Subscapularis Tendon Tears – Usefulness of Written MRI Reports for Guiding Patient Referral to Shoulder Specialists

Abstract

Introduction Rotator cuff tears are one of the most common reasons for shoulder pain, and patients often present initially to general practitioners. However, subscapularis tears are especially difficult to diagnose and hence adequate therapy is often delayed. General practitioners or non-specialist orthopedic surgeons need reliable MRI findings to allow timely referral of patients to shoulder specialists. The purpose of this study was to determine the validity of the written MRI report of patients with arthroscopically proven subscapularis tendon tears. Method In this retrospective study, 97 patients (mean age 62.4 ± 10 years, 63 men) who underwent arthroscopic subscapularis repair between April 2013 and January 2015 by two experienced shoulder surgeons and who underwent a preoperative 1.5 T MRI study were included. All of these patients had high-field strength (i. e., ≥ 1.5 T) standard MRI scans performed within 4–164 (mean 57.4 ± 38.4) days before their arthroscopic procedures. Results and Conclusion Subscapularis tendon tears, verified by arthroscopy, were correctly identified in only 37 of 97 cases in the written report of the preoperative MRI. This resulted in an overall low sensitivity of 38.1 %. Correctly predicted lesions were as follows: Fox and Romeo I 29.4 % (5/17 patients), Fox and Romeo II 20 % (7/35 patients), Fox and Romeo III 46.7 % (14/30 patients) and Fox and Romeo IV 73.3 % (11/15 patients). In contrast, concurrent supraspinatus tendon tears were identified correctly in 88.2 % of patients (60/68 cases, sensitivity 88.2 %, specificity 96.5 %). Preoperative written radiology reports provided by a heterogeneous group of 39 presumably non-MSK-specialized radiologic centers do not reliably detect subscapularis tendon tears and are not sufficient for guiding patients to specialist centers. Compared to other rotator cuff injuries, this study shows difficulties in the correct diagnosis of subscapular tendon injuries. However, this is necessary to provide patients with timely therapy. It can be assumed that MRI review by musculoskeletal-specialized radiologists would more often than not lead to the correct diagnosis. Key Points: Citation Format

Both Radiologists and Surgeons Miss a Substantial Number of Subscapularis Tears on Magnetic Resonance Imaging Examination Prior to Shoulder Arthroscopy

“…However, it is worth noting that the MRI interpretations in this study came solely from musculoskeletal radiologists, which may have resulted in more accurate interpretations. 24 When these results are compared with our findings, the radiologists had lower sensitivity and specificity values in diagnosing SSC tears. Several factors could have contributed to this difference.…”

Arthroscopic subscapularis repair using the subscapularis interlocking (SICK)-stitch technique leads to restoration of clinical function with low complication and revision rates

“…In a clinical multicenter study comparing ultrasound examination by a trained shoulder surgeon and arthroscopy as the gold standard compared to reports by musculoskeletal radiologists using standard MRI, a high number of false-negative reports was observed, especially for smaller lesions. 40 Zhu et al were able to prove a significantly higher sensitivity of ultrasound (78%) compared to MRI (50%) for the detection of arthroscopically confirmed SCP lesions, especially partial lesions. 55 …”

Manejo conservador e técnicas cirúrgicas para reparação de lesões do manguito rotador: uma revisão integrativa / Conservative management and surgical techniques for repair of rotator cuff tears: an integrative review

“…As lesões do manguito rotador são uma das razões mais comuns para a dor no ombro de maneira que os pacientes inicialmente procuram atendimento de um médico generalista. No entanto, as lesões do subescapular são especialmente difíceis de diagnosticar e, portanto, a terapia adequada geralmente é atrasada, geralmente demandando atendimento especializado de um médico ortopedista (LENZ et al, 2021).…”