Clinical Value of Pre-Operative Gleno-Humeral Arthrography in the Treatment of Shoulder Instability

Introduction: MRI arthrogram is part of the routine preoperative evaluation of patients diagnosed with traumatic anterior shoulder instability. In addition to its well described complications, shoulder arthrography is associated with significant discomfort to patients, economic burden for the healthcare system and potentially hindering surgical procedure and rehabilitation. However, the clinical value of data acquired by shoulder arthrogram of young patients with isolated post-traumatic anterior shoulder instability is unclear.

Methods: In this IRB approved study we retrospectively analyzed the medical records of 48 consecutive patients (ages 15 to 40, 100% males), who were diagnosed with post-traumatic anterior shoulder instability after a documented anterior dislocation, referred for arthroscopic stabilization and underwent an MRI arthrogram as part of the pre-operative workup. Imaging studies were retrieved and read by a blinded musculoskeletal radiologist. MRI findings were evaluated for cases in which obtained data may affect clinical course.

Results: MRI arthrogram findings in our cohort showed Hill-Sachs lesion in 42 patients (87%), anterior labral tear in 37 patients (77%), tear of the anterior inferior gleno-humeral ligament (AIGHL) in 15 patients (31%) and SLAP tear in 12 patients (25%). The surgical decision was not altered in any of the cases however the timing of surgery was delayed by an average of 3 months.

Conclusion: Our results indicate very limited clinical value for MRI arthrogram in young patients referred to surgical stabilization of the shoulder following a documented anterior dislocation. With arthroscopic stabilization advocated for first time dislocation, the contribution of MRI arthrogram to clinical decision making and its effect on treatment course should be weighed against complications, inconvenience and delay in rehabilitation.