DIAGNOSIS OF GLENOID LABRAL TEARS - A COMPARISON BETWEEN MAGNETIC-RESONANCE-IMAGING AND CLINICAL EXAMINATIONS

We studied 54 patients with shoulder pain secondary to anterior instab ility or glenoid labral tears refractory to 6 months of conservative m anagement with no evidence of rotator cuff lesions. All patients had s ufficient preoperative clinical data, magnetic resonance imaging, and shoulder arthroscopy results for analysis. The ability to predict the presence of a glenoid labral tear by physical examination was compared with that of magnetic resonance imaging (conventional and arthrogram) and confirmed with arthroscopy. There were 37 men and 17 women (avera ge age, 34 years) in the study group. Of this group, 64% were throwing athletes and 61% recalled specific traumatic events. clinical assessm ent included history with specific attention to pain with overhead act ivities, clicking, and instances of shoulder instability. Physical exa mination included the apprehension, relocation, load and shift, inferi or sulcus sign, and crank tests. Shoulder arthroscopy confirmed labral tears in 41 patients (76%). Magnetic resonance imaging produced a sen sitivity of 59% and a specificity of 85%. Physical examination yielded a sensitivity of 90% and a specificity of 85%. Physical examination i s more accurate in predicting glenoid labral tears than magnetic reson ance imaging. In this era of cost containment, completing the diagnost ic workup in the clinic without expensive ancillary studies allows the patient's care to proceed in the most timely and economic fashion.