Background/Purpose:

Shoulder pain is a common problem in the general population and can cause significant difficulties with activities of daily living. Magnetic resonance imaging (MRI) is often used in the assessment of shoulder pain. This pilot study aimed to determine if the pathology demonstrated on shoulder MRI correlates with the pain reported by study participants.

Methods: Participants for this pilot study were obtained from the North West Adelaide Study (NWAHS), a longitudinal cohort study of 4056 randomly selected adults aged 18 years and over at the time of recruitment from the northern and western regions of Adelaide, Australia.  Thirty participants aged 55 to 74 years were recruited from the cohort and allocated to one of three groups, those with no shoulder pain in Stage 2 and 3 of the NWAHS, those with pain in Stage 2 but not Stage 3 and those with pain in Stage 2 and Stage 3.  Range of movement was assessed and the Shoulder Pain and Disability Index (SPADI) completed. An MRI and X-ray were undertaken of the affected or previously affected shoulder, or matched side (in those with no current or previous shoulder pain). The X-rays and MRIs were read independently by two radiologists blinded to the participant group and each other. All participants provided written informed consent.

Results:

Overall, 30 participants took part in the study.  The mean range of flexion, abduction and external rotation were all lower for the pain group compared to the other two groups.  The mean SPADI percentage score for the pain group was 41.80 (SD 20.10, range 18-74) and the mean percentage function score was 31.88 (SD 20.41, range 8.75-60).  On X-ray there were few differences between each group.  The MRI findings are presented in Table 1.  Subacromial bursitis was common (90%) in each group, 90% of participants also demonstrated a degree of acromioclavicular degeneration.  There was a slightly higher number of supraspinatus tendinosis/tears and involvement of the LHB in the current pain group.

Table 1: MRI findings

	No shoulder pain		Previous shoulder pain		Current shoulder pain
	n	%	n	%	n	%
Supraspinatus
Normal/Equivocal	3	30.0	3	30.0	–	–
Tendinosis	1	10.0	2	20.0	2	20.0
Partial thickness tear with/without tendinosis	4	40.0	3	30.0	6	60.0
Full thickness tear with/without tendinosis	2	20.0	2	20.0	2	20.0
Infraspinatus
Normal/Equivocal	7	70.0	4	40.0	7	70.0
Tendinosis	3	30.0	5	50.0	1	10.0
Partial thickness tear with/without tendinosis	–	–	1	10.0	2	20.0

 

Subscapularis
Normal/Equivocal	4	40.0	3	30.0	5	50.0
Tendinosis	2	20.0	5	50.0	1	10.0
Partial thickness tear with/without tendinosis	4	40.0	2	20.0	4	40.0
Teres Minor
Normal/Equivocal	10	100.0	10	100.0	10	100.0
Long head of biceps
Normal/Equivocal	8	80.0	6	60.0	2	20.0
Tendinosis	1	10.0	3	30.0	3	30.0
Partial thickness tear with/without tendinosis	1	10.0	1	10.0	4	40.0
Full thickness tear	–	–	–	–	1	10.0
GHJ cartilage degeneration
Normal/Equivocal	2	20.0	3	30.0	4	40.0
Mild	8	80.0	7	70.0	5	50.0
Moderate	–	–	–	–	1	10.0

 

Conclusion: Shoulder pathology is present on imaging in people with shoulder pain, those who have a history of shoulder pain, and those who have never had shoulder pain. Clinical symptoms do not necessarily match the radiological findings.  The value of MRI as a clinically useful diagnostic investigation for shoulder pain is questionable.

---

« Back to 2013 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/an-examination-of-shoulder-pain-using-magnetic-resonance-imaging-in-older-people/