Arthrosonography of the Shoulder Joint for Evaluation of the Glenoid Labrum, Glenoid Rim and Humeral Head: Comparison with Conventional Ultrasonography and MR Arthrography

Abstract

Purpose: To compare the diagnostic role of arthrosonography, conventional ultrasonography and MR arthrography in the assessment of glenoid labral tear, glenoid rim fracture and humeral head fracture of the shoulder joint. Materials and Methods: The findings of arthrosonography, conventional ultrasonography and MR arthrography were prospectively evaluated in 62 consecutive patients with chronic pain or a history of recurrent dislocation of the shoulder joint. The glenoid labrum was arbitrarily divided into four quadrants: anterosuperior, anteroinferior, posterosuperior, and posteroinferior, and for each, visibility at arthrosonography and conventional ultrasonography was subjectively scored as one of four grades. By means of statistical analysis, the two techniques were then compared. Twenty-six patients subsequently underwent arthroscopy, and the presence or absence of labral tear, glenoid rim fracture and humeral head fracture was determined. The sensitivity and specificity of each modality were separately calculated for each of the three types of shoulder joint injury, and observed differences in these findings were statistically analysed. Results: For all individual quadrants of the labrum, visibility at arthrosonography was higher than at conventional ultrasonography (p.05), though its specificity was significantly higher (p=.003). In this respect, there was no significant difference in sensitivity or specificity between arthrosonography and MR arthrography (p>.05). For the detection of glenoid rim and humeral head fracture, there were no statistical differences in sensitivity and specificity between the three imaging modalities (p> .05). Conclusion: Compared with conventional ultrasonography, arthrosonography provides higher visibility of the labrum, thus improving the capacity of ultrasonography to detect labral tear. Arthrosonography could therefore be useful in the diagnosis of labral tear, glenoid rim fracture and humeral head fracture, and may thus partially replace MR arthrography.