title: Magnetic Resonance Arthrogram Referrals by Subspecialist and Non-Subspecialist Orthopaedic Surgeons: What are the Findings?
abstract: BACKGROUND
  Although subspecialist orthopaedic surgeons usually request Magnetic Resonance Arthrogram (MRA) examinations, some orthopaedic surgeons may request this examination for a body part that is different from their subspecialty. The purpose of the study is to compare the MRA and the clinical findings in the subspecialist and non-subspecialist groups.
  
  
  METHODS
  Retrospective analysis of MRA examinations over a 6-month period. Findings were compared with the clinical information.
  
  
  RESULTS
  There were 144 examinations (69 shoulder, 42 wrist and 33 hip). 85% of these were subspecialist referrals; 60% of them showed findings compatible with the clinical diagnosis. 15% of the MRA examinations were non-subspecialist referrals; 52% of them correlated with the clinical findings. Overall, clinical information agreed with MRA findings for shoulder labral tears, hip labral tears and wrist triangular fibrocartilage complex tears in 63.3%, 64.5% and 61.5% respectively. The subspecialist group were more accurate than the non-subspecialist group in diagnosing hip labral tears (68%vs. 50%) and triangular fibrocartilage complex tears (62.5%vs. 50%). On the contrary, shoulder MRA and clinical findings correlated better in the non-subspecialist group (77.8%) compared to the subspecialist group (63.3%). However, the small number of requests generated by the non-subspecialist group may affect the results. Suspected scapholunate ligament injury showed low correlation with MRA at 26.7% (33.3% in the subspecialist group and 0% in the non-subspecialist group).
  
  
  CONCLUSIONS
  Generally, the clinical findings are more accurate in the subspecialist referrals when compared to MRA findings and therefore a subspecialist referral is preferred. The low agreement between clinically suspected scapholunate ligament injuries and wrist MRA probably reflects the relative difficulty in establishing this diagnosis clinically.
authors.affiliation: Radiology Department, Royal Preston Hospital, Sharoe Green Lane, Preston, PR2 9HT, UK.
authors.forename: Zeid
authors.initials: Z
authors.lastname: Al-Ani
authors.affiliation: Radiology Department, Royal Preston Hospital, Sharoe Green Lane, Preston, PR2 9HT, UK.
authors.forename: Syed
authors.initials: S
authors.lastname: Ali
authors.affiliation: Radiology Department, Royal Preston Hospital, Sharoe Green Lane, Preston, PR2 9HT, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Beardmore
authors.affiliation: Radiology Department, Royal Preston Hospital, Sharoe Green Lane, Preston, PR2 9HT, UK.
authors.forename: Vinay
authors.initials: V
authors.lastname: Parmar
authors.affiliation: Radiology Department, Royal Preston Hospital, Sharoe Green Lane, Preston, PR2 9HT, UK.
authors.forename: Teik
authors.initials: T
authors.lastname: Chooi Oh
keywords: Clinical findings; Diagnostic accuracy; MR arthrogram; Non-subspecialist orthopaedic referrals; Radiological findings; Subspecialist orthopaedic referrals