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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Chillemi C, Franceschini V, Dei Giudici L, et al. Epidemiology of isolated acromioclavicular joint dislocation. Emerg Med Int. 2013;2013:171609. Review/Other-Dx 108 patients To analyze the epidemiology of isolated AC dislocation in an urban population. 105 (97.2%) had an isolated AC dislocation, and 3 (2.8%) were associated with a clavicle fracture. The estimated incidence was 1.8 per 10000 inhabitants per year and the male-female ratio was 8.5 : 1. 50.5% of all dislocations occurred in individuals between the ages of 20 and 39 years. The most common traumatic mechanism was sport injury and the most common type of dislocation was Rockwood type III. 4
2. Zacchilli MA, Owens BD. Epidemiology of shoulder dislocations presenting to emergency departments in the United States. J Bone Joint Surg Am. 2010;92(3):542-549. Review/Other-Dx 8,940 shoulder dislocations To determine the incidence of shoulder dislocations presenting to hospital emergency departments in the United States and define demographic risk factors for these injuries. A total of 8940 shoulder dislocations were identified, resulting in an overall incidence rate in the United States of 23.9 (95% confidence interval, 20.8 to 27.0) per 100,000 person-years. The male incidence rate was 34.90 (95% confidence interval, 30.08 to 39.73) per 100,000 person-years, with an incidence rate ratio of 2.64 (95% confidence interval, 2.39 to 2.88) relative to the female incidence rate. It was found that 71.8% of the dislocations were in males. Stratified by decade, the maximum incidence rate (47.8 [95% confidence interval, 41.0 to 54.5]) occurred in those between the ages of twenty and twenty-nine years; 46.8% of all dislocations were in patients between fifteen and twenty-nine years of age. There were no significant differences based on race. Dislocations most frequently resulted from a fall (58.8%) and occurred at home (47.7%) or at sites of sports or recreation (34.5%). Overall, 48.3% of injuries occurred during sports or recreation. 4
3. Petersen SA, Murphy TP. The timing of rotator cuff repair for the restoration of function. J Shoulder Elbow Surg. 2011;20(1):62-68. Observational-Tx 36 patients To evaluate the time to repair and subsequent functional outcome in patients who sustain an acute loss of shoulder strength as the result of a painful, traumatic, full thickness rotator cuff tear. Pain scores improved from 7 to 1.4 (P < .01) and active elevation improved from 55 degrees to 133 degrees (P < .01). UCLA/ASES scores improved from 8/30 to 26/79, respectively (P < .01, P < .01). All but 2 of the 36 patients were satisfied with their result. Preoperative fatty atrophy did not correlate with postoperative function. Rotator cuff tear size had no influence on patient outcome if repaired before 4 months. Massive tears repaired after 4 months had the worst outcome. 2
4. Nicholas N, Fox MG, Blankenbaker DG, et al. ACR Appropriateness Criteria® Chronic Shoulder Pain: 2022 Update. J Am Coll Radiol 2023;20:S49-S69. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for chronic shoulder pain. No results stated in abstract. 4
5. Subhas N, Wu F, Fox MG, et al. ACR Appropriateness Criteria® Chronic Extremity Joint Pain-Suspected Inflammatory Arthritis, Crystalline Arthritis, or Erosive Osteoarthritis: 2022 Update. J Am Coll Radiol 2023;20:S20-S32. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for chronic extremity joint pain-suspected inflammatory arthritis, crystalline arthritis, or erosive osteoarthritis. No results stated in abstract. 4
6. Griffith JF, Yung PS, Antonio GE, Tsang PH, Ahuja AT, Chan KM. CT compared with arthroscopy in quantifying glenoid bone loss. AJR Am J Roentgenol. 2007;189(6):1490-1493. Observational-Dx 50 patients To investigate the accuracy of CT in determining the presence and severity of glenoid bone loss in patients with unilateral anterior shoulder dislocation. Glenoid bone loss was evident in 41 (82%) of the 50 patients at arthroscopy. Compared with arthroscopy, CT had a sensitivity in detecting glenoid bone loss of 92.7%; specificity, 77.8%; positive predictive value, 95.0%; and negative predictive value, 70.0%. Three false-negative CT assessments had 5%, 10%, and 10% glenoid bone loss, respectively, at arthroscopy. Two false-positive CT assessments had 8.7% and 5.7% glenoid bone loss on CT, although no bone loss was apparent at arthroscopy. There was a strong correlation between CT and arthroscopy with respect to the severity of glenoid bone loss (r = 0.79, 95% CI = 0.659-0.877, p < 0.0001). 2
7. Mahadeva D, Dias RG, Deshpande SV, Datta A, Dhillon SS, Simons AW. The reliability and reproducibility of the Neer classification system--digital radiography (PACS) improves agreement. Injury. 2011;42(4):339-342. Observational-Dx 50 randomly selected radiographs with a confirmed proximal humeral fracture. To investigate if digital radiography improved inter-observer and intra-observer agreement levels with the Neer classification system. In general, good (0.61-0.80) results were obtained using kappa value for inter-observer reliability throughout all grades. On further analysis, however, discrepancies persist in the classification between Neer type 1/2 and Neer type 5 categories. The latter was not restricted to more inexperienced surgeons. Intra-observer agreement (> 0.81) was excellent throughout all grades. 4
8. Ozaki R, Nakagawa S, Mizuno N, Mae T, Yoneda M. Hill-sachs lesions in shoulders with traumatic anterior instability: evaluation using computed tomography with 3-dimensional reconstruction. Am J Sports Med. 2014;42(11):2597-2605. Observational-Dx 142 shoulders To investigate the influence of the number of dislocations and subluxations on the prevalence and size of Hill-Sachs lesions evaluated by computed tomography (CT) with 3-dimensional reconstruction. Hill-Sachs lesions were detected in 90 shoulders by initial CT evaluation and were found in 118 shoulders at arthroscopy. The Hill-Sachs lesions missed by initial CT were 15 chondral lesions and 13 osseous lesions. However, all 103 osseous Hill-Sachs lesions were detected by reviewing the CT data. In patients with primary subluxation, the prevalence of Hill-Sachs lesions was 26.7%, and the mean length, width, and depth of the lesions (calculated as a percentage of the diameter of the humeral head) were 9.0%, 5.3%, and 2.1%, respectively, while the corresponding numbers for primary dislocation were 73.3%, 27.7%, 14.8%, and 7.0%, all showing statistically significant differences. Among all 142 shoulders, the corresponding numbers were, respectively, 56.3%, 20.7%, 11.2%, and 4.8% in patients who had subluxations but never a dislocation; 83.3%, 33.4%, 19.1%, and 7.6% in patients with 1 episode of dislocation; and 87.5%, 46.8%, 22.2%, and 10.2% in patients with >/=2 episodes, all showing statistically significant differences. There were no differences in lesion measurements in relation to the number of subluxations. 3
9. Kahn JH, Mehta SD. The role of post-reduction radiographs after shoulder dislocation. J Emerg Med. 2007;33(2):169-173. Observational-Dx 73 patients To determine whether post-reduction radiographs add clinically important information to what is seen on pre-reduction X-rays in Emergency Department (ED) patients with anterior shoulder dislocations. On preliminary reading, all patients' shoulders were relocated on post-reduction X-rays (100%; 95% CI 93.5-100%). Forty of these patients had their X-rays read by a blinded attending radiologist. Sixteen fractures were seen on post-reduction X-rays, of which 6 (15.0%; 95% CI 5.7-29.8%) were not seen on pre-reduction X-rays. All patients (100%; 95% CI 91.2-100%) whose post-reduction films were read by blinded attending radiologists had shoulder relocation confirmed. 3
10. Emond M, Le Sage N, Lavoie A, Moore L. Refinement of the Quebec decision rule for radiography in shoulder dislocation. CJEM. 2009;11(1):36-43. Observational-Dx 210 patients To refine previously derived factors associated with clinically important fractures in ED patients with anterior glenohumeral dislocation and to develop a clinical decision rule for radiography in such patients. A total of 222 patients were included in the study. Forty (18.0%) had clinically important fracture-dislocation. A clinical decision rule using 4 factors reached a sensitivity of 100% (95% confidence interval [CI] 89.4%-100%), a specificity of 34.2% (95% CI 27.7%-41.2%), a negative predictive value of 99.2% (95% CI 92.8%-99.9%) and a negative likelihood ratio of 0.04 (95% CI 0.002-0.27). Patients younger than 40 years are at high risk for clinically important fracture- dislocation only if the mechanism of injury involves substantial force (i.e., a fall greater than their own height, a sport injury, an assault or a motor vehicle collision). Patients 40 years of age or older are at high risk only in the presence of humeral ecchymosis or after their first dislocation. Projected use of the rule would reduce the absolute number of prereduction radiographs by 27.9% and of postreduction by 81.9%. 3
11. Vaisman A, Villalon Montenegro IE, Tuca De Diego MJ, Valderrama Ronco J. A novel radiographic index for the diagnosis of posterior acromioclavicular joint dislocations. Am J Sports Med. 2014;42(1):112-116. Observational-Dx 150 patients To introduce and to validate a novel radiographic index, in plain bilateral Zanca views, for the accurate diagnosis of posterior AC joint dislocations. The average value of the AC width index per group (according to the Rockwood classification) was as follows: type I, 2.1% (range, -12% to 25%); type II, 4.2% (range, -19% to 29%); type III, 19.1% (range, -59% to 91%); type IV, 110.3% (range, 47% to 181%); and type V, -3.8% (range, -71% to 62%). There was a significant difference between the average width index in the patients with type IV injuries and those in the remaining groups (P < .05). The ROC curve showed that a width index of 60% has a sensitivity of 95.7% and specificity of 97.5%, with a positive predictive value of 96.7% and negative predictive value of 95.6% to predict a type IV injury. Intraobserver reliability was rated as substantial agreement for each of 3 observers; the interobserver reliability of the 3 independent raters was almost perfect. 3
12. Foruria AM, Martinez-Catalan N, Pardos B, Larson D, Barlow J, Sanchez-Sotelo J. Classification of proximal humerus fractures according to pattern recognition is associated with high intraobserver and interobserver agreement. JSES International. 6(4):563-568, 2022 Jul. Observational-Dx 103 treated proximal humerus fractures. To evaluate the intraobserver and interobserver agreement of the Mayo-FJD classification system using plain radiographs (xR) and computed tomography (CT). Three fellowship-trained shoulder surgeons blindly and independently evaluated the xR and CT. The average intraobserver agreement was 0.9 (almost perfect) for xR and 0.9 (almost perfect) for CT scans. The average interobserver agreement was 0.69 (substantial) for xR and 0.81 (almost perfect) for CT scans at the first round, and 0.66 (substantial) for xR and 0.75 (substantial) for CT scans at the second round. 2
13. Rutten MJ, Collins JM, de Waal Malefijt MC, Kiemeney LA, Jager GJ. Unsuspected sonographic findings in patients with posttraumatic shoulder complaints. J Clin Ultrasound. 2010;38(9):457-465. Observational-Dx 50 patients To prospectively assess the frequency of abnormal sonographic findings in patients with posttraumatic shoulder pain and/or disability in whom ultrasound (US) was not considered and to assess the effect of sonographic findings on working diagnosis and therapeutic strategy, to analyze the possible role of US in the diagnostic workup of these patients. US showed relevant pathology in 45 (90%) of 50 patients, a proximal humerus fracture in 25 (50%) patients, and a rotator cuff tear in 43 (86%) patients. Twenty-three (92%) fractures were accompanied by a rotator cuff tear, and 23 (54%) rotator cuff tears were accompanied by a fracture. Ten fractures were initially missed radiographically. US findings changed the working diagnosis and therapeutic strategy in 37 (74%) and 26 (52%) patients, respectively. 2
14. Stoddart M, Pearce O, Smith J, McCann P, Sheridan B, Al-Hourani K. Proximal Humerus Fractures: Reliability of Neer Versus AO Classification on Plain Radiographs and Computed Tomography. Cureus. 12(6):e8520, 2020 Jun 09. Observational-Dx 22 patients To a) assess and compare the reliability of the Neer (complete and Neer-6 versions) and AO (Arbeitsgemeinschaft für Osteosynthesefragenbeing) classifications, and b) identify if CT made any difference to the reliability of Neer and AO classifications when compared to plain radiographs alone. Two specialty orthopaedic trainees analysed the plain radiographs as well as CT images over two rounds, spaced two weeks apart. The mean age was 62 years (SD 14.5). Management changed in 9/22 patients based on CT. Computed tomography changed Neer-16 type in 16% observations, Neer-6 in 10%, and AO in 23%. This was significant when comparing Neer-6 and AO classifications (p = 0.04). Neer-6 had the best inter-observer reliability (0.737) with the management of one patient changing after CT. On X-ray and CT, intra-observer agreement was substantial, >0.7, using Neer-16 and Neer-6 (p<0.005). Inter-observer agreement for Neer-16 and Neer-6 was substantial, >0.7 (p<0.005). In comparison, intra- and inter-observer agreements for AO were lower on X-ray and CT, 0.4-0.6, (p<0.005). 2
15. Ropp AM, Davis DL. Scapular Fractures: What Radiologists Need to Know. AJR Am J Roentgenol. 2015;205(3):491-501. Review/Other-Dx N/A To review scapular anatomy and function, describe imaging features of traumatic scapular injury, and discuss the role of diagnostic imaging in clinical decision making after shoulder trauma. No results stated in abstract. 4
16. Tadros AM, Lunsjo K, Czechowski J, Corr P, Abu-Zidan FM. Usefulness of different imaging modalities in the assessment of scapular fractures caused by blunt trauma. Acta Radiol. 2007;48(1):71-75. Observational-Dx 44 patients To analyze the usefulness of chest and scapular trauma radiographs, axial computed tomography (CT), and two- and three-dimensional (2D and 3D) reconstruction CT in detecting fractures of the six anatomical regions of the scapula. Axial and 3D reconstruction tomographic studies were the only useful modalities in assessing fractures in all six anatomical scapular regions. Three-dimensional CTs reconstructed from chest and scapula axial views were equally sensitive and specific. 2
17. Saragaglia D, Barthomeuf C, Banihachemi JJ. Deciphering acute shoulder trauma with normal initial X-ray: Contributions of ultrasonography and MRI. Orthopaedics & traumatology, surgery & research. 107(5):102965, 2021 09. Observational-Dx 48 patients To assess the contribution of ultrasonography (US) and magnetic resonance imaging (MRI) in deciphering such trauma. The study hypothesis was that MRI can confirm most diagnoses and reveal occult lesions. Diagnoses comprised: 14 shoulder contusions; 13 rotator cuff tears; 8 acromioclavicular sprains; 6 fractures: 3 greater tuberosity, 2 humeral head, 1 lateral quarter of the clavicle; 3 subluxations or anterior dislocations with spontaneous reduction; 1 posterior dislocation with spontaneous reduction; 1 case of resorption of calcification in the pectoralis major tendon; 1 case of coracobrachialis strain; and 1 partial pectoralis major detachment. Concordance with final diagnosis was 42% (20/48) on initial clinical examination and 52% (25/48) on reassessment. On US, concordance was 71% (34/48), with 82% positive predictive value for cuff tear and 0% for instability. MRI was contributive in all cases, revealing 48 abnormal signals in 41 patients, thus establishing 48 diagnoses. 2
18. Gulotta LV, Lobatto D, Delos D, Coleman SH, Altchek DW. Anterior shoulder capsular tears in professional baseball players. J Shoulder Elbow Surg. 2014;23(8):e173-178. Review/Other-Tx 5 patients To report on midsubstance glenohumeral capsular tears in professional baseball players. The mean age was 33.5 years (range, 31-37 years), and all patients presented with anterior shoulder pain and the inability to throw. No patient had an acute traumatic injury. Magnetic resonance imaging provided the correct diagnosis in 4 patients, and the diagnosis was made with diagnostic arthroscopy in the fifth. Three underwent arthroscopic repair, and 2 underwent open repair of the anterior capsule. Of the 5 players, 4 (80%) returned to their preinjury level by a mean of 13.3 months (range, 8-18 months). 4
19. Nemec U, Oberleitner G, Nemec SF, et al. MRI versus radiography of acromioclavicular joint dislocation. AJR Am J Roentgenol. 2011;197(4):968-973. Observational-Dx 47 patients To describe the MRI findings of acromioclavicular joint dislocation in comparison with the radiographic findings. Among 44 patients with Rockwood type I-IV injuries on radiographs, classification on radiographs and MR images was concordant in 23 (52.2%) patients. At MRI, the injury was reclassified to a less severe type in 16 (36.4%) patients and to a more severe type in five (11.4%) patients. Compared with the findings according to the original Rockwood system, with the adapted system that included MRI findings, additional ligamentous lesions were found in 11 (25%) patients. 3
20. Bahrs C, Zipplies S, Ochs BG, et al. Proximal humeral fractures in children and adolescents. J Pediatr Orthop. 2009;29(3):238-242. Observational-Tx 43 patients To assess the rate of soft tissue entrapment, and investigate the long-term clinical and radiological results after an age- and deformity-focused treatment regimen according to national guidelines. Operative and postoperative complications did not occur. All surgically treated fractures anatomically reduced and healed without loss of reduction. At a mean follow-up of 39 months (range, 12-118 months), all patients who were evaluated had excellent results according to the Constant score and had a normal range of motion and excellent strength of the shoulder joint. 2
21. Lee JT, Nasreddine AY, Black EM, Bae DS, Kocher MS. Posterior sternoclavicular joint injuries in skeletally immature patients. J Pediatr Orthop. 2014;34(4):369-375. Review/Other-Dx 48 patients To characterize posterior SC injuries in SI patients in terms of the prevalence of dislocation versus medial clavicle physeal fracture. All patients treated operatively underwent primary repair without reconstruction. Twenty (50%), of the 40 patients treated operatively had a true SC joint dislocation and 20 patients (50%) had a medial clavicle physeal fracture. Twenty-two (46%) of the 48 total patients had an attempted closed reduction of which only 8 (36%) were successful. Among the 14 unsuccessful closed reductions, 12 (86%) were true dislocations (P<0.001). All successful closed reductions occurred in patients within 24 hours from injury. Eleven of the 48 (23%) patients' injuries were missed on initial presentation. 4
22. Poeze M, Lenssen AF, Van Empel JM, Verbruggen JP. Conservative management of proximal humeral fractures: can poor functional outcome be related to standard transscapular radiographic evaluation? J Shoulder Elbow Surg. 2010;19(2):273-281. Observational-Dx 55 patients To investigate whether functional outcome could be predicted using the angulation of the fractured humeral head on the standard radiographic evaluation. Mean (SD) angulations at time of the fracture were 53 degrees (19 degrees ) on AP view and 59 degrees (21 degrees ) on Y-view. After 1 week, these angulations were 47 degrees (20 degrees ) and 62 degrees (21 degrees ), respectively. Significant correlations between Constant-Murley (R(2)=0.43, P=.007) and DASH (R(2)=0.43, P=.04) outcome scores and the angulation of the humeral head fragment on the Y view, and not with AP angulation were found. The optimum predictive angulation at the Y view at time of fracture was 55 degrees or less for predicting adverse functional outcome with an area under the ROC curve of 0.78 (95% confidence interval [CI], 0.64-0.93; P=.006). Regression analysis showed that angulations on the initial Y view and after 1 week were the most important predictors of the functional outcome at a median of 2.2 years of follow-up. 3
23. Throckmorton T, Kuhn JE. Fractures of the medial end of the clavicle. Journal of Shoulder & Elbow Surgery. 16(1):49-54, 2007 Jan-Feb. Review/Other-Dx 57 medial fractures in 55 patients. To review retrospectively a case series of medial clavicle fractures treated at a tertiary trauma center. Patients were typically men in the fifth decade injured as a result of vehicular trauma. Fractures were occasionally missed on chest radiographs but were always identifiable by computed tomography scan. Injuries were most often closed and without neurovascular injury. However, patients almost always had multisystem trauma. Operative treatment was rarely performed, and patients typically had little or no pain at the time of follow-up. Finally, it was found that 11 patients died within 1 month of their injuries, indicating that 20% (11/55) of patients with medial clavicle fractures died as a result of the trauma associated with their injury. 4
24. Armitage BM, Wijdicks CA, Tarkin IS, et al. Mapping of scapular fractures with three-dimensional computed tomography. J Bone Joint Surg Am. 2009;91(9):2222-2228. Review/Other-Dx 90 fractures To create a frequency map of a series of surgically treated scapular fractures that specifically involved the scapular body and/or neck. Of ninety fractures that met the criteria for inclusion, 68% involved the inferior aspect of the glenoid neck and 71% involved the superior vertebral border. Seventeen percent of the patterns included articular extension, and 22% of the fractures entered the spinoglenoid notch. Of fractures involving the inferior aspect of the glenoid neck at the lateral scapular border, 84% traversed medially to exit just inferior to the medial extent of the scapular spine, and 59% of these inferior neck fractures also had propagation to the inferior third of the vertebral border. Among the fractures involving the spinoglenoid notch, the most common pattern was demonstrated by coexisting fracture lines; 60% of the fractures of the spinoglenoid notch exited just inferior to the glenoid, 65% extended to the superior-medial vertebral border, and 45% extended to the inferior-medial vertebral border. In contrast, articular fractures did not follow predictable patterns; they demonstrated the greatest variability in trajectory, which was almost random, and there was a wide distribution of exit points along the vertebral border. 4
25. Bozkurt M, Can F, Kirdemir V, Erden Z, Demirkale I, Basbozkurt M. Conservative treatment of scapular neck fracture: the effect of stability and glenopolar angle on clinical outcome. Injury. 2005;36(10):1176-1181. Observational-Tx 18 patients To determine the effect of stability and glenopolar angle on the clinical outcome of conservatively treated scapular neck fractures. Twelve of the 18 patients had surgical neck fractures, whilst six of them had anatomical neck fractures. Anteroposterior radiographs and computerised tomography were performed for each patient. Glenopolar angle was measured through anteroposterior radiographs in the scapular plane. After 3-5 weeks of immobilisation, a rehabilitation programme was started, throughout which all the patients were treated in a 3-phase rehabilitation programme. The mean follow-up was 25 months, and the Constant score was 78.83+/-8.12 point (range: 68-94 points). 2
26. Fjalestad T, Hole MO, Blucher J, Hovden IA, Stiris MG, Stromsoe K. Rotator cuff tears in proximal humeral fractures: an MRI cohort study in 76 patients. Arch Orthop Trauma Surg. 2010;130(5):575-581. Review/Other-Dx 76 patients To evaluate if concomitant injury to the rotator cuff is important for functional outcome in proximal humerus fractures, and to relate loss of function to malunion of the fractures. Magnetic resonance imaging (MRI) examinations confirmed 22 rotator cuff tears (four full thicknesses) diagnosed at the time of injury, and 10 additional tears (three full thicknesses) at one year. Functional loss at one year significantly corresponded to the tears at the time of injury (P = 0.004), varus malunion of the head and displacement of tubercles (P < 0.001). 4
27. Delage Royle A, Balg F, Bouliane MJ, et al. Indication for Computed Tomography Scan in Shoulder Instability: Sensitivity and Specificity of Standard Radiographs to Predict Bone Defects After Traumatic Anterior Glenohumeral Instability. Orthopaedic Journal of Sports Medicine. 5(10):2325967117733660, 2017 Oct. Observational-Dx 70 patients To determine the diagnostic properties, sensitivity, and specificity of standard AP radiographs, with and without axillary view, to identify significant bone loss on the glenoid and humeral sides in a population known for recurrent shoulder instability, using the CT scan as the gold standard. Radiographs of the 70 patients were analyzed twice: The first viewing showed the glenohumeral true AP view and the second viewing was of both the true AP and axillary lateral views. The 2 presentations were reviewed by 4 fellowship-trained shoulder surgeons. Detection of glenoid bone loss on plain film radiographs, with and without axillary view, had a sensitivity of 86% for both views and a specificity of 73% and 64% with and without the axillary view, respectively. For detection of humeral bone loss, the sensitivity was 8% and 17% and the specificity was 98% and 91% with and without the axillary view, respectively. Regular radiographs would have missed 1 instance of significant bone loss on the glenoid side and 20 on the humeral side. Interobserver reliabilities were moderate for glenoid detection (? = 0.473-0.503) and poor for the humeral side (? = 0.278-0.336). 2
28. Gyftopoulos S, Beltran LS, Yemin A, et al. Use of 3D MR reconstructions in the evaluation of glenoid bone loss: a clinical study. Skeletal Radiol. 2014;43(2):213-218. Observational-Dx 15 patients To assess the ability of 3D MR shoulder reconstructions to accurately quantify glenoid bone loss in the clinical setting using findings at the time of arthroscopy as the gold standard. There were a total of 15 patients (13 men, two women; mean age, 28, range, 19-51 years). There was no significant difference, on average, between the MRI (mean 3.4 mm/12.6 %; range, 0-30 %) and OR (mean, 12.7 %; range, 0-30 %) measurements of glenoid bone loss (p = 0.767). A 95 % confidence interval for the mean absolute error extended from 0.45-2.21 %, implying that, when averaged over all patients, the true mean absolute error of the MRI measurements relative to the OR measurements is expected to be less than 2.21 %. Inter-reader agreement between the two readers had an IC of 0.92 and CC of 0.90 in terms of percentage of bone loss. 2
29. Oh JH, Kim JY, Choi JA, Kim WS. Effectiveness of multidetector computed tomography arthrography for the diagnosis of shoulder pathology: comparison with magnetic resonance imaging with arthroscopic correlation. J Shoulder Elbow Surg 2010;19:14-20. Observational-Dx 148 patients To evaluate the diagnostic efficacy of computed tomography arthrography (CTA) in the assessment of various shoulder pathologies with arthroscopic correlation. The sensitivity, specificity, and agreement were comparable in each imaging study for Bankart, SLAP, and Hill-Sachs lesions, and full-thickness rotator cuff tears, but those of CTA were significantly lower than MRA for partial-thickness cuff tears. The AUROC curve for CTA and MRA were not significantly different for any of the pathologies, except partial-thickness cuff tears. 2
30. Stecco A, Guenzi E, Cascone T, et al. MRI can assess glenoid bone loss after shoulder luxation: inter- and intra-individual comparison with CT. Radiol Med. 2013;118(8):1335-1343. Observational-Dx 23 patients To verify if magnetic resonance imaging (MRI) can quantify the area of bone loss without any significant difference from CT. The mean glenoid surface area was 575.29 mm(2) as measured by MRI, and 573.76 mm(2) as measured by CT; the calculated mean glenoid bone loss was respectively 4.38% and 4.34%. The interobserver agreement was good (k>0.81), and the coefficient of variance was 5% of the mean value using both methods. The two series of measurements were within two standard deviations of each other. 3
31. Pavic R, Margetic P, Bensic M, Brnadic RL. Diagnostic value of US, MR and MR arthrography in shoulder instability. Injury. 2013;44 Suppl 3:S26-32. Observational-Dx 200 patients To compare US, conventional MRI and MR arthrography findings in patients with anterior shoulder instability and with a clinical diagnosis of labral capsular ligamentous complex lesion. A total of 200 consecutive patients who met the inclusion criteria were included in this study. The mean age was 39 years (range 15 to 83); 147 were male and 133 involved the right shoulder. Chronic instability was documented in 133 patients, whereas acute instability was documented in 67 patients. We detected a statistically significant difference between US and MR arthrography in SLAP (Superior Labrum Anterior to Posterior) lesions (TypeII, III and IV), in Bankart lesions, in glenohumeral ligament lesions (superior, middle, anterior-inferior and anterior inferior glenohumeral ligament) in Hill-Sachs lesions, in diagnosing internal subacromial impingement and in normal findings. MR arthrography was superior to the US. A statistically significant difference was evident between MRI and MR arthrography findings in SLAP lesions (III and IV Type lesions), in glenohumeral ligament lesions (anterior inferior and posterior inferior glenohumeral ligament), in partial rotator cuff ruptures and in normal findings. MR arthrography diagnosed this lesion better than MRI without contrast. We also found a statistically significant difference between US and MRI findings in SLAP Type II lesions, in partial rotator cuff ruptures, in Hill-Sachs lesions and in diagnosing internal subacromial impingement. 3
32. Waldt S, Burkart A, Imhoff AB, Bruegel M, Rummeny EJ, Woertler K. Anterior shoulder instability: accuracy of MR arthrography in the classification of anteroinferior labroligamentous injuries. Radiology 2005;237:578-83. Observational-Dx 104 patients and 101 controls To retrospectively evaluate the accuracy of magnetic resonance (MR) arthrography in the classification of anteroinferior labroligamentous injuries by using arthroscopy as the reference standard. At arthroscopy, 104 anteroinferior labroligamentous lesions were diagnosed, including 44 Bankart lesions, 22 ALPSA lesions, 12 Perthes lesions, and three GLAD lesions. Twenty-three labral lesions were nonclassifiable at arthroscopy, all of which occurred after a history of chronic instability. Nineteen (83%) of these 23 lesions were also nonclassifiable at MR arthrography. With arthroscopy used as the reference standard, labroligamentous lesions were detected and correctly classified at MR arthrography with sensitivities of 88% and 77%, specificities of 91% and 91%, and accuracies of 89% and 84%, respectively. Bankart, ALPSA, and Perthes lesions were correctly classified in 80%, 77%, and 50% of cases, respectively. The three GLAD lesions were all correctly assessed. 3
33. Magee T. 3-T MRI of the shoulder: is MR arthrography necessary? AJR Am J Roentgenol 2009;192:86-92. Observational-Dx 150 patients To report the diagnostic sensitivity of 3-T conventional MRI versus MR arthrography of the shoulder in the same patient population. Three full-thickness and nine partial-thickness supraspinatus tendon tears, seven SLAP tears, six anterior labral tears, and two posterior labral tears were seen on MR arthrography but not on conventional MRI. All additional MR arthrography findings were confirmed at arthroscopy. On conventional MRI, sensitivities and specificities compared with arthroscopy were as follows: anterior labral tear, 83% sensitivity and 100% specificity; posterior labral tear, 84% and 100%; SLAP tear, 83% and 99%; supraspinatus tendon tear, 92% and 100%; partial-thickness articular surface tear, 68% and 100%; and partial-thickness bursal surface tear, 84% and 100%. On MR arthrography, sensitivities and specificities compared with arthroscopy were as follows: anterior labral tear, 98% sensitivity and 100% specificity; posterior labral tear, 95% and 100%; SLAP tear, 98% and 99%; supraspinatus tendon tear, 100% and 100%; partial-thickness articular surface tear, 97% and 100%; and partial-thickness bursal surface tear, 84% and 100%. MR arthrography showed a statistical improvement in sensitivity (p<0.05) for detection of partial-thickness articular surface supraspinatus tears, anterior labral tears, and SLAP tears at 3 T. 3
34. Acid S, Le Corroller T, Aswad R, Pauly V, Champsaur P. Preoperative imaging of anterior shoulder instability: diagnostic effectiveness of MDCT arthrography and comparison with MR arthrography and arthroscopy. AJR Am J Roentgenol 2012;198:661-7. Observational-Dx 40 patients To assess the diagnostic effectiveness of MDCT arthrography in the preoperative planning of anterior shoulder instability compared with MR arthrography and arthroscopy. In detecting glenoid rim fractures, MDCT arthrography had a sensitivity of 100% (12/12), a specificity of 96% (27/28), and better agreement with surgery (kappa = 0.94) than did MR arthrography (kappa = 0.74). For the depiction of glenoid cartilage lesions, MDCT arthrography had a sensitivity of 82% (18/22), a specificity of 89% (16/18), and slightly better agreement with surgery (kappa = 0.70) than did MR arthrography (kappa = 0.66). In identifying anterior labral periosteal sleeve avulsion lesions, MDCT arthrography had a sensitivity of 93% (26/28), a specificity of 100% (12/12), and better agreement with surgery (kappa = 0.89) than did MR arthrography (kappa = 0.74). For the diagnosis of humeral avulsion of the inferior glenohumeral ligament lesions, MDCT arthrography had a sensitivity and a specificity of 100% (2/2) and better agreement with surgery (kappa = 1) than did MR arthrography (kappa = 0.79). 2
35. Foti G, Mantovani W, Catania M, et al. Evaluation of glenoid labral tears: comparison between dual-energy CT arthrography and MR arthrography of the shoulder. Radiologia Medica. 125(1):39-47, 2020 Jan. Observational-Dx 47 patients. To compare the diagnostic accuracy of dual-energy computed tomography arthrography (DE-CTA) and magnetic resonance arthrography (MRA) of the shoulder in depicting glenoid labral tears. Surgery revealed the presence of labral tears in 38/47 patients (80.9%). Sensitivity and specificity values in diagnosing labral tears were 84.2% and 77.8% for MRA (Reader 3), 84.2% and 77.8% for CTA (Reader 1), 84.2% and 88.9% for CTA (Reader 2), 89.5% and 88.9% for DE-CTA (Reader 1), and 92.1% and 88.9% for DE-CTA (Reader 2). A nonsignificant increase in AUC values with respect to MRA was obtained by reading the CTA (p = 0.470) and DE-CTA dataset (p = 0.217), respectively. Inter-observer agreements were near perfect for CTA (k = 0.84) and substantial for DE-CTA reading (k = 0.76). Intra-observer agreements were near perfect both for CTA (k = 0.88) and for DE-CTA reading (k = 0.82). 2
36. Fogerty S, King DG, Groves C, Scally A, Chandramohan M. Interobserver variation in reporting CT arthrograms of the shoulder. Eur J Radiol. 2011;80(3):811-813. Observational-Dx 50 CT arthrograms To analyze interobserver variation in reporting CT arthrograms of the shoulder. The results were collated and analysed for the level of agreement. Hill-Sachs showed Kappa (K) statistic to be 0.37 (fair agreement), soft tissue Bankart 0.32 (fair agreement), bony Bankart 0.61 (substantial agreement), anterior capsular laxity 0.41 (moderate agreement) and glenohumeral osteoarthritis 0.20 (slight agreement). All the results were significant with a p value of <0.05. Nine (18%) of the 50 scans were in complete agreement. The results demonstrate that there can be considerable interobserver variation (IOV) in the reports of a CT arthrogram of a shoulder. 2
37. Amin MF, Youssef AO. The diagnostic value of magnetic resonance arthrography of the shoulder in detection and grading of SLAP lesions: comparison with arthroscopic findings. Eur J Radiol. 2012;81(9):2343-2347. Observational-Dx 59 patients To determine the usefulness of magnetic resonance arthrography (MRA) in diagnosis and grading of superior labrum anterior to posterior (SLAP) lesions of the Glenoid Labrum Compared with surgery. Out of fifty nine patients, 25 patients had positive MR findings in conventional MRI, and 34 patients had negative MR findings, who underwent MR arthrography; 10 out of them had normal arthrogram (only 6 of them underwent arthroscopy), 22 had SLAP (superior labrum anterior to posterior) lesions, one had Bankart's lesion and one had internal impingement syndrome. These results were compared with arthroscopy results. The overall sensitivity of MRA in detection of SLAP lesions was 90% while the specificity was 50%, negative predictive value (NPV) was 66.6% and positive predicative value (PPV) was 81.8%. MRA and arthroscopy results were concurrent in 79.3% patients. 2
38. Antonio GE, Griffith JF, Yu AB, Yung PS, Chan KM, Ahuja AT. First-time shoulder dislocation: High prevalence of labral injury and age-related differences revealed by MR arthrography. J Magn Reson Imaging. 2007;26(4):983-991. Review/Other-Dx 66 patients To evaluate abnormalities and age-related differences after first-time shoulder dislocation. Forty-eight patients (73%) showed anteroinferior labral avulsion, consisting of: 6% (4/34 vs. 0/32) Perthes; 23% (8/34 vs. 7/32) free ALPSA (anterior labrum periosteal sleeve avulsion) lesion); 6% (1/34 vs. 3/32) adherent ALPSA; 23% (9/34 vs. 6/32) Bankart; 14% (5/34 vs. 4/32) inferiorly displaced avulsed labrum; 2% (1/34 vs. 0/32) GLAD. Extensive labral detachment (extended above 3 o'clock position) was present in 31% (11/28 vs. 4/20). There were 14% (6/34 vs. 3/32) superior labrum anterior-posterior (SLAP) lesion; 27% (1/34 vs. 17/34) rotator cuff tendon tear; 71% (25/34 vs. 22/32) Hill-Sachs defect. Young patients were more likely to have extensive labral avulsions (P = 0.054), but less likely to have rotator cuff tears (P < 0.001). 4
39. Genovese E, Spano E, Castagna A, et al. MR-arthrography in superior instability of the shoulder: correlation with arthroscopy. Radiol Med. 2013;118(6):1022-1033. Observational-Dx 42 patients To evaluate magnetic resonance (MR) arthrography in the detection and classification of lesions that may cause superior instability. We detected 31 superior labral anterior posterior (SLAP) lesions, all confirmed on arthroscopy with three cases of underestimation: in the detection of SLAP lesions, the sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of MR arthrography were 100%; in the evaluation of the type of SLAP lesion, sensitivity was 100%, specificity was 78.5%, accuracy was 92.8%, PPV was 71.7% and NPV was 100%. All cases of capsular laxity (13/42) and biceps tendon lesions (3/42) were confirmed on arthroscopy with sensitivity, specificity, accuracy, PPV and NPV of 100%. Eleven cuff lesions were detected on MR arthrography, 10 of which confirmed at arthroscopy: sensitivity was 100%, specificity was 96.8%, accuracy was 97.6%, PPV was 90.9% and NPV was 100%. Associated lesions were found in 38/42 patients. 3
40. Iqbal HJ, Rani S, Mahmood A, Brownson P, Aniq H. Diagnostic value of MR arthrogram in SLAP lesions of the shoulder. Surgeon. 2010;8(6):303-309. Observational-Dx 124 patients To evaluate the diagnostic performance of MR Arthrogram in SLAP tears. Out of 124 cases, 54(43.54%) had normal MR Arthrogram, 32 (25.8%) had impingement or cuff related problems, 2 (1.61%) had Bankart lesions, and in 36 (29%) cases SLAP lesions were identified. Out of 54 patients with normal MR Arthrogram, 44 were discharged to physiotherapy and 10 underwent arthroscopy, showing SLAP lesion in one patient. Out of 32 patients with impingement or cuff problems, 19 were discharged to rehabilitation and 13 underwent surgery. Out of 36 patients with SLAP lesions, 5 recovered spontaneously, 5 were awaiting outpatient review and 26 underwent arthroscopy showing SLAP lesions in 22 cases. Overall, only 51 patients underwent arthroscopy. The MR Arthrogram was falsely positive in 4 cases (15.38%) and falsely negative in one case (3.84%). The sensitivity of MR Arthrogram was 95.6% (22/23), specificity 85.7% (24/28), positive predictive value 84.6% (22/26) and the negative predictive value was 96% (24/25). 3
41. Smark CT, Barlow BT, Vachon TA, Provencher MT. Arthroscopic and magnetic resonance arthrogram features of Kim's lesion in posterior shoulder instability. Arthroscopy. 2014;30(7):781-784. Observational-Dx 41 shoulders To describe the anatomic features of the glenoid and labrum for shoulders with and without Kim's lesions, as well as define the sensitivity, specificity, and reliability of magnetic resonance arthrogram for the detection of these lesions and determine the interobserver reliability of Kim's classification for posterior labral tears. There were no differences in glenoid version, chondrolabral version, glenoid depth, and labral height between the groups. The sensitivity, specificity, positive predictive value, and negative predictive value for diagnosing Kim's lesions were 85.7%, 75%, 78.3%, and 83.3%, respectively. The kappa values for interobserver reliability for detecting and classifying Kim's lesions were 0.739 (substantial) and 0.329 (fair), respectively. 3
42. Jonas SC, Walton MJ, Sarangi PP. Is MRA an unnecessary expense in the management of a clinically unstable shoulder? A comparison of MRA and arthroscopic findings in 90 patients. Acta Orthop. 2012;83(3):267-270. Observational-Dx 90 patients To assess the accuracy of MRA in a group of patients undergoing anterior stabilization for clinical instability. 83 of the 90 patients had glenoid labrum tears at arthroscopy. Only 54 were correctly identified at MRA. All normal glenoid labra were identified at MRA. This gave a sensitivity of 65% and a specificity of 100% in identification of all types of glenoid labrum tear. 74 patients had anterior glenoid labral tears that were detected at an even lower rate of sensitivity (58%) 3
43. Arirachakaran A, Boonard M, Chaijenkij K, Pituckanotai K, Prommahachai A, Kongtharvonskul J. A systematic review and meta-analysis of diagnostic test of MRA versus MRI for detection superior labrum anterior to posterior lesions type II-VII. [Review]. Skeletal Radiology. 46(2):149-160, 2017 Feb. Meta-analysis 32 studies (2,013 shoulders) and 11 studies (1,498 shoulders) were evaluated with MRA and MRI. To determine the diagnostic performance of magnetic resonance arthrography (MRA) and magnetic resonance imaging (MRI) in superior labrum anterior to posterior lesions (type II-VII) of the shoulder. The summary sensitivity, specificity, likelihood ratio (positive and negative) and AUROC were 0.87 (95 % confidence interval, CI: 0.82, 0.91), 0.92 (95 %CI: 0.85, 0.95), 10.28 (95 %CI: 5.84, 18.08), 0.14 (95 %CI: 0.10, 0.20) and 0.94 (95 %CI: 0.92, 0.96) respectively for MRA, and 0.76 (95 %CI: 0.61, 0.86), 0.87 (95 %CI: 0.71, 0.95), 5.89 (95 %CI: 2.5, 13.86), 0.28 (95 %CI: 0.17, 0.47) and 0.94 (95 %CI: 0.92, 0.96) respectively for MRI. Good
44. Ajuied A, McGarvey CP, Harb Z, Smith CC, Houghton RP, Corbett SA. Diagnosis of glenoid labral tears using 3-tesla MRI vs. 3-tesla MRA: a systematic review and meta-analysis. [Review]. Archives of Orthopaedic & Trauma Surgery. 138(5):699-709, 2018 May. Meta-analysis Ten studies including 929 patients. To compare 3-tesla MRI and 3-tesla MRA in the diagnosis of glenoid labral tears. For anterior labral lesions, 3T MRI was less sensitive (0.83 vs. 0.87 p = 0.083) than 3T 2D neutral MRA. Compared to 3T 2D neutral MRA, both 3T 3D Isotropic MRA and 3T ABER MRA significantly improved sensitivity (0.87 vs. 0.95 vs. 0.94). For SLAP lesions, 3T 2D neutral MRA was of similar sensitivity to 3T MRI (0.84 vs. 0.83, p = 0.575), but less specific (0.99 vs. 0.92 p < 0.0001). For posterior labral lesions, 3T 2D neutral MRA had greater sensitivity than 3T 3D Isotropic MRA and 3T MRI (0.90 vs. 0.83 vs. 0.83). Good
45. Shafiei M, Shomal Zadeh F, Shafiee A, Soltanolkotabi M, Gee AO, Chalian M. Diagnostic performance of MRA in abduction and external rotation position in the detection of glenoid labral lesions: a systematic review and meta-analysis. Skeletal Radiology. 51(8):1611-1621, 2022 Aug. Meta-analysis 9 studies. A total of 733, 504, and 313 lesions assessed by conventional MRA, ABER MRA, and conventional plus ABER MRA, respectively, were included in To compare the diagnostic performance of direct magnetic resonance arthrography (MRA) for labral lesions during conventional, abduction and external rotation (ABER), conventional plus abduction, and external rotation (ABER) positioning by using a systematic review and meta-analysis. Pooled sensitivities of MRA in conventional, ABER, and conventional plus ABER position for labral tear diagnosis were 81.5%, 81.6%, and 95.7%, respectively. Pooled specificities of MRA in conventional, ABER, and conventional plus ABER position for labral tear diagnosis were 88.8%, 85.6%, and 94.5%, respectively. Summary receiver operator characteristic (ROC) curve demonstrated improved accuracy of conventional plus ABER MRA compared with conventional MRA or ABER MRA with the area under the curve (AUC) of 0.99, 0.90, and 0.88, respectively. Good
46. Symanski JS, Subhas N, Babb J, Nicholson J, Gyftopoulos S. Diagnosis of Superior Labrum Anterior-to-Posterior Tears by Using MR Imaging and MR Arthrography: A Systematic Review and Meta-Analysis. [Review]. Radiology. 285(1):101-113, 2017 10. Meta-analysis 32 studies including 3524 imaging examinations. To evaluate the diagnostic accuracies of nonenhanced magnetic resonance (MR) imaging and MR arthrography for diagnosis of superior labrum anterior-to-posterior (SLAP) tears by using a systematic review and meta-analysis. Mean sensitivities of direct MR arthrography, MR imaging, and indirect MR arthrography for SLAP tear diagnosis were 80.4%, 63.0%, and 74.2%, respectively. Mean specificities of direct MR arthrography, MR imaging, and indirect MR arthrography were 90.7%, 87.2%, and 66.5%, respectively. Summary receiver operator characteristic (ROC) curve demonstrated superior accuracy of direct MR arthrography compared with those of MR imaging and indirect MR arthrography. Similar findings were observed in the low-bias subanalysis. Summary ROC curve demonstrated overall superiority of 3-T imaging, with or without intra-articular contrast material compared with 1.5-T imaging, with or without intra-articular contrast material. Significant variance was observed for MR imaging and direct MR arthrography (P < .001) studies for both mean sensitivity and specificity. Good
47. Schwartzberg R, Reuss BL, Burkhart BG, Butterfield M, Wu JY, McLean KW. High Prevalence of Superior Labral Tears Diagnosed by MRI in Middle-Aged Patients With Asymptomatic Shoulders. Orthopaedic Journal of Sports Medicine. 4(1):2325967115623212, 2016 Jan. Observational-Dx 53 asymptomatic adults with no history of surgery or injury to either shoulder. To evaluate the prevalence of superior labral tears diagnosed by MRI in the asymptomatic shoulders of middle-aged people (age range, 45-60 years). Two musculoskeletal fellowship-trained radiologists (K.W.M., J.Y.W.) with 2 and 4 years of experience after training, respectively, evaluated the MRIs. Each radiologist was blinded to the purposes and nature of the study. Radiologists interpreted the MRIs as consistent with superior labral tears in 55% and 72% of the cohort. Comparison of the radiological evaluations of the superior labra were moderate (? = 0.410, P = .033). There were no differences in readings for superior labral tear regarding age (P = .87), sex (P = .41), whether the dominant shoulder underwent MRI (P = .99), whether the subject worked a physical job (P = .08), or whether the subject participated in overhead sports for a period of 1 year (P = .62). 3
48. Li L, Dong J, Li Q, et al. MRA improves sensitivity than MRI for the articular-sided partial-thickness rotator cuff tears. Science Progress. 104(4):368504211059976, 2021 Oct. Meta-analysis Eleven studies involving 1703 patients and 1704 shoulders were included. To compare the diagnostic accuracy of magnetic resonance imaging (MRI) and MR arthrography (MRA) for the articular-sided partial-thickness rotator cuff tear (PTRCT). The pooled sensitivity, specificity, DOR and AUC and their 95% CIs of MRA to diagnose articular-sided PTRCTs were 0.81 (95% CI, 0.65–0.90), 0.96 (95% CI, 0.91–0.98), 68.14 (95% CI, 33.20–139.84) and 0.96 (95% CI, 0.94–0.97), respectively. The pooled sensitivity, specificity, DOR and AUC and their 95% CIs of MRI were 0.78 (95% CI, 0.65–0.87) and 0.97 (95% CI, 0.84–0.99), 47.82 (95% CI, 8.29–275.89) and 0.89 (95% CI, 0.86–0.92), respectively. Good
49. Roy JS, Braen C, Leblond J, et al. Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterisation of rotator cuff disorders: a systematic review and meta-analysis. Br J Sports Med. 2015;49(20):1316-1328. Meta-analysis 82 articles To perform a meta-analysis on the diagnostic accuracy of medical imaging for characterisation of RC disorders. Diagnostic accuracy of US, MRI and MRA in the characterisation of full-thickness RC tears was high with overall estimates of sensitivity and specificity over 0.90. As for partial RC tears and tendinopathy, overall estimates of specificity were also high (>0.90), while sensitivity was lower (0.67-0.83). Diagnostic accuracy of US was similar whether a trained radiologist, sonographer or orthopaedist performed it. M
50. Al-Shawi A, Badge R, Bunker T. The detection of full thickness rotator cuff tears using ultrasound. J Bone Joint Surg Br. 2008;90(7):889-892. Observational-Dx 143 patients To investigate whether an orthopaedic surgeon can develop both the technical skills involved in acquiring ultrasound images and interpreting pathological findings with a similar degree of accuracy as trained musculoskeletal radiologists. There were 78 full thickness tears which we confirmed by surgery or MRI. Three moderate-size tears were assessed as partial-thickness at ultrasound scan (false negative) giving a sensitivity of 96.2%. One partially torn and two intact cuffs were over-diagnosed as small full-thickness tears by ultrasound scan (false positive) giving a specificity of 95.4%. This gave a positive predictive value of 96.2% and a negative predictive value of 95.4%. Estimation of tear size was more accurate for large and massive tears at 96.5% than for moderate (88.8%) and small tears (91.6%). These results are equivalent to those obtained by several studies undertaken by experienced radiologists. 2
51. Fotiadou AN, Vlychou M, Papadopoulos P, Karataglis DS, Palladas P, Fezoulidis IV. Ultrasonography of symptomatic rotator cuff tears compared with MR imaging and surgery. Eur J Radiol. 2008;68(1):174-179. Observational-Dx 88 patients To compare the accuracy of ultrasonography and magnetic resonance imaging in the detection of rotator cuff tears. Full-thickness tear was confirmed in 57 cases, partial-thickness tear in 30 cases and degenerative changes without tear in 1. In all 57 cases of full-thickness tear and in 28 out of 30 cases of partial-thickness tear the supraspinatus tendon was involved. The accuracy in the detection of full-thickness tears was 98 and 100% for ultrasonography and magnetic resonance imaging, respectively. The accuracy in the detection of bursal or articular partial-thickness tears was 87 and 90% for ultrasonography and magnetic resonance imaging, respectively. 3
52. Frei R, Chladek P, Trc T, Kopecny Z, Kautzner J. Arthroscopic evaluation of ultrasonography and magnetic resonance imaging for diagnosis of rotator cuff tear. Ortop Traumatol Rehabil. 2008;10(2):111-114. Observational-Dx 20 patients To determine the ability of ultrasonography and MRI to correctly diagnose rotator cuff tears. Sensitivity of USG--1.0, specificity 0.9. Sensitivity of MRI--0.92, specificity 1.0. DISCUSSION: Clinical examination and physical tests are not fully reliable diagnostic tools in patients with shoulder pain, because symptoms of different conditions overlap. Using ultrasound to visualize the shoulder area has some advantages to other imaging techniques such as CT scan or MRI, and has a very good sensitivity and good specificity. Many authors agree that MRI is one of the most effective methods for the diagnosis of rotator cuff tear. 3
53. de Jesus JO, Parker L, Frangos AJ, Nazarian LN. Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: a meta-analysis. AJR Am J Roentgenol 2009;192:1701-7. Meta-analysis 65 articles To compare the diagnostic accuracy of MRI, MR arthrography, and ultrasound for the diagnosis of rotator cuff tears through a meta-analysis of the studies in the literature. In diagnosing a full-thickness tear or a partial-thickness rotator cuff tear, MR arthrography is more sensitive and specific than either MRI or ultrasound (p < 0.05). There are no significant differences in either sensitivity or specificity between MRI and ultrasound in the diagnosis of partial- or full-thickness rotator cuff tears (p > 0.05). Summary ROC curves for MR arthrography, MRI, and ultrasound for all tears show the area under the ROC curve is greatest for MR arthrography (0.935), followed by ultrasound (0.889) and then MRI (0.878); however, pairwise comparisons of these curves show no significant differences between MRI and ultrasound (p > 0.05). M
54. Moosmayer S, Heir S, Smith HJ. Sonography of the rotator cuff in painful shoulders performed without knowledge of clinical information: results from 58 sonographic examinations with surgical correlation. J Clin Ultrasound. 2007;35(1):20-26. Observational-Dx 58 shoulders To assess the value of sonography as an isolated diagnostic test for the detection and quantification of rotator cuff tears. All 24 full-thickness tears observed at surgery had been diagnosed correctly via sonography. In 19 of 20 cases with an intact rotator cuff, preoperative sonography was negative. Thirteen of 14 partial-thickness tears were not detected via sonography; 1 was misinterpreted as a full-thickness tear. Location of the tears relative to the rotator cuff tendons was described correctly in 21 of 25 cases. For tear size measurement, the 95% range of agreement was less than +/-1 cm. 2
55. Okoroha KR, Fidai MS, Tramer JS, Davis KD, Kolowich PA. Diagnostic accuracy of ultrasound for rotator cuff tears. Ultrasonography. 38(3):215-220, 2019 Jul. Review/Other-Dx N/A To review the diagnostic accuracy of US for identifying RCTs. No results stated in abstract. 4
56. Le Corroller T, Cohen M, Aswad R, Pauly V, Champsaur P. Sonography of the painful shoulder: role of the operator's experience. Skeletal Radiol. 2008;37(11):979-986. Observational-Dx 65 patients To determine the role of the operator's experience in the sonographic evaluation of the painful shoulder and to validate assumptions about its technical performance in routine practice. The sensitivity of the expert ultrasound operator was 95.3% for full-thickness rotator cuff tears (41/43), 70.6% for partial-thickness tears (12/17), 64.3% for intratendinous tears (9/14), 100% for abnormality of the long head of biceps tendon (seven of seven), 88.9% for supraspinatus tendinosis (16/18), 96.4% for subacromial bursa abnormalities (53/55), and 91.7% for acromioclavicular joint osteoarthritis (33/36). The two sonographic operators were in very good agreement about full-thickness rotator cuff tears (kappa = 0.90), supraspinatus tendinosis (kappa = 0.80), abnormalities of the long head of biceps tendon (kappa = 0.84), subacromial bursa abnormalities (kappa = 0.89), and acromioclavicular osteoarthritis (kappa = 0.81). The agreement was only moderate for partial-thickness tears (kappa = 0.63) and intratendinous tears (kappa = 0.57). 2
57. O'Connor PJ, Rankine J, Gibbon WW, Richardson A, Winter F, Miller JH. Interobserver variation in sonography of the painful shoulder. J Clin Ultrasound. 2005;33(2):53-56. Observational-Dx 24 patients To quantify interobserver variation in a comprehensive sonographic shoulder examination between radiologists with different levels of sonographic experience. There was good agreement (kappa >0.60, p <0.01) between the experienced operators for full-thickness rotator cuff tear, tendon calcification, dynamic signs of impingement, and abnormality of the long head of biceps tendon. There was no significant agreement between the experienced operators and the less experienced operator in several categories, including (and importantly) full-thickness rotator cuff tears (kappa=0.18-0.21) 2
58. National Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education; Committee on National Statistics; Committee on Measuring Sex, Gender Identity, and Sexual Orientation. Measuring Sex, Gender Identity, and Sexual Orientation. In: Becker T, Chin M, Bates N, eds. Measuring Sex, Gender Identity, and Sexual Orientation. Washington (DC): National Academies Press (US) Copyright 2022 by the National Academy of Sciences. All rights reserved.; 2022. Review/Other-Dx N/A Sex and gender are often conflated under the assumptions that they are mutually determined and do not differ from each other; however, the growing visibility of transgender and intersex populations, as well as efforts to improve the measurement of sex and gender across many scientific fields, has demonstrated the need to reconsider how sex, gender, and the relationship between them are conceptualized. No abstract available. 4
59. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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