Physical Examination and Magnetic Resonance Imaging in the Diagnosis of Superior Labrum Anterior-Posterior Lesions of the Shoulder: A Sensitivity Analysis
Authors: Nirav K. Pandya, Anne Colton, David Webner, Brian Sennett, G. Russell Huffman
References: Arthroscopy. March 2008 (Vol. 24, Issue 3, Pages 311-317
Purpose: The overall purpose of our study was to examine the sensitivity of physical examination, magnetic resonance imaging (MRI), and magnetic resonance (MR) arthrogram for the identification of arthroscopically confirmed SLAP lesions of the shoulder.
Methods: An analysis of 51 consecutive patients with arthroscopically confirmed SLAP lesions and no history of shoulder dislocation was performed. Before undergoing surgery, all patients underwent a standardized physical examination and had either an MRI and/or MR arthrogram performed. Sensitivity analysis was then performed on the results of both the physical examination maneuvers and the radiologic imaging compared to the arthroscopic findings at surgery.
Results: The sensitivity of O'Brien's (active compression) test was 90%, whereas the Mayo (dynamic) shear was 80% and Jobe's relocation test was 76%. The sensitivity of a physical examination with any 1 of these 3 SLAP provocative tests being positive was 100%. Neer's sign (41%) and Hawkin's impingement tests (31%) each had low sensitivity for SLAP lesions. The sensitivity of MRI for SLAP lesions was 67% when interpreted by the performing surgeon, 53% when read by a radiologist. When the MR arthrograms were analyzed alone, the sensitivity was 72% (surgeon) and 50% (radiologist), respectively.
Conclusions: All 3 physical examination maneuvers traditionally considered provocative for SLAP pathology (O'Brien's, Mayo shear, and Jobe's relocation) were sensitive for the diagnosis of SLAP lesions. MRI and MR arthrogram imaging had lower sensitivity than these physical examination tests in diagnosing SLAP lesions. Patient history, demographics, and the surgeon's physical examination should remain central to the diagnosis of SLAP lesions.
Level of Evidence: Level II, development of diagnostic criteria on basis of consecutive patients with universally applied gold standard.
Physical Examination Test
|Any one positive physical examination test (O'Brien's, Mayo shear, or Jobe's relocation tests)||100%|
The majority of patients (61%) had their MRI performed at a community-based radiology center. MRI for the diagnosis of SLAP lesions was not statistically more sensitive (P = .22) when interpreted by the performing surgeon (67%) or when read by a radiologist (53%). This was also true when the MR arthrograms were analyzed as a subset (performed in 18 patients) with sensitivities of 72% (surgeon) and 50% (radiologist), respectively (P = .17).
MR images read by radiologists at academic centers were more sensitive (65%) than those at community centers (42%), although the difference did not reach statistical significance (P = .20) within the power of this study.