ORTHOPEDIC AREA   

Medicina dello Sport 2010 December;63(4):547-56

Copyright © 2011 EDIZIONI MINERVA MEDICA

language: English, Italian

Role of MR arthrography in shoulder micro-instability: personal experience

Francavilla G. ¹, Sutera R. ², Iovane A. ², Candela F. ², Sanfilippo A. ³, Francavilla V. C. ², D’Arienzo M. ³

¹ Department of Clinical Medicine, Cardiovascular and Nephro-Urological Diseases, University of Palermo, Palermo, Italy; ² DIBIMEF - Section of Radiological Sciences, University of Palermo, Palermo, Italy; ³ Clinic of Orthopaedic and Trauma, University of Palermo, Palermo, Italy

Aim. Glenohumeral instability has been classically divided into two broad categories: on the one hand the so-called TUBS (Traumatic, Unidirectional, Bankart lesion, responds to surgery) and on the other AMBRII (Atraumatic, Multidirectional, Bilateral, responds to rehabilitation, inferior capsular shift, interval closure). However, between these two extremes there is a set of conditions defined as “minor instability”, including AIOS (Acquired Instability in overstressed shoulder, Surgery) and AMSI (Atraumatic Minor Shoulder Instability). The aim of this study was to assess the ability of the MR arthrography examination to detect minor shoulder instability, later confirmed by arthroscopic examination.
Methods. MR arthrography was used to study 14 patients, who were later submitted to arthroscopic surgery of the shoulder. We used an MRI scanner with high field strength (1.5 Tesla), and for each patient performed SE T1-weighted sequences with and without fat signal suppression, SE-T2-weighted sequences with fat signal suppression, GRE, and an additional T1-weighted sequence was acquired in the ABER (Abduction and External Rotation) position.
Results. MR arthrography revealed the presence of an alteration in the normal anatomy of the shoulder in all 14 patients. In all cases arthroscopic examination confirmed the findings of MR arthrography. The structural abnormalities which might result from microtraumatic glenohumeral instability may be described with MR arthrography. MR arthrography can be used to confirm the diagnosis of a PSI and thus determine the choice of proper treatment, demonstrating the extent of joint damage. MR arthrography plays a less important role in the study of AMSI than in the study of AIOS, as clinical aspects are more fundamental for the recognition of the cause of shoulder pain typical in patients who neither suffered trauma nor practiced so-called “overhead” sports.
Conclusion. MR arthrography can play an important role in evaluating the shoulders of athletes, especially those engaged in “overhead” activities, if the aim is to provide essential information for treatment decisions at a level on a par with that of diagnostic arthroscopy.