Shoulder Instability – Surgeons and Radiologists differ on intepretations

The problems of treating chronic shoulder instability and dislocation can be compounded by confusion in reading an MRA magnetic resonance arthrography / MRI. New research published in the Journal of Shoulder and Elbow Surgery compared the interpretations.

Here is a summary of their findings:
The researchers compared the interpeting accuracy of  musculoskeletal radiologists with orthopaedic shoulder surgeons in 2 large medical centers in assessing magnetic resonance arthrograms (MRAs) of patients with traumatic anterior shoulder instability.

Forty-five surgically confirmed MRAs were assessed by 4 radiologists, 4 orthopaedic surgeons, 2 radiologic teams, and 2 orthopaedic teams.

The overall difference in assessment between the individual radiologists and orthopaedic surgeons was moderate although radiologists tended to agree with each other more on the diagnosis than the surgeons did with themselves.

They concluded that an experienced orthopaedic surgeons are more accurate than radiologists in assessing traumatic anterior shoulder instability-related lesions on MRA. In case of diagnosis disagreement, these orthopaedic surgeons should base their treatment decision on their own MRA interpretation.

So basically the surgeons should not rely on the MRA/MRI report.

The use of MRI in Prolotherapy

Prolotherapy doctors also have also known that the MRI can be tricky and sometimes deceiving, leading a doctor down the wrong path of treatment. Recently doctors suggested that 43% of knee MRIs are useless as a means of helping the patient situation. You can read more about concerns over MRI accuracy.

Please see this article by Tim Speciale DO to learn more about Prolotherapy treatments for multi-directional shoulder instability.

1. van Grinsven S, Nijenhuis TA, Konings PC, van Kampen A, van Loon CJ. Are radiologists superior to orthopaedic surgeons in diagnosing instability-related shoulder lesions on magnetic resonance arthrography? A multicenter reproducibility and accuracy study. J Shoulder Elbow Surg. 2015 Jul 11. pii: S1058-2746(15)00295-5. doi: 10.1016/j.jse.2015.05.050. [Epub ahead of print]