRI at our institution; (3) surgery performed via arthroscopy or mini-open repair at our institution. Exclusion criteria: 1. Patients not having preoperative MRI taken at our institution. After applying the inclusion and exclusion criteria 61 patients were analyzed. Each patient’s MRI was reviewed and the subscapularis tendon was evaluated in detail. The tendon was described as intact partial thickness tear (PTT) and full thickness tear (FTT). The integrity of other rotator cuff tendons (supraspinatus, infraspinatus and teres minor), ancillary findings such as subacromial-subdeltoid bursal effusion, subcoracoid bursal effusion, joint effusion, and acromioclavicular joint arthritis, and the patient’s epidemiological data were also analyzed.
Results : MRI had 60.7% sensitivity, 100% specificity, 100% PPV, and 84.7% NPV for the identification of partial thickness tendon tears and 100% sensitivity, specificity, PPV, and NPV for Full thickness tendon tears. Shoulder MRI demonstrated an overall accuracy of 91.36% in diagnosing subscapularis tendon tears. The accuracy for detection of PTTs was 87.6%, and for FTTs was 100%
Conclusion : Preoperative 1.5T MRI has high sensitivity and high PPV for the diagnosis of FTTs of the supscapularis tendon , though it does not reliably predict PTTs of the subscapularis tendon. Shoulder arthroscopy should be considered in patients with negative MRIs and continuing symptoms.
References
2. Tung GA, Yoo DC, Levine SM, Brody JM, Green A. Subscapularis tendon tear: primary and associated signs on MRI. J Comput Assist Tomogr. 2001 May-Jun;25(3):417-24.
3. Adams CR, Schoolfield JD, Burkhart SS. Accuracy of preoperative magnetic resonance imaging in predicting a subscapularis tendon tear based on arthroscopy. Arthroscopy. 2010 Nov;26(11):1427-33.
4. Pfirrmann CW, Zanetti M, Weishaupt D, Gerber C, Hodler J. Subscapularis tendon tears: detection and grading at MR arthrography. Radiology. 1999 Dec;213(3):709-14.
5. Foad A, Wijdicks CA. The accuracy of magnetic resonance imaging and magnetic resonance arthrogram versus arthroscopy in the diagnosis of subscapularis tendon injury. Arthroscopy. 2012 May;28(5):636-41.
6. Garavaglia G, Ufenast H, Taverna E. The frequency of subscapularis tears in arthroscopic rotator cuff repairs: A retrospective study comparing magnetic resonance imaging and arthroscopic findings. Int J Shoulder Surg. 2011 Oct;5(4):90-4.
7. Lafosse L, Jost B, Reiland Y, Audebert S, Toussaint B, Gobezie R. Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. J Bone Joint Surg Am. 2007 Jun;89(6):1184-93.
8. Toussaint B, Barth J, Charousset C, Godeneche A, Joudet T, Lefebvre Y, Nove-Josserand L, Petroff E, Solignac N, Hardy P, Scymanski C, Maynou C, Thelu CE, Boileau P, Graveleau N, Audebert S; French Arthroscopy Society (SFA). New endoscopic classification for subscapularis lesions. Orthop Traumatol Surg Res. 2012 Dec;98(8 Suppl):S186-92.
9. Burkhart SS, Brady PC. Arthroscopic subscapularis repair: surgical tips and pearls A to Z. Arthroscopy. 2006 Sep;22(9):1014-27.
10. Yoo JC, Rhee YG, Shin SJ, Park YB, McGarry MH, Jun BJ, Lee TQ. Subscapularis tendon tear classification based on 3-dimensional anatomic footprint: a cadaveric and prospective clinical observational study. Arthroscopy. 2015 Jan;31(1):19-28.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Sandra Chathemparambil Mani C.
Junior Resident, Department of Radiology, MES Academy of Medical Sciences, Malappuram, Kerala, India.
Dr. Hameed Fazal
Associate Professor, Department of Radiology, MES Academy of Medical Sciences, Malappuram, Kerala, India.
Dr. Rejeesh Saseendran
Associate Professor, Department of Radiology, MES Academy of Medical Sciences, Malappuram, Kerala, India.
Dr. M.N. Brahmadathan
Professor, Department of Radiology, MES Academy of Medical Sciences, Malappuram, Kerala, India.