• Direct MR arthrography
• Labrum
• Ligament
• MRI
• Meniscectomy
• Plica
• Post-operative

• Humans
• Arthrography/methods
• Radiography
• Magnetic Resonance Imaging/methods
• Shoulder/diagnostic imaging
• Wrist

• ICRS
• MRI
• ankle fracture
• chondral lesions
• orthopedic surgeon
• radiologist

• Humans
• Shoulder/pathology
• Arthrography/methods
• Rotator Cuff Injuries/diagnostic imaging
• Retrospective Studies
• Prospective Studies
• Magnetic Resonance Imaging/methods
• Sensitivity and Specificity

• rotator cuff injuries
• magnetic resonance imaging
• anatomy
• classification

• Labrum
• SLAP
• Shoulder MR imaging
• Thrower’s shoulder

• MRA
• MRI
• rotator cuff tear
• shoulder pain
• ultrasound

• Clinical decision making
• clinical rationale
• clinical symptoms
• imaging
• magnetic resonance imaging
• pathoanatomic model

• Baseball
• GIRD
• Internal impingement
• MR imaging
• Rotator cuff
• SLAP tear
• Shoulder
• Throwing

• Shoulder joint
• accuracy
• agreement
• anterior traumatic shoulder dislocation
• instability
• magnetic resonance arthrography
• reproducibility
• sensitivity and specificity

Different diagnostic imaging modalities, such as ultrasonography (US), MRI, MR arthrography (MRA) are commonly used for the characterisation of rotator cuff (RC) disorders. Since the most recent systematic reviews on medical imaging, multiple diagnostic studies have been published, most using more advanced technological characteristics. The first objective was to perform a meta-analysis on the diagnostic accuracy of medical imaging for characterisation of RC disorders. Since US is used at the point of care in environments such as sports medicine, a secondary analysis assessed accuracy by radiologists and non-radiologists.

A systematic search in three databases was conducted. Two raters performed data extraction and evaluation of risk of bias independently, and agreement was achieved by consensus. Hierarchical summary receiver-operating characteristic package was used to calculate pooled estimates of included diagnostic studies.

Diagnostic accuracy of US, MRI and MRA in the characterisation of full-thickness RC tears was high with overall estimates of sensitivity and specificity over 0.90. As for partial RC tears and tendinopathy, overall estimates of specificity were also high (>0.90), while sensitivity was lower (0.67–0.83). Diagnostic accuracy of US was similar whether a trained radiologist, sonographer or orthopaedist performed it.

Our results show the diagnostic accuracy of US, MRI and MRA in the characterisation of full-thickness RC tears. Since full thickness tear constitutes a key consideration for surgical repair, this is an important characteristic when selecting an imaging modality for RC disorder. When considering accuracy, cost, and safety, US is the best option.

• MRI
• Meta-analysis
• Shoulder
• Ultrasound

It is unknown which combination of patient information and clinical tests might be optimal for the diagnosis of rotator cuff tears. This study aimed to determine the diagnostic value of nine individual clinical tests for evaluating rotator cuff tear and to develop a prediction model for diagnosing rotator cuff tear.

This prospective cohort study included 169 patients with shoulder complaints. Patients who reported a previous shoulder dislocation were excluded from the analysis (N = 69). One experienced clinician conducted 25 clinical tests of which 9 are specifically designed to diagnose rotator cuff pathology (empty can, Neer, Hawkins-Kenney, drop arm, lift-off test, painful arc, external rotation lag sign, drop sign, infraspinatus muscle strength test). The final diagnosis, based on magnetic resonance arthrography (MRA), was determined by consensus between the clinician and a radiologist, who were blinded to patient information. A prediction model was developed by logistic regression analysis.

In this cohort, 38 patients were diagnosed with rotator cuff tears. The individual overall accuracy of the rotator cuff clinical tests was 61%–75%. After backward selection, the model determined that the most important predictors of rotator cuff tears were higher age and a positive Neer test. This internally validated prediction model had good discriminative ability (area under the receiver operating characteristic curve (AUC) = 0.73).

Our results showed that individual clinical shoulder tests had moderate diagnostic value for diagnosing rotator cuff tear. Our prediction model showed improved diagnostic value. However, the prediction value is still relatively low, supporting a low threshold for additional diagnostic tests for the diagnosis of rotator cuff tears.

Study of diagnostic test: level I.

Evaluation of rotator cuff is a common indication for magnetic resonance imaging (MRI) scanning of the shoulder. Conventional MRI is the most commonly used technique, while magnetic resonance (MR) arthrography is reserved for certain cases. Rotator cuff disorders are thought to be caused by a combination of internal and external mechanisms. A well-structured MRI report should comment on the relevant anatomic structures including the acromial type and orientation, the presence of os acromiale, acromio-clavicular degenerative spurs and fluid in the subacromial subdeltoid bursa. In addition, specific injuries of the rotator cuff tendons and the condition of the long head of biceps should be accurately reported. The size and extent of tendon tears, tendon retraction and fatty degeneration or atrophy of the muscles are all essential components of a surgically relevant MRI report.

• Magnetic resonance imaging
• Rotator cuff tendons
• Tendon tear
• Review
• Shoulder

Because of its inherent superior soft tissue contrast and lack of ionizing radiation, magnetic resonance imaging (MRI) is highly suited to study the complex anatomy of the shoulder joint, particularly when assessing the relatively high incidence of shoulder injuries in young, athletic patients. This review aims to serve as a primer for understanding shoulder MRI in an algorithmical approach, including MRI protocol and technique, normal anatomy and anatomical variations of the shoulder, pathologic conditions of the rotator cuff tendons and muscles, the long head of the biceps tendon, shoulder impingement, labral and glenohumeral ligament pathology, MR findings in shoulder instability, adhesive capsulitis, and osteoarthritis.

• MRI
• imaging
• shoulder
• shoulder anatomy
• shoulder pathologies

• humans
• arthroscopy
• magnetic resonance imaging
• rotator cuff injuries
• ultrasonography
• arthrography
• arthrography/methods
• prospective studies
• rotator cuff
• rotator cuff/surgery
• shoulder pain
• shoulder pain/etiology
• shoulder pain/surgery

• Arthrography/methods
• Arthroscopy
• Humans
• Magnetic Resonance Imaging
• Prospective Studies
• Rotator Cuff/surgery
• Rotator Cuff Injuries
• Shoulder Pain/etiology
• Shoulder Pain/surgery
• Ultrasonography

• Humans
• Joint Diseases/diagnosis
• Magnetic Resonance Imaging/trends
• Shoulder Injuries
• Shoulder Joint/pathology

• inter-observer agreement
• accuracy
• orthopaedic surgeons
• radiologists
• shoulder joint
• mr imaging

To assess the diagnostic performance of MR arthrography in the diagnosis of the various types of partial-thickness rotator cuff tears by comparing the MR imaging findings with the arthroscopic findings.

The series of MR arthrography studies included 202 patients consisting of 100 patients with partial-thickness rotator cuff tears proved by arthroscopy and a control group of 102 patients with arthroscopically intact rotator cuffs, which were reviewed in random order. At arthroscopy, 54 articular-sided, 26 bursal-sided, 20 both articular- and bursal-sided partial-thickness tears were diagnosed. The MR arthrographies were analyzed by two radiologists for articular-sided tears, bursal-sided tears, and both articular- and bursal-sided tears of the rotator cuff. The sensitivity and specificity of each type of partial-thickness tears were determined. Kappa statistics was calculated to determine the inter- and intra-observer agreement of the diagnosis of partial-thickness rotator cuff tears.

The sensitivity and specificity of the various types of rotator cuff tears were 85% and 90%, respectively for articular-sided tears, 62% and 95% for bursal-sided tears, as well as 45% and 99% for both articular- and bursal-sided tears. False-negative assessments were primarily observed in the diagnosis of bursal-sided tears. Conversely, both articular- and bursal-sided tears were overestimated as full-thickness tears. Inter-observer agreement was excellent for the diagnosis of articular-sided tears (k = 0.70), moderate (k = 0.59) for bursal-sided tears, and fair (k = 0.34) for both articular- and bursal-sided tears, respectively. Intra-observer agreement for the interpretation of articular- and bursal-sided tears was excellent and good, respectively, whereas intra-observer agreement for both articular- and bursal-sided tears was moderate.

MR arthrography is a useful diagnostic tool for partial-thickness rotator cuff tears, but has limitations in that it has low sensitivity in bursal- and both articular- and bursal-sided tears. In addition, it shows only fair inter-observer agreement when it comes to predicting both articular- and bursal-sided tears.

• MR arthrography
• Partial-thickness tear
• Rotator cuff
• Shoulder

• shoulder joint
• shoulder instability
• magnetic resonance imaging
• arthrography
• aber