A comparison of magnetic resonance imaging findings of the acromioclavicular joint in symptomatic versus asymptomatic patients

Stein, Beth E. Shubin; Ahmad, Christopher S.; Pfaff, Charles; Bigliani, Louis U.; Levine, William N.

doi:10.1016/j.jse.2005.05.013

Cited by 66 publications

(21 citation statements)

References 12 publications

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“…This have probably affected the results, particularly in the myalgia and AC joint osteoarthritis groups. AC joint osteoarthritis is reported as increasingly present with age in persons without shoulder pain [9] and was most likely underestimated in older age groups in our study. Myalgia is almost always present in joint diseases as an additional extra-articular source of pain but was only accounted for when present as the main diagnosis in our cohort.…”

Section: Discussionmentioning

confidence: 75%

“…There is no conclusive gold standard and the pain generator is not known for conditions such as subacromial pain syndrome and myalgia. This is even true in the degenerative diseases where studies have shown both full thickness rotator cuff tears [8] and osteoarthritis [9] in non-painful shoulders. Therefore, the diagnostic criteria sets used in the literature might differ and cause frequency differences across studies.…”

Section: Discussionmentioning

confidence: 99%

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Shoulder diagnoses in secondary care, a one year cohort

Juel

Natvig

2014

BMC Musculoskelet Disord

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BackgroundShoulder pain is common in the general population. Reports on specific diagnoses in general populations are scarce and only from primary care. The diagnostic distribution of shoulder disorders in secondary care is not reported. Most of the clinical research in the shoulder field is done in hospital settings. The aim of this study was to identify the diagnoses in a 1-year cohort in a hospital-based outpatient clinic using standardized diagnostic criteria and to compare the results with previous studies.MethodsA diagnostic routine was conducted among patients referred to our physical medicine outpatient clinic at Oslo University Hospital. Diagnostic criteria were derived from the literature and supplemented with research criteria.ResultsOf 766 patients diagnosed, 55% were women and the mean age was 49 years (range 19–93, SD ± 14). The most common diagnoses were subacromial pain (36%), myalgia (17%) and adhesive capsulitis (11%). Subacromial pain and adhesive capsulitis were most frequent in persons aged 40–60 years. Shoulder myalgia was most frequent in age groups under 40. Labral tears and instability problems (8%) were most frequent in young patients and not present after age 50. Full-thickness rotator cuff tears (8%) and glenohumeral osteoarthritis (4%) were more prevalent after the age of 60. Few differences were observed between sexes. We identified three studies reporting shoulder diagnoses in primary care.ConclusionSubacromial pain syndrome, myalgia and adhesive capsulitis were the most prevalent diagnoses in our study. However, large differences in prevalence between different studies were found, most likely arising from different use of diagnostic criteria and a difference in populations between primary and secondary care. Of the diagnoses in our cohort, 20% were not reported by the studies from primary care (glenohumeral osteoarthritis, full thickness rotator cuff tears, labral tears and instabilities).

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Shoulder diagnoses in secondary care, a one year cohort

Juel

Natvig

2014

BMC Musculoskelet Disord

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“…More advanced imaging investigations such as magnetic resonance arthrogram (MRA) are also available, providing improved visualisation of pathologies such as glenoid labral lesions and tendon pathology [17]. While previous studies report the prevalence of imaging findings in the general population [18], specific athletic populations [19,20], samples of convenience [21,22] or case-control comparisons for specific shoulder pathology [23], the prevalence of imaged pathology in a prospective cohort of primary care patients suffering a current episode of shoulder pain has not been previously reported. Diagnostic decisions rely upon knowledge of prevalence of a condition in specific populations in order to estimate the likelihood of a positive 'disease' status or outcome following specific tests or investigations [24].…”

Section: Introductionmentioning

confidence: 99%

A prospective study of shoulder pain in primary care: Prevalence of imaged pathology and response to guided diagnostic blocks

Cadogan

Laslett

Hing

et al. 2011

BMC Musculoskelet Disord

120

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BackgroundThe prevalence of imaged pathology in primary care has received little attention and the relevance of identified pathology to symptoms remains unclear. This paper reports the prevalence of imaged pathology and the association between pathology and response to diagnostic blocks into the subacromial bursa (SAB), acromioclavicular joint (ACJ) and glenohumeral joint (GHJ).MethodsConsecutive patients with shoulder pain recruited from primary care underwent standardised x-ray, diagnostic ultrasound scan and diagnostic injections of local anaesthetic into the SAB and ACJ. Subjects who reported less than 80% reduction in pain following either of these injections were referred for a magnetic resonance arthrogram (MRA) and GHJ diagnostic block. Differences in proportions of positive and negative imaging findings in the anaesthetic response groups were assessed using Fishers test and odds ratios were calculated a for positive anaesthetic response (PAR) to diagnostic blocks.ResultsIn the 208 subjects recruited, the rotator cuff and SAB displayed the highest prevalence of pathology on both ultrasound (50% and 31% respectively) and MRA (65% and 76% respectively). The prevalence of PAR following SAB injection was 34% and ACJ injection 14%. Of the 59% reporting a negative anaesthetic response (NAR) for both of these injections, 16% demonstrated a PAR to GHJ injection. A full thickness tear of supraspinatus on ultrasound was associated with PAR to SAB injection (OR 5.02; p < 0.05). Ultrasound evidence of a biceps tendon sheath effusion (OR 8.0; p < 0.01) and an intact rotator cuff (OR 1.3; p < 0.05) were associated with PAR to GHJ injection. No imaging findings were strongly associated with PAR to ACJ injection (p ≤ 0.05).ConclusionsRotator cuff and SAB pathology were the most common findings on ultrasound and MRA. Evidence of a full thickness supraspinatus tear was associated with symptoms arising from the subacromial region, and a biceps tendon sheath effusion and an intact rotator cuff were associated with an intra-articular GHJ pain source. When combined with clinical information, these results may help guide diagnostic decision making in primary care.

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“…The purpose of this methodology was to facilitate data analysis and understanding. A similar methodology has been used by other authors 8 , 9 and may affect some results, especially for acromioclavicular osteoarthritis, joint degeneration that which affects up to 82% of asymptomatic individuals 12 . However, we chose to highlight clinical findings over changes in imaging.…”

Section: Discussionmentioning

confidence: 99%

Shoulder disorders in an outpatient clinic: an epidemiological study

et al. 2017

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OBJECTIVE: To describe shoulder disorders in patients evaluated by two shoulder and elbow surgeons. METHODS: This cross-sectional study analyzed patients evaluated by two authors, excluding acute fractures and dislocations and patients with symptoms not involving the shoulder. Age and sex distribution was determined for the different diagnoses. RESULTS: We evaluated 1001 patients. Mean age was 51.43±15.15 years and 51.0% were female. Disorders of the rotator cuff occurred in 64.3% (41.2% tendinopathy, 11.0% partial tears and 12.2% full-thickness tears). Adhesive capsulitis occurred in 13.5% of cases and glenohumeral instability in 8.1%. Rotator cuff disorders were more common in women, with a peak between 50 and 59 years for tendinopathy and partial tears and between 60 and 69 years for full-thickness tears. Glenohumeral instability was more frequent in men, with a peak between 30 and 39 years. CONCLUSION: The most frequent diagnosis was rotator cuff tendinopathy, followed by adhesive capsulitis, full-thickness rotator cuff tears, partial rotator cuff tears and glenohumeral instability. Rotator cuff lesions were more common in women, with a peak between 60 and 69 years for full-thickness tears. Level of Evidence IV, Case Series.

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A comparison of magnetic resonance imaging findings of the acromioclavicular joint in symptomatic versus asymptomatic patients

Cited by 66 publications

References 12 publications

Shoulder diagnoses in secondary care, a one year cohort

Shoulder diagnoses in secondary care, a one year cohort

A prospective study of shoulder pain in primary care: Prevalence of imaged pathology and response to guided diagnostic blocks

Shoulder disorders in an outpatient clinic: an epidemiological study

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