PAPER 038: ASSOCIATION OF CLINICAL ASSESSMENT, MRI AND ARTHROSCOPIC FINDINGS IN PATIENTS WITH SLAP LESIONS

Abstract

Purpose: The diagnosis and treatment of superior labral antero posterior (SLAP) lesions is a controversial subject in shoulder pathology. The aim of this retrospective study was to evaluate the strength of association between clinical assessment (O’Brien test), standard MRI, and arthroscopic identification of a SLAP lesion.

Method: Patients who underwent isolated arthroscopic treatment of a SLAP lesion by two senior orthopaedic surgeons between 2004 and 2007 were included in this study. Pre-operatively, all had a standard MRI and the outcome of O’Brien test had been documented. Sensitivity of these measures in detecting a SLAP lesion confirmed through arthroscopy were calculated independently and combined. The relationship between O’Brien test and standard MRI are also presented.

Results: Forty-five patients were included in this study. The O’Brien test demonstrated a sensitivity of 42% (true positive) in detecting a SLAP lesion while sensitivity of the standard MRI was only 13%. The sensitivity of the O’Brien test and standard MRI when considered together was 47%, only slightly higher than the O’Brien test alone. The association between the O’Brien test and standard MRI in identifying a SLAP lesion as measured by the phi correlation coefficient was −0.19 which suggests little to no relationship (p = 0.095).

Conclusion: The current study illustrates the difficulties in accurately diagnosing a SLAP lesion pre-operatively. Previously documented sensitivity of the O’Brien test in identifying a SLAP lesion was not replicated herein. Furthermore, this study draws into question the practice of patient’s undergoing a standard MRI for SLAP lesion identification because the added value from this investigation was nominal. A standard MRI is often requested when the diagnosis is not certain or to exclude other shoulder pathology. If, however, a SLAP lesion is suspected clinically in absence of other shoulder pathology, then a diagnostic tool other than standard MRI may be more meaningful. Some literature suggests MRI arthrogram may be useful in diagnosing a SLAP lesion but access to this tool can be limited.