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Shoulder pain: Correlation between MR imaging and operative findings
J. Shoulder Elbow Surg. Volume 5, Number 2, Part 2
337
THE DIAGNOSTIC VALUE OF ULTRASONOGRAPHY IN SOFT TISSUE PATHOLOGIES OF SHOULDER JOINT
Abstracts $103
339
@enol Akman, M.D., Mehmet Demirhan, M.D., CengiZ ,~en, M.D., Mustafa Caniklioglu, M.D., Y/ImazAkahn, M.D. Dept. of Orthopaedics, Univ. of Istanbul, Istanbul Medical Faculty, Turkey & Istanbul SSK Hospital, Turkey Seven hundred and sixty-six shoulder joints of three hundred and eighty three patients was ultrasonographically examined between October 1991 and October 1993 in the Department of Orthopaedics and Traumatology, Istanbul Medical Faculty, University of Istanbul. Two hundred and nine examinations yielded pathological results. There were thirty-eight complete rotator cuff degenerations, eleven patients with calcified supraspinatus tendinitis, fi~ty-three subacromia~ effusions, seventeen bicipital effusions, five Hill-Sachs deformities, three deltoid atrophies, two cases with frozen shoulder findings, eighteen rotator cuff thinnings, one septic arthritis and tWenty-four miscellaneous diagnosis. We compared uttrasonographic diagnosis with the findings at surgery in fifty-six of these patients; there were two fatse negative results ( Ultrasound revealed no change but we found rotator cuff tears less than one centimeter) but no false positives ones. All ultrasonographies was performed by the same surgeon. This imaging method has an important role in the evaluation of rotator cuff tears, subaoromial effusion and biceps teodinitis in skillful hands. The dynamic examination especially has to be done by the surgeon. The rotator cuff tears were re-evaluated by" artrography and recently by MRI. Ultrasonography is a non-invasive, easily performed, cost-effective and reliable diagnostic method in the shoulder joint disorders.
338
THE VALIDATION OF CT-ARTHROGRAM(CTA) FOR ARTHROSCOPIC BANKART REPAIR. Kunihiko Yanaga, Yasusuke Hirasawa, M.D and Masao Kurokawa, M.D, Dept. of Orthop., Kyoto Prof. Univ. of Meal., Japan The purpose of this study is to classify the type of Bankart lesion in traumatic anterior instability before arthroscoDicsurgery. Thirtyfour shoulders with traumatic anterior instability were examined using CT-arthrography and performed arthroscopes. Arthroscopio findings were evaluated with Kurokawa's classification. The authors proposed a new classification of Bankart lesion on CTA scans as follows; articular surface of glenoid as Area A(A-1 ; irregularity of the surface, A-2; defect of the surface), AIGHL-labral complex as Area BIB-1 ; capsular avulsion with the trigonal shadow, B-2; defect of the complex shadow), scapular neck as Area C (C-1 ; bare neck, C-2; displacement of the trigonal shadow, C-3; empty space cf glenoid rim) and ossified glenoid as Area DID-1 ; fracture of glenoid rim). The A-l, B-1 were showed in type1 or type2. The A-2 and B-2 were indicated in the type 3 or 4, but the A-2 was also showed in half of the type1 or 2. Half of type1 showed the A-1 and D-1. Type4a indicated the A-2, B-2 and C-1. In conclusion, type 1,2n or 2a includes CTA findings in the area A, which type 1 or 2n has the A-1 ~nd type 2a shows the A-2, The A-1 with the D-1 is considered type1. The A-1 or C-1 with the B-3 is considered type 4.
SHOULDER PAIN: CORRELATION BETWEEN MR IMAGING AND OPERATIVE FINDINGS. S.WDELLA SALA, G. BIANCHINI - U.O. RADIOLOGIA, H S.CH]ARA, TRENTO, ITALY We studied by means of magnetic resonance (MR) from January 1993 to December 1994 80 patients complaining shoulder pain 28 subsequentely underwent surgical operation, with exhaustive inspection of the structures of the shoulder and treatment of pathological findings. In this group we identified at MR 14/28 cases of complete tear of the rotator cuff, 4/28 cases of partial tear, 7/28 cases of narrowing of subacromial space causing impingement, 1/28 of acromioclavicolar impingement, 1/28 humeral head ostheocondrytls, 1/28 total tear of the rotator cuff and humeral head eatheocondrytis. We compared MR diagnosis with surgical findings: in all cases the MR diagnosis was confirmed at operation MR demonstrated high reliability in the study of shoulder pain. Because of the possibility of evaltrating pathological changes of all the structures of the joint (tendons, bones, articular space) that cause shoulder pain MR seems to be the best imaging method for the study of these patients.
340
S O N O G R A P H I C E V A L U A T I O N OF THE B A N K A R T B .A. Fleega, MD. ,O. Buckub, MD, GO C l i n i c Bonn, G e r m a n y
LESION
Nonivasive clinical and radiologicaI diagnoses of the 8ankart lesion is not reliable.The sonographic examination of the Bankart lesion in a special position is studied. A preoperative evaluation was compaired to the operative findings. MATERIAL AND METHOD: The patient lies in a semisitting position on his back and the scapula will be fixed with a pad.The shoulder will be held in 30 to 80 ~ abduction,10 ~ extension and neutral rotation.The patient must relax the sonograph-head is placed paraUal to the clavical on the lower border of the pectoralis major.It is then possible to see the glenoid with the attachment of the capsule-labrum band .Thru rotation of the shoulder it is possible to evaluate the Bankart lesion. 12 cases with post-dislocation anterior instability symptoms were examined and evaluated sonographically and treated ~ater with open surgery. RESULTS :The sonographic evaluation showed a Bankart lesion in 6 cases.At surgery all the cases were conformed.In the other 6 cases there were 2 frayed labrum and one Bankart lesion with about 1 cm detachment.When sonography was compared to surgery in the 12 patients its sensitivity was 75% and its overall accuracy was 92% CONCLUSION: This nonivasive method is the only cheep and easy method to diagnose a Bankart lesion with more than 90% accuracy.The technique allows evaluation of rotator cuff and both shoulders at once. We suspect that improvement in the accuracy of sonographic diagnosis will continue.
337
THE DIAGNOSTIC VALUE OF ULTRASONOGRAPHY IN SOFT TISSUE PATHOLOGIES OF SHOULDER JOINT
Abstracts $103
339
@enol Akman, M.D., Mehmet Demirhan, M.D., CengiZ ,~en, M.D., Mustafa Caniklioglu, M.D., Y/ImazAkahn, M.D. Dept. of Orthopaedics, Univ. of Istanbul, Istanbul Medical Faculty, Turkey & Istanbul SSK Hospital, Turkey Seven hundred and sixty-six shoulder joints of three hundred and eighty three patients was ultrasonographically examined between October 1991 and October 1993 in the Department of Orthopaedics and Traumatology, Istanbul Medical Faculty, University of Istanbul. Two hundred and nine examinations yielded pathological results. There were thirty-eight complete rotator cuff degenerations, eleven patients with calcified supraspinatus tendinitis, fi~ty-three subacromia~ effusions, seventeen bicipital effusions, five Hill-Sachs deformities, three deltoid atrophies, two cases with frozen shoulder findings, eighteen rotator cuff thinnings, one septic arthritis and tWenty-four miscellaneous diagnosis. We compared uttrasonographic diagnosis with the findings at surgery in fifty-six of these patients; there were two fatse negative results ( Ultrasound revealed no change but we found rotator cuff tears less than one centimeter) but no false positives ones. All ultrasonographies was performed by the same surgeon. This imaging method has an important role in the evaluation of rotator cuff tears, subaoromial effusion and biceps teodinitis in skillful hands. The dynamic examination especially has to be done by the surgeon. The rotator cuff tears were re-evaluated by" artrography and recently by MRI. Ultrasonography is a non-invasive, easily performed, cost-effective and reliable diagnostic method in the shoulder joint disorders.
338
THE VALIDATION OF CT-ARTHROGRAM(CTA) FOR ARTHROSCOPIC BANKART REPAIR. Kunihiko Yanaga, Yasusuke Hirasawa, M.D and Masao Kurokawa, M.D, Dept. of Orthop., Kyoto Prof. Univ. of Meal., Japan The purpose of this study is to classify the type of Bankart lesion in traumatic anterior instability before arthroscoDicsurgery. Thirtyfour shoulders with traumatic anterior instability were examined using CT-arthrography and performed arthroscopes. Arthroscopio findings were evaluated with Kurokawa's classification. The authors proposed a new classification of Bankart lesion on CTA scans as follows; articular surface of glenoid as Area A(A-1 ; irregularity of the surface, A-2; defect of the surface), AIGHL-labral complex as Area BIB-1 ; capsular avulsion with the trigonal shadow, B-2; defect of the complex shadow), scapular neck as Area C (C-1 ; bare neck, C-2; displacement of the trigonal shadow, C-3; empty space cf glenoid rim) and ossified glenoid as Area DID-1 ; fracture of glenoid rim). The A-l, B-1 were showed in type1 or type2. The A-2 and B-2 were indicated in the type 3 or 4, but the A-2 was also showed in half of the type1 or 2. Half of type1 showed the A-1 and D-1. Type4a indicated the A-2, B-2 and C-1. In conclusion, type 1,2n or 2a includes CTA findings in the area A, which type 1 or 2n has the A-1 ~nd type 2a shows the A-2, The A-1 with the D-1 is considered type1. The A-1 or C-1 with the B-3 is considered type 4.
SHOULDER PAIN: CORRELATION BETWEEN MR IMAGING AND OPERATIVE FINDINGS. S.WDELLA SALA, G. BIANCHINI - U.O. RADIOLOGIA, H S.CH]ARA, TRENTO, ITALY We studied by means of magnetic resonance (MR) from January 1993 to December 1994 80 patients complaining shoulder pain 28 subsequentely underwent surgical operation, with exhaustive inspection of the structures of the shoulder and treatment of pathological findings. In this group we identified at MR 14/28 cases of complete tear of the rotator cuff, 4/28 cases of partial tear, 7/28 cases of narrowing of subacromial space causing impingement, 1/28 of acromioclavicolar impingement, 1/28 humeral head ostheocondrytls, 1/28 total tear of the rotator cuff and humeral head eatheocondrytis. We compared MR diagnosis with surgical findings: in all cases the MR diagnosis was confirmed at operation MR demonstrated high reliability in the study of shoulder pain. Because of the possibility of evaltrating pathological changes of all the structures of the joint (tendons, bones, articular space) that cause shoulder pain MR seems to be the best imaging method for the study of these patients.
340
S O N O G R A P H I C E V A L U A T I O N OF THE B A N K A R T B .A. Fleega, MD. ,O. Buckub, MD, GO C l i n i c Bonn, G e r m a n y
LESION
Nonivasive clinical and radiologicaI diagnoses of the 8ankart lesion is not reliable.The sonographic examination of the Bankart lesion in a special position is studied. A preoperative evaluation was compaired to the operative findings. MATERIAL AND METHOD: The patient lies in a semisitting position on his back and the scapula will be fixed with a pad.The shoulder will be held in 30 to 80 ~ abduction,10 ~ extension and neutral rotation.The patient must relax the sonograph-head is placed paraUal to the clavical on the lower border of the pectoralis major.It is then possible to see the glenoid with the attachment of the capsule-labrum band .Thru rotation of the shoulder it is possible to evaluate the Bankart lesion. 12 cases with post-dislocation anterior instability symptoms were examined and evaluated sonographically and treated ~ater with open surgery. RESULTS :The sonographic evaluation showed a Bankart lesion in 6 cases.At surgery all the cases were conformed.In the other 6 cases there were 2 frayed labrum and one Bankart lesion with about 1 cm detachment.When sonography was compared to surgery in the 12 patients its sensitivity was 75% and its overall accuracy was 92% CONCLUSION: This nonivasive method is the only cheep and easy method to diagnose a Bankart lesion with more than 90% accuracy.The technique allows evaluation of rotator cuff and both shoulders at once. We suspect that improvement in the accuracy of sonographic diagnosis will continue.