title: Correlation between MRI and Arthroscopy in Diagnosis of Shoulder Pathology.
abstract: BACKGROUND
  Shoulder pain can cause significant pain, discomfort and reduce the ability to perform activities of daily living, thus making it the third most common cause of musculoskeletal consultation. The current gold standard diagnostic investigation is arthroscopy. MRI is a proved sensitive and accurate non-invasive tool in investigating shoulder pathology, but false and misleading results are equally reported.
  
  
  OBJECTIVE
  The aim of the study is to compare the efficacy of MRI in diagnosing shoulder pathologies in comparison to arthroscopy, considering arthroscopy as the gold standard.
  
  
  METHODS
  Thirty nine consecutive patients, between 18-80 years of age, presenting with chronic shoulder pain or instability of more than 6 weeks, or with clinical signs of impingement or tear were included in the study. MRI of the shoulder joint was done followed by shoulder arthroscopy. The data collected was analysed for the significant correlation between MRI of shoulder and arthroscopic findings by kappa statistics.
  
  
  RESULTS
  Out of 39 patients, Rotator cuff (RC) tear was the most common pathology. MRI showed excellent sensitivity in the diagnosis of rotator cuff tears (0.91) and osteochondral defects (OCD), very good sensitivity for Bankart's lesion (0.8) and had poor sensitivity to detect SLAP tear (0.15). MRI was specific for all shoulder pathologies. MRI detected RC tears with kappa score of 0.73, Bankart's tear and OCD's with kappa score of 0.83 and 1.0 respectively and SLAP lesion with kappa score of 0.14. The accuracy of MRI was highest in diagnosing OCD's (1.0), followed by RC tear (0.9), Bankart's tear (0.9) and accuracy was least in diagnosing SLAP lesion (0.7). False negative results were more than false positives.
  
  
  CONCLUSIONS
  The present study supports that MRI is effective in diagnosing rotator cuff tears, Bankart's tear and ostechondral defects but was not found to be helpful in diagnosing SLAP lesions. MRI and arthroscopy have complimentary roles in the diagnosis of shoulder pathology.
authors.affiliation: Registrar, Department of Orthopaedics, Fortis Hospital , Mumbai, India .
authors.forename: Abhinav
authors.initials: A
authors.lastname: Bhatnagar
authors.affiliation: Consultant, Department of Orthopaedics, Fortis Hospital , Mumbai, India .
authors.forename: Sachin
authors.initials: S
authors.lastname: Bhonsle
authors.affiliation: Registrar, Department of Orthopaedics, Fortis Hospital , Mumbai, India .
authors.forename: Sonu
authors.initials: S
authors.lastname: Mehta
keywords: Accuracy; Bankart’s; Osteochondral defect; Rotator cuff; SLAP; Sensitivity