Background Shoulder pain is a common musculoskeletal complaint, roughly equal in incidence to neck pain (1). The shoulder pain syndrome has a prevalence to 47% in general population (2) and an incidence to 87–100.000 persons per year, an increasing indicator in the latest years (3). The identified etiology of painful shoulder were: rotator cuff tendinopathies (85%), impingement syndrome (74%), acromioclavicular joint involvement (24%), adhesive capsulitis (15%) si radiated pain (7%) (4). MRI imaging of rotator cuff disease, features of impingement are the techniques of choice at most institutions (5,6).
For all physicians, the shoulder is a complex joint, with difficulty in clinical and MRI examination. The type of therapy (medical, physical or surgical) can be estabilished according with MRI conclusion, but sometimes this was a debate between physicians.
Objectives To assess the concordance between two radiologists in interpretation of the same shoulder MRI in patients with rotator cuff disease.
Methods Our prospective observational study included 51 patients (median age 57±9.9 years, 70.6% female) with nontraumatic shoulder pain. The assessment had included a clinical examination of the shoulder for inclusion criterias, lab tests for exclusion an inflammatory diseases and shoulder MRI with purpose to pathological diagnose of cuff rotator disease. Two experienced radiologists independently, blindly and retrospectively interpreted the MRI images. One of the radiologist had more MRI trainnings and do daily musculoskeletal MRI images. We have analized the each MRI changes, as rotator cuff tendinopathies (tendinitis, tendinosis, tears), bicipital tendinopathy and other changes (subacromial bursitis, impingement syndrome, retractile capsulitis). Statistical analysis was performed using SPSS-18 and a p-value <0.05 was considered for statistical significance.
Results There was identified a statistically significant difference between readers. There was a poor to moderate concordance (Cohen's Kappa<0,40, p<0.05) between MRI interpretations for supraspinos tendinopathy, subacromial bursitis, capsulitis, but a good agreement between for subscapular tendinosis (accuracy=98%, Kappa=0,79, p=0.000) and perfect compatibility (accuracy=100%, Kappa=1, p=0,000) for terres minor tendinitis. The poorest concordance between readers was in impingement syndrome (compatibility=55%, kappa=0,11, p>0,05).
Conclusions The MRI examination is significant in rotator cuff disease only when the radiologist is overtrained for shoulder, otherwise the technique is unuseful and doubtful in clinical practice.
McCarthy DJ, Koopman WJ, Arthritis and Allied Conditions, 12th Edition.
Ole M Ekeberg et al, Clinical, socio-demographic and radiological predictors of short-term outcome in rotator cuff disease. BMC Musculoskeletal Disorders 2010, 11:239.
White JJ et al, An epidemiological study of rotator cuff pathology using The Health Improvement Network database. Bone Joint J. 2014 Mar; 96-B(3):350–3.
Oster AJ et al, Diagnosis and relation to general health of shoulder disorders presenting to primary care, Rheumatology 2005; 44: 800–805.
Berquist TH, Musculoskeletal Companion, Second Ed, Lippincot, 2007.
Roy J-S et al, BrJSportsMed 2015; 49:1316–1328.
Disclosure of Interest None declared