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Glenohumeral instability and shoulder impingement lesions remain a very complex and sometimes challenging diagnostic problem, the clinical history and physical findings are not always sufficient to make accurate diagnosis.
In the past, several imaging modalities were used to examine the shoulder ranging from conventional radiography, US to conventional MR images and computerized axial arthrography.
All these modalities have a limited role when they come to diagnose labral capsular ligamentous complex lesions at which the arthroscopy is the gold standard procedure.
Duo to the invasive nature and coastlines of arthroscopy, there was a need for a less invasive, coast effective and more accurate investigation modality
To improve the evaluation of smaller intra-articular structures such as the glenoid labrum and glenohumeral ligaments, MR arthrography is increasingly recognized as the examination of choice in glenohumeral instability providing demarcation of complex anatomic structures of the joint and demonstration of subtle abnormalities, with excellent delineation of associated intra-articular lesions.
MR arthrography extends the capabilities of conventional MR imaging because contrast solution distends the joint capsule, outlines intra-articular structures, and leaks into abnormal areas.
The aim of this work was to investigate the value of MR arthrography in cases of glenohumeral instability and shoulder impingement.
This study included 33 patients, clinically presented with symptoms of shoulder instability or impingement. MR arthrography, conventional MRI and arthroscopy were done for all patients. The results were collected, tabulated and compared with each other and with the arthroscopy results.
In our study, MR arthrography showed SLAP lesions and labral tears with greater sensitivity than conventional MRI in addition to what it afforded in imaging capsule-ligamentous, cartilaginous injuries as well as small injuries
In the present study, the sensitivity of conventional MRI was the same as MR arthrography in detection of osseous hill sachs lesions, AC osteoarthritis and supraspinatus tendenopathy, more than MR arthrography in detection of paralabral cysts, while in detection of the subtle lesions or ligamentous pathology the MR arthrography had the upper hand being incomparable to the conventional MRI study.
In conclusion, our study recommend that MR arthrography could replace arthroscopy in diagnosis of cases of shoulder instability showing capsular cartilaginous and labro-ligamnetous injuries with the same accuracy, sensitivity and specificity compared to arthroscopy, But in cases of paralabral cysts and shoulder impingement arthroscopy still has the upper hand.