ROLE OF MAGNETIC RESONANCE IMAGING IN EVALUATION OF INTERNAL DERANGEMENT OF SHOULDER JOINT IN INDIAN POPULATION
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Abstract
Background:
The shoulder complex comprises three joints namely the sternoclavicular, acromioclavicular, and glenohumeral joints. Internal derangement of shoulder is evaluated with radiography, CT, MRI, arthrography and arthroscopy. MRI and MR arthrography are the imaging modality of choice due to excellent contrast resolution and multiple imaging planes provide the most detailed evaluation and diagnosis of abnormalities of the rotator cuff especially partial versus intact or full-thickness tears, the biceps tendon and also useful in the assessment of instability of shoulder joint.
Aim & Objective: 1. To study the MRI characteristics of various non-neoplastic pathologies of shoulder joint. 2. To assess the role of MRI in evaluation of patients with painful shoulder, predominantly rotator cuff, impingement and labral pathologies. 3. To study the relationship between the clinical presentation and MRI findings.
Methods: Study design: A Cross sectional study. Study setting: Department of Radiodiagnosis BJGMC & Sassoon General Hospital, Pune.Study duration: conducted from Dec 2018 to May 2019.
Study population: All Patients referred to the department of Radiodiagnosis BJGMC & Sassoon General Hospital, Pune for MRI shoulder with shoulder pain or clinically suspected with internal derangement of shoulder joint were enrolled. Sample size: 50
Results:
The male to female ratio is 2.1:1. Majority of the patients, 22 (44%) were in the age group of 21 to 40 years, followed by 18 in the age group of 41 to 60 years (36%). There were 8 patients (16%) in the age group of 61 to 80 years and 2 were less than 20 years of age (4%). The most common clinical presentation was pain in shoulder, seen in 43 patients (86%) followed by restricted movements in 34 patients (68%). Joint instability, trauma and joint stiffness was seen in 19 (38%), 22 (44%), 9 (18%) patients respectively. Also 7(14%) patients gave history of recurrent dislocations. rotator cuff pathologies were seen in 41 out of 50 cases (82%).
The commonest rotator cuff pathology was found to be partial tear of the supraspinatus tendon seen in 19(38%) patients. Impingement syndrome was seen in 5(10%) patients. Significant association was seen between the rotator cuff pathologies and age (p = 0.028). Most common clinical presentation in patients with rotator cuff pathologies was pain, seen in total 37 out of 41 patients (90.24%) followed by restricted movements in 30 out of 41 patients (73.17%), trauma in 18 patients (43.90%) and joint instability in 14 patients (34.15%). Stiffness was seen in 7 cases (17.07%) and H/o Recurrent Dislocations was observed in 5 cases (12.20%).
Conclusions:
Magnetic resonance imaging of the shoulder is an excellent non invasive investigation for evaluation of shoulder pain and suspected cases with internal derangement due to multiplanar imaging and excellent delineation of the soft tissue structures.