Rotator cuff repairs in individuals with paraplegia.

Shoulder pain and dysfunction are common problems among those individuals with a spinal cord injury (SCI). Among individuals with SCI who have shoulder pain, the prevalence of rotator cuff tears is 65 TO 71%. To date, there has been little discussion as to the efficacy of various treatments for shoulder pain used in the SCI population. The purpose of this retrospective study was to evaluate the outcome of rotator cuff repairs at the Spinal Cord Injury Center (Veterans Administration Puget Sound Health Care System). Five patients (six shoulders) were identified who had undergone shoulder surgery for rotator cuff tear since 1987. Four individuals (five shoulders) had large rotator cuff tears, and following surgery, none of these repairs resulted in improvement of shoulder function or improvement in active range of motion. The one patient with a smaller tear limited to the supraspinatus had a successful surgical outcome in that he had decreased pain, increased strength, and increased range of motion. There is a general lack of epidemiologic information about shoulder pain in individuals with paraplegia. There is also a remarkable lack of research as to the functional impact of shoulder pain and the outcome of nonsurgical and surgical treatments. This case series, drawn from a population of 511 individuals with spinal cord injury, demonstrates that poor outcome was more likely in those with supraspinatus atrophy, those with upward displacement of the humeral head on x-ray, and in those with tears involving more than one muscle. There is a need for further study of conservative treatment and development of selection criteria for those individuals who are being considered for surgery.

MR imaging of clinically suspected scaphoid fractures.

OBJECTIVE: The purpose of this study was to evaluate the usefulness of MR imaging in revealing occult fractures in patients with clinically suspected acute scaphoid fractures who have normal or equivocal findings on radiographs. SUBJECTS AND METHODS: Thirty-six patients underwent MR imaging within 7 days of wrist injury. All had physical findings suggestive of scaphoid fracture. Coronal T1-weighted, short inversion time inversion recovery, and either T2-weighted or proton density-weighted fast spin-echo sequences with fat suppression were used. Follow-up radiographs were obtained at least 2 weeks after MR imaging whenever possible. All imaging studies were reviewed by two musculoskeletal radiologists. RESULTS: MR imaging revealed 22 occult fractures in 20 patients. Thirteen of these 22 fractures were in the scaphoid bone, and nine were in the distal radius. On MR images, 16 patients had no evidence of fracture. Follow-up radiographs were available in 14 of the 20 patients who had occult fracture revealed by MR imaging. Eleven of the 13 occult fractures of the scaphoid bone were followed up (two were lost to follow-up), and 10 of the 11 showed signs of healing. Five of the nine lesions of the distal radius were followed up, and three of these showed evidence of healing fracture. Three patients without MR evidence of a fracture had follow-up radiographs that showed no fracture. Three patients had findings consistent with bone contusion on MR images; in two patients, the contusion was associated with other fractures, and in one patient, the contusion was isolated. CONCLUSION: MR imaging can reveal occult wrist fractures when findings on radiographs are normal or equivocal.

MR imaging of rotator cuff tears in individuals with paraplegia.

OBJECTIVE: The purpose of this study was to use MR imaging to evaluate the prevalence and extent of rotator cuff tears in paraplegic patients, who are at increased risk for impingement caused by overuse. MATERIALS AND METHODS: Sixty-four MR examinations of the shoulder were evaluated for partial or full-thickness rotator cuff tears and for single or multiple rotator cuff tendon tears. Thirty-seven MR studies were from paraplegic subjects (26 symptomatic, 11 asymptomatic), and 27 MR studies were from able-bodied subjects (17 symptomatic, 10 asymptomatic). RESULTS: Among subjects who were symptomatic and paraplegic, 73% of shoulders imaged showed evidence of rotator cuff tear on MR images compared with 59% of shoulders in able-bodied symptomatic subjects. Of all subjects with paraplegia, 57% of shoulders imaged showed rotator cuff tears. Among all paraplegic subjects, prevalence and severity of tears correlated positively with age and duration of spinal cord injury. Tears that involved the posterior portion of the rotator cuff were revealed on MR images in 74% of the paraplegic subjects compared with 50% of the able-bodied subjects. CONCLUSION: MR imaging revealed a high percentage and degree of severity of rotator cuff tears in individuals with paraplegia and thus proved useful in evaluating shoulders in these patients.

Usefulness of turbo spin-echo MR imaging in the evaluation of meniscal tears: comparison with a conventional spin-echo sequence.

OBJECTIVE: Fast (turbo) spin-echo imaging techniques have replaced conventional spin-echo protocols in a large proportion of MR applications, with the principle advantage of decreased imaging time. The choice of echo train length is a key determinant of time savings realized, but the echo train length can also adversely affect image quality if too many echoes are incorporated into an image. Several recent studies have shown conflicting results regarding the usefulness of turbo spin-echo imaging in the evaluation of meniscal tears. We compare a turbo spin-echo sequence that has an echo train length of five with a conventional spin-echo sequence for evaluating meniscal tears. SUBJECTS AND METHODS: Forty knees in 39 consecutive patients referred for MR study of the knee were imaged using both conventional spin-echo and turbo spin-echo sequences. The turbo spin-echo sequence provided both proton density-weighted and T2-weighted images (dual echo technique) with an effective echo-train length of five. Nineteen knees (38 menisci) were studied arthroscopically. The arthroscopic findings were considered the reference standard. Spin-echo and turbo spin-echo images were reviewed retrospectively, and results were compared statistically. RESULTS: Of the 80 menisci evaluated with MR imaging, spin-echo and turbo spin-echo images provided concordant results in 95% of cases, with no statistically significant difference found between the two techniques (p < .05). Seventeen tears were found at arthroscopy in 38 menisci studied. Spin-echo and turbo spin-echo imaging had identical specificities (90%) and similar sensitivities (88% and 82%, respectively). CONCLUSION: This study shows that proton density-weighted sequences with an echo train length of five preserve sufficient high-spatial-frequency information to provide performance similar to that of conventional spin-echo sequences. Our data support the conclusion that fast spin-echo imaging with short echo train length is a reasonable substitute for conventional spin-echo imaging in the evaluation of the knee.

MRI in acute knee dislocation. A prospective study of clinical, MRI, and surgical findings.

We treated 17 knees in 15 patients with severe ligament derangement and dislocation by open repair and reconstruction. We assessed the competence of all structures thought to be important for stability by clinical examination, MRI interpretation, and surgery. Our findings showed that in these polytrauma patients clinical examination was not an accurate predictor of the extent or site of soft-tissue injury (53% to 82% correct) due mainly to the limitations of associated injuries. MRI was more accurate (85% to 100% correct) except for a negative result for the lateral collateral ligament and posterolateral capsule. The detail and reliability of MRI are invaluable in the preoperative planning of the surgical repair and reconstruction of dislocated knees.

Magnetic resonance imaging of dialysis-related amyloidosis of the shoulder and hip.

OBJECTIVE: The purpose of this study was to evaluate the usefulness of MRI in identifying abnormalities of the periarticular structures in patients with symptoms of dialysis-related amyloid arthropathy. DESIGN AND PATIENTS: MR images of shoulders and hips in 5 dialysis patients with symptoms of amyloid arthropathy were compared to images of shoulders and hips in 4 asymptomatic dialysis patients, shoulders in 9 nondialysis patients, and hips in 12 nondialysis patients. These were evaluated for the presence of focal periarticular osseous lesions, tendinous and capsular thickening, and periarticular fluid. RESULTS: Increased thickness of the supraspinatus tendon was found in both symptomatic and asymptomatic patients. Capsular thickening at the hip was present in all symptomatic patients, and in 3 of 8 asymptomatic hips. Joint and bursal fluid was common in the symptomatic group, and was present in some asymptomatic individuals. Osseous lesions were detected in the absence of plain film findings, and demonstrated variable signal intensity. CONCLUSIONS: MRI is useful in detecting signs of dialysis-related amyloidosis. Findings of a milder degree in asymptomatic dialysis patients suggests that MRI may also be valuable in the early diagnosis of this syndrome.

MR imaging of ulnar impaction.

The ulnar impaction syndrome of the wrist is a well-recognized clinical entity, usually showing distinct radiographic features including a positive ulnar variance and degenerative subchondral changes of the distal ulna, proximal lunate, and proximal triquetrum. Confirmation of the clinical and plain film findings with advanced imaging is often necessary to exclude other entities with a similar clinical presentation. Although arthrography and bone scintigraphy are helpful in this work-up, magnetic resonance imaging (MRI) appears to be both a sensitive and a specific means of evaluation. The imaging studies in four patients with clinically and surgically diagnosed ulnar impaction are described, with emphasis on MRI findings. MRI appears to be the modality of choice in the evaluation of patients with suspected ulnolunate impingement.

SLAP lesions of the glenoid labrum: CT arthrographic and arthroscopic correlation.

Tears in the superior part of the glenoid labrum in the anterior and posterior directions (SLAP, superior labrum anterior, posterior) result from injuries that place excessive stress on the tendon of the long head of the biceps brachii muscle. The intimate relationship of the tendon and the superior glenoid labrum promotes injury to the latter structure. Four types of SLAP lesions are seen at arthroscopy. Images from 17 patients with surgically proved SLAP lesions who had undergone preoperative computed tomographic (CT) arthrography were retrospectively reviewed to evaluate the value of CT arthrography in the detection and accurate depiction of these labral injuries. The authors compared the findings at videotaped arthroscopic surgery with those from CT arthrography and found that abnormalities of the labral-capsular apparatus could be detected with CT arthrography in 16 of the 17 patients. Furthermore, the CT arthrographic criteria developed during this review helped determine the type of tear in 15 of the 17 patients. CT arthrography appears to be useful in the evaluation of patients with suspected SLAP lesions.