Bilateral MRI for Unilateral Shoulder Pain

Barreto, RG et al. Bilateral magnetic resonance imaging findings in individuals with unilateral shoulder pain. JSES: 2019
  • Several previous studies have shown bilateral changes in MRI findings in people with only unilateral shoulder symptoms and asymptomatic individuals. However, these studies have assessed only athletes or age-restricted samples.
  • Primary objective of this study was to determine MRI-identified frequency of tissue pathology in individuals with unilateral shoulder pain. Secondary objective was to determine agreement of findings between a board-certified fellowship-trained shoulder surgeon and a radiologist.
  • 123 participants were included with unilateral shoulder pain located anterolateral or lateral arm that was exacerbated by movement. People were excluded if bilateral complaints, neck pain, history of surgery or fractures, GH dislocations w/in past 2 years, clinical signs of adhesive capsulitis, neck pain, or unable or fearful of MRI
  • Prevalence of bilateral findings on MRI was high in both symptomatic and asymptomatic shoulders with RC tendinopathy (90%) and AC jt alterations (75%). The shoulder surgeon reported a higher prevalence of FT tear of SST and GH OA in symptomatic shoulders compared to asymptomatic.
  • Agreement b/w surgeon and radiologist ranged from 45% to 98% with best observed agreements for presence of SST atrophy, GH OA, and alterations to LHB
  • Overall, the results of this study found a high prevalence of bilateral MRI alterations in individuals with unilateral shoulder symptoms with few differences b/w symptomatic and asymptomatic sides. Main differences were presence of FT RCT and OA on symptomatic side, which calls into question the utility of MRI as most effective treatment planning tool.
  • Alterations were also observed more frequently in people over 60 years including higher frequencies of RC tears, labral and biceps pathology, and OA. However, the same pattern of bilateral findings in both symptomatic and asymptomatic shoulders was observed.
  • Results also suggest that FT tears may be related to symptoms but tendinopathy was not consistently found more commonly in symptomatic shoulders
  • This study questions the utility of MRI for treatment planning in individuals with unilateral shoulder pain as a high prevalence of alterations in asymptomatic shoulder was found. MRI cannot discriminate whether altered anatomy is associated with specific clinical findings.
  • It is important to note that the issue is not the accuracy of MRI, but the lack of relationship of the findings with symptom status