title: Is the Apprehension Test Sufficient for the Diagnosis of Anterior Shoulder Instability in Young Patients without Magnetic Resonance Imaging (MRI)?
abstract: BACKGROUND
  The purpose of this study is to compare the sensitivities and positive predictive values (PPV) of the anterior apprehension test and magnetic resonance imaging (MRI) in the diagnosis of anterior labral tears in young patients with shoulder instability and to determine if surgery could be carried out without this investigation in selected patients.
  
  
  METHODS
  We undertook a retrospective study of 168 patients aged between 15 and 30 years with a history of shoulder dislocation and compared the sensitivities and the PPV of the apprehension test with both MRI and magnetic resonance arthrograms (MRA) in the diagnosis of a Bankart lesion. The radiological investigations were interpreted by general practice radiologists and specialised musculoskeletal radiologists. All patients had their diagnosis confirmed by shoulder arthroscopy.
  
  
  RESULTS
  Our results showed that the apprehension test was highly reliable when it was positive with a PPV of 96%. It was more sensitive than MRI in the diagnosis of a Bankart lesion. The clinical test was significantly better when a musculoskeletal radiologist interpreted the MRI. The MRA interpreted by a musculoskeletal radiologist had the highest rates of sensitivity in detecting Bankart lesions. The figure was similar to that for the apprehension test. There was no difference in the PPVs among the clinical test, the MRI and the MRA read by the 2 categories of radiologists.
  
  
  CONCLUSIONS
  We conclude that a routine MRI may be unnecessary in evaluating a young patient with clinically evident anterior shoulder instability if the apprehension test is positive. A MRA that can be interpreted by a musculoskeletal radiologist will be the next best investigation if the clinical test is negative or equivocal.
authors.affiliation: University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Hospital, National University Health System, Singapore.
authors.forename: Krishna
authors.initials: K
authors.lastname: Kumar
authors.forename: Milindu
authors.initials: M
authors.lastname: Makandura
authors.forename: Nicholas J J
authors.initials: NJ
authors.lastname: Leong
authors.forename: Louise
authors.initials: L
authors.lastname: Gartner
authors.forename: Chin Hwee
authors.initials: CH
authors.lastname: Lee
authors.forename: Dennis Z W
authors.initials: DZ
authors.lastname: Ng
authors.forename: Chyn Hong
authors.initials: CH
authors.lastname: Tan
authors.forename: V Prem
authors.initials: VP
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D010808:Physical Examination / Q000379:methods*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012783:Shoulder Dislocation / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D012785:Shoulder Joint / Q000601:surgery; D055815:Young Adult