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MR arthrography including abduction and external rotation images in the assessment of atraumatic multidirectional instability of the shoulder

  • Musculoskeletal
  • Published:
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Abstract

Objective

To evaluate diagnostic signs and measurements in the assessment of capsular redundancy in atraumatic multidirectional instability (MDI) of the shoulder on MR arthrography (MR-A) including abduction/external rotation (ABER) images.

Methods

Twenty-one MR-A including ABER position of 20 patients with clinically diagnosed MDI and 17 patients without instability were assessed by three radiologists. On ABER images, presence of a layer of contrast between the humeral head (HH) and the anteroinferior glenohumeral ligament (AIGHL) (crescent sign) and a triangular-shaped space between the HH, AIGHL and glenoid (triangle sign) were evaluated; centring of the HH was measured. Anterosuperior herniation of the rotator interval (RI) capsule and glenoid version were determined on standard imaging planes.

Results

The crescent sign had a sensitivity of 57 %/62 %/48 % (observers 1/2/3) and specificity of 100 %/100 %/94 % in the diagnosis of MDI. The triangle sign had a sensitivity of 48 %/57 %/48 % and specificity of 94 %/94 %/100 %. The combination of both signs had a sensitivity of 86 %/90 %/81 % and specificity of 94 %/94 %/94 %. A positive triangle sign was significantly associated with decentring of the HH. Measurements of RI herniation, RI width and glenoid were not significantly different between both groups.

Conclusions

Combined assessment of redundancy signs on ABER position MR-A allows for accurate differentiation between patients with atraumatic MDI and patients with clinically stable shoulders; measurements on standard imaging planes appear inappropriate.

Key Points

• MR arthrography has the possibility to accurately identify patients with atraumatic MDI.

• Imaging of the shoulder in abduction and external rotation provides additive information.

• Capsular enlargement of the shoulder can be diagnosed on MR arthrography.

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Abbreviations

ABER:

abduction and external rotation

AIGHL:

anteroinferior glenohumeral ligament

HH:

humeral head

MDI:

multidirectional instability

MR-A:

magnetic resonance arthrography

RI:

rotator interval

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Acknowledgments

The scientific guarantor of this publication is Prof. Dr. Klaus Woertler. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Methodology: retrospective, diagnostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Technische Universität München, Ismaninger Str.22, 81675, Munich, Germany

    Christoph Schaeffeler, Simone Waldt, Jan S. Bauer, Ernst J. Rummeny & Klaus Woertler

  2. Musculoskeletal Imaging, Kantonsspital Graubünden, Loëstr. 170, 7000, Chur, Switzerland

    Christoph Schaeffeler

  3. Department of Traumatology, Technische Universität München, Ismaninger Str.22, 81675, Munich, Germany

    Chlodwig Kirchhoff

  4. Department of Orthopedic Sports Medicine, Technische Universität München, Ismaninger Str.22, 81675, Munich, Germany

    Andreas B. Imhoff

  5. Orthosportiv, Center for Sports Orthopedics and Medicine, Zweibrückenstr. 2, 80331, Munich, Germany

    Michael Schröder

  6. Institute for Medical Statistics and Epidemiology, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany

    Bernhard Haller

Authors
  1. Christoph Schaeffeler
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  2. Simone Waldt
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  9. Klaus Woertler
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Correspondence to Christoph Schaeffeler.

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Schaeffeler, C., Waldt, S., Bauer, J.S. et al. MR arthrography including abduction and external rotation images in the assessment of atraumatic multidirectional instability of the shoulder. Eur Radiol 24, 1376–1385 (2014). https://doi.org/10.1007/s00330-014-3133-x

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  • DOI: https://doi.org/10.1007/s00330-014-3133-x

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