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Shoulder MR Arthrography: Which Patient Group Benefits Most?

Beth Israel Deaconess Medical Center and Harvard Medical School Boston, MA 02215

Magee et al. [1] performed sequential MRI and MR arthrography on 20 professional baseball players (mean age, 24 years) and 50 nonprofessional athletes (mean age, 26 years). They concluded that

MR arthrography is considerably more sensitive for detection of partial-thickness supraspinatus tears and labral tears than conventional MRI..... These results suggest high-performance athletes may be a subgroup of patients for whom MR arthrography yields considerable more diagnostic information than conventional MRI.

This article documents the experience of most experts: Labral abnormalities are more common and rotator cuff tears are relatively less common in young individuals, particularly athletes. Indeed, many orthopedists and musculoskeletal radiologists strongly discourage conventional MRI of the shoulder in persons under age 35. In my department, approximately one half of patients who are younger than 35 years and who undergo shoulder MR examinations, which are often requested by nonorthopedists, undergo subsequent MR arthrography, usually to assess labral injuries suspected on the unenhanced examination.

In their discussion, Magee et al. [1] state:

The reason MR arthrography yielded additional information more often in the professional athlete population than in the nonprofessional athlete population is open to speculation.

I agree that this finding is surprising, which may partially reflect the fact that all the professional athletes in the study play baseball, one of the consummate overhand throwing sports that is known to predispose players to superior labral anteroposterior (SLAP) tears. Indeed, many of the additional abnormalities noted on MR arthrography by Magee et al. [1] were SLAP tears. However, I was surprised at the number of rotator cuff tears, particularly full-thickness tears, missed on conventional MRI.

My take-home message from this article is a bit different than that of the authors: MR arthrography, rather than conventional MRI, should be the shoulder examination of choice in all young individuals and its relative benefits will be even greater in throwing athletes.

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1. Magee T, Williams D, Mani N. Shoulder MR arthrography: which patient group benefits most? AJR2004; 183:969 –974[Abstract/Free Full Text]

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This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Hall, F. M. Search for Related Content PubMed PubMed Citation Articles by Hall, F. M. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?