[Role of standard radiography and computed tomography in the assessment of shoulder instability: decision-making value in surgical planning. (Radio-anatomic study of 51 unstable shoulders)].
The therapeutic algorythm for shoulder instability, either arthroscopically, either surgically, should focus on clinical data as well as imaging ones. The latter involve standard X-rays and arthrotomodensitometry (AOTDM). Both of these are crucial for the surgical approach. This paper emphasizes their limits and places. We analysed anatomical and imaging data of 51 unstable shoulders operated on between January 1998 and February 2000. Our purpose was to determine the sensitivity and specificity of imaging techniques for each anatomical structure playing a role in the management. Standard X-rays include comparative AP and Bernageau's views. Based on our results, their efficiency is confirmed for the therapeutic approach of bony lesions. Their sensitivity was respectively 96% and 93% for the reconnaissance of Hill-Sachs lesions and lesions of the anterior glenoïd rim. The sensitivity of AOTDM in identifying labral desinsertions was 91% but their extent was not precisely documented likewise for the labral degeneration and absence. The sensitivity was respectively 69% and 71%. Results were poor for the evaluation of the anterior ligament complex. TDM could not accurately document 90% soft tissues lesions which carry a poor prognosis for arthroscopic reconstructive procedures. There is a good correlation between the aspect of anterior capsular attachment and the sprain lesions (P = 0.003). We could conclude that the AOTDM is not determinant factor for choice of the reconstructive procedure, either arthroscopically, either surgically.
Galand
O
O
CHU de Hautepierre, Strasbourg.
Kempf
J F
JF
Dosch
J C
JC
Delcour
J P
JP
D000293:Adolescent; D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007593:Joint Instability; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D011379:Prognosis; D012680:Sensitivity and Specificity; D012785:Shoulder Joint / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed