THE EFFECT OF SHOULDER MAGNETIC-RESONANCE-IMAGING ON CLINICAL DECISION-MAKING

One hundred cases were prospectively evaluated to determine the impact of magnetic resonance imaging on clinical decision making in an ortho paedic practice devoted to the treatment of disorders about the should er. Each was analyzed for changes in the clinical diagnosis or treatme nt. A change that either changed the primary diagnosis or type of trea tment (operative versus nonoperative) was classified as category one. If additional clinically relevant findings were noted on the imaging s tudies without altering the primary diagnosis, or if the Form of treat ment was modified but not changed from operative or nonoperative, ii w as considered category two. Among the 100 imaging studies reviewed, ca tegory one and two changes were observed in 11 and 7 cases, respective ly. Magnetic resonance imaging was particularly helpful in diagnosing ganglion cysts about the shoulder, a category one change in three out of three cases. For specific diagnoses a category one or two change wa s observed in 17% (10 of 59), 29% (4 of 14), 8% (1 of 13), and 100% (2 of 2) for rotator cuff disease, glenohumeral instability, adhesive ca psulitis, and biceps disease, respectively. In 35 cases magnetic reson ance imaging was considered to be unnecessary for the diagnosis or tre atment of the patient. For the 65 patients who underwent magnetic reso nance imaging, category one and two changes were noted in 10 and 5 pat ients, respectively. Statistical significance was demonstrated for cat egory one changes in the entire group (100 cases) and the in subgroup recommended for magnetic resonance imaging (65 cases) (p < 0.05), indi cating that the judicious use of magnetic resonance imaging can have a significant increase its impact on clinical decision making. Magnetic resonance imaging was found to be of limited diagnostic value in pati ents with an isolated primary clinical diagnosis of adhesive capsuliti s, glenohumeral or acromioclavicular arthritis, brachial plexopathy, a nd cervical degenerative disk disease.