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DIAGNOSIS OF ROTATOR CUFF TEARS: A COMPARISON BETWEEN CLINICAL EXAMINATION, MRI AND OPERATIVE FINDINGS. OUR EXPERIENCE IN A DISTRICT GENERAL HOSPITAL.



Abstract

Introduction: Diagnosis of rotator cuff tears by clinical examination and MRI is not always accurate. If the extent of the tear could be predicted pre-operatively, both the patient and the surgeon would be better equipped for the subsequent operation and rehabilitation.

Aim: To assess the accuracy of clinical examination and MRI in detecting the presence of rotator cuff tears.

Method and Results: Retrospective analysis of 86 patients with symptoms and signs of rotator cuff disease. All underwent clinical examination of the shoulder followed by an MRI scan. The diagnosis was confirmed intra-operatively.

Sensitivity of clinical examination for all tears was 69%, with a specificity of 64% and a positive predictive value of 80%. Individual sensitivities were as follows: grade I 50%, II 76%, III 100%. MRI had a sensitivity of 82.8% for all tears, specificity of 57% and a positive predictive value of 80%. Individual sensitivities: I 69%, II 90%, III 100%.

Conclusion: In some patients clinical examination remains uncertain, MRI is helpful but the diagnosis is not always reliable.

Honorary Secretary Mr Bimal Singh. Correspondence should be addressed to BOSA (British Orthopaedic Specialists Association), c/o Royal College of Surgeons, 35 – 43 Lincoln’s Inn Fields, London WC2A 3PE.