Role of Ultrasonography and MRI in Diagnosis of Glenohumeral Instability
Muataz Khadim Hussain;
Abstract
The shoulder joint is anatomically complex, where its stability depends on a combination of osseous structures and soft tissue structures surrounding the shoulder known as the labral ligamentous complex, joint capsule, , muscles and tendons where they are acting as dynamic as well as static stabilizers preventing the joint from exceeding the optimized range of motion.
Glenohumeral joint instability involves multiple different diagnoses with a broad range of underlying pathology. It is important to understand the anatomy, pathology, history, physical examination, and classification systems to diagnose these patients correctly. After arriving at an accurate diagnosis, an appropriate treatment program that may entail nonoperative or surgical interventions can be instituted.
Glenohumeral instability remains a very complex and sometimes challenging diagnostic problem. There are potential lesions of the capsule and labroligamentous structures that can occur in association with shoulder instability, and the clinical history and physical findings are not always sufficient to make accurate diagnosis.
Reliable diagnostic imaging is mandatory not only for establishing a correct diagnosis but also for evaluation when different treatment options are considered. Imaging is especially important when clinical findings are contradictory or sparse.
In the past, several imaging modalities were used ranging from conventional radiography, arthrography to computerized axial arthrography. Recently, various imaging modalities are now available including ultrasonography, CT arthrography, conventional MRI and MR arthrography.
This study included 30 patients, clinically presented with multiple episodes of shoulder dislocation. Ultrasound as well as conventional MRI was done for all patients.
Ultrasonography is cheap, readily available, fast, capable to provide high-resolution images, and does not use ionizing radiations. In addition, US allows performing dynamic evaluation of musculoskeletal structures, that may help to further increase diagnostic performance and can produce important pre-operative information in patients who have recurrent, anterior shoulder instability.
In the present study the ultrasound shows 73.3% sensitivity in labral tears detection, 100% sensitivity for effusion and Hill Sach’s defect.
US imaging is minimally affected by metal artifacts (eg, cochlear implants, hardware, or pacemakers) and also can be used in certain patients who have contraindications to MRI imaging (eg, claustrophobic or obese patients).
Glenohumeral joint instability involves multiple different diagnoses with a broad range of underlying pathology. It is important to understand the anatomy, pathology, history, physical examination, and classification systems to diagnose these patients correctly. After arriving at an accurate diagnosis, an appropriate treatment program that may entail nonoperative or surgical interventions can be instituted.
Glenohumeral instability remains a very complex and sometimes challenging diagnostic problem. There are potential lesions of the capsule and labroligamentous structures that can occur in association with shoulder instability, and the clinical history and physical findings are not always sufficient to make accurate diagnosis.
Reliable diagnostic imaging is mandatory not only for establishing a correct diagnosis but also for evaluation when different treatment options are considered. Imaging is especially important when clinical findings are contradictory or sparse.
In the past, several imaging modalities were used ranging from conventional radiography, arthrography to computerized axial arthrography. Recently, various imaging modalities are now available including ultrasonography, CT arthrography, conventional MRI and MR arthrography.
This study included 30 patients, clinically presented with multiple episodes of shoulder dislocation. Ultrasound as well as conventional MRI was done for all patients.
Ultrasonography is cheap, readily available, fast, capable to provide high-resolution images, and does not use ionizing radiations. In addition, US allows performing dynamic evaluation of musculoskeletal structures, that may help to further increase diagnostic performance and can produce important pre-operative information in patients who have recurrent, anterior shoulder instability.
In the present study the ultrasound shows 73.3% sensitivity in labral tears detection, 100% sensitivity for effusion and Hill Sach’s defect.
US imaging is minimally affected by metal artifacts (eg, cochlear implants, hardware, or pacemakers) and also can be used in certain patients who have contraindications to MRI imaging (eg, claustrophobic or obese patients).
Other data
| Title | Role of Ultrasonography and MRI in Diagnosis of Glenohumeral Instability | Other Titles | دور الرنين المغناطيسى والموجات الصوتية فى تشخيص عدم اتزان مفصل الكتف | Authors | Muataz Khadim Hussain | Issue Date | 2015 |
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