title: Magnetic Resonance Imaging Currently Fails to Fully Evaluate the Biceps-Labrum Complex and Bicipital Tunnel.
abstract: OBJECTIVE
  To determine the diagnostic accuracy of magnetic resonance imaging (MRI) for biceps-labrum complex (BLC) lesions, including the extra-articular bicipital tunnel.
  
  
  METHODS
  A retrospective review of 277 shoulders with chronic refractory BLC symptoms that underwent arthroscopic subdeltoid transfer of the long head of the biceps tendon (LHBT) to the conjoint tendon was conducted. Intraoperative lesions were categorized as "inside" (labral tears and dynamic LHBT incarceration), "junctional" (LHBT partial tears, LHBT subluxation, and biceps chondromalacia), or "bicipital tunnel" (extra-articular bicipital tunnel scar/stenosis, loose bodies, LHBT instability, and LHBT partial tears) based on anatomic location. Attending radiologist-generated MRI reports were graded dichotomously as positive or negative for biceps and labral damage and then compared with intraoperative findings. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for MRI with respect to intraoperative findings.
  
  
  RESULTS
  With regard to inside lesions, MRI had an overall sensitivity, specificity, PPV, and NPV for labrum lesions of 77.3%, 68.2%, 57.3%, and 84.5% respectively. The sensitivity, specificity, PPV, and NPV of MRI for junctional lesions were 43.3%, 55.6%, 73.1%, and 26.0%, respectively. For the bicipital tunnel, MRI had a sensitivity, specificity, PPV, and NPV of 50.4%, 61.4%, 48.7%, and 63.0%, respectively.
  
  
  CONCLUSIONS
  MRI was unreliable for ruling out BLC lesions among chronically symptomatic patients, including when the bicipital tunnel was affected.
authors.affiliation: Hospital for Special Surgery, New York, New York, U.S.A.. Electronic address: samueltaylor.md@gmail.com.
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Taylor
authors.affiliation: Hospital for Special Surgery, New York, New York, U.S.A.
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Newman
authors.affiliation: Hospital for Special Surgery, New York, New York, U.S.A.
authors.forename: Joseph
authors.initials: J
authors.lastname: Nguyen
authors.affiliation: Hospital for Special Surgery, New York, New York, U.S.A.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Fabricant
authors.affiliation: Hospital for Special Surgery, New York, New York, U.S.A.
authors.forename: Nikolas J
authors.initials: NJ
authors.lastname: Baret
authors.affiliation: Hospital for Special Surgery, New York, New York, U.S.A.
authors.forename: Mary
authors.initials: M
authors.lastname: Shorey
authors.affiliation: Hospital for Special Surgery, New York, New York, U.S.A.
authors.forename: Prem
authors.initials: P
authors.lastname: Ramkumar
authors.affiliation: Hospital for Special Surgery, New York, New York, U.S.A.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: O'Brien
mesh_terms: D000328:Adult; D000368:Aged; D002357:Cartilage Diseases / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000473:pathology* / Q000601:surgery; D013708:Tendon Injuries / Q000473:pathology / Q000601:surgery; D013710:Tendons / Q000473:pathology* / Q000601:surgery