Table depicting accuracies for SLAP lesions regarding various MRI types and training levels of radiologists.
Methods: 140 patients with arthroscopically confirmed SLAP lesions and 100 patients with arthroscopically confirmed normal superior labra were included. The transcribed radiologists’ interpretations of the respective noncontrast shoulder MRIs were compared with the operative findings.
Results: For the diagnosis of SLAP lesion, noncontrast MRI yielded a sensitivity of 38% and specificity of 94%. Musculoskeletal fellowship trained radiologists had greater sensitivity results than non-musculoskeletal radiologists.
Conclusion: Noncontrast MRI is not a reliable diagnostic tool for SLAP lesion diagnosis in the community setting.
MRI of the Asymptomatic Shoulder in Patients 45-60 Years Old
Randy Schwartzberg, M.D., Bryan Reuss, M.D., Bradd Burkhart, M.D., Matt Butterfield, M.D.
Overview: It is generally believed that labral tears seen on MRI in middle-aged patients reflect different issues than when seen in younger athletes. There is some thought that the findings of labral tears in middle-aged patients may represent a normal degenerative process. A radiologist interpreting an MRI as a labral tear may lead an orthopaedic surgeon to recommend a labral tear surgery. The purpose of this study is to evaluate MRI findings in the shoulders of asymptomatic middle-aged people.
Methods: 52 people between the ages of 45-60 with no history of shoulder pain, no prior shoulder problem and a normal shoulder physical exam underwent shoulder MRI. Two musculoskeletal radiologists who were blinded to the purposes of the study were asked to read the MRIs. They were asked to specifically evaluate all aspects of the labrum, rotator cuff and long head biceps tendon. The radiologists are currently evaluating the MRIs.
Efficacy of Continuous Infusion Ropivacaine Interscalene Blocks Versus Placebo for Pain Control After Arthroscopic Rotator Cuff Repair
Randy Schwartzberg, M.D., Bryan Reuss, M.D., Bradd Burkhart, M.D., Amanda Hanekom, Chris Warrell, M.D., Firas Abdul, M.D.
Overview: Since arthroscopic rotator cuff repair is a common and painful outpatient surgical procedure, the efficacy of continuous ropivacaine scalene block infusion catheters for pain control is being evaluated. It was hypothesized that patients receiving continuous ropivacaine scalene block infusions after arthroscopic rotator cuff repair will have less postoperative pain during the period the catheter is in place and for several days after it is removed.
Methods: Patients undergoing arthroscopic rotator cuff repair are candidates for the study. All patients will receive a preoperative scalene block with 0.5% ropivacaine by an anesthesiologist and a continuous infusion catheter will be placed. Patients will be randomized to receive either 0.2% ropivacaine or saline in the reservoir. The infusion will last for 50 hours. Patients will document their pain visual analog scores at multiple time points each day for five days. They will also maintain a medication log. The two groups will be compared postoperative for pain and narcotic pain medication consumption.
By Corey Gehrold and Randy Schwartzberg, M.D.
Originally Published in FloridaMD Magazine, April 2014