Comparative evaluation of the sensitivity and specificity of clinical and magnetic resonance methods of assessing damage to the fibrocartilage lip in pediatric patients with traumatic instability of the shoulder joint

Abstract

BACKGROUND: The shoulder joint provides the greatest degree of freedom in movement, making it one of the most unstable and frequently dislocated joints, accounting for almost 50% of large-joint dislocations. Recurrent instability of the shoulder joint develops in 96%100% of children and adolescents, making it important to accurately diagnose possible anatomical causes of persistent pain syndrome violating the habitual function of the shoulder. At the same time, the symptoms of intra-articular injuries of the shoulder joint are often vague, and a definitive diagnosis cannot be made without the use of instrumental research methods.
 AIM: To compare the diagnostic value of clinical examination and magnetic resonance imaging in detecting intra-articular pathology in adolescents with anterior instability of the shoulder joint of traumatic origin.
 MATERIALS AND METHODS: This retrospective study included parameters of clinical examination and instrumental methods of investigation of 72 children (72 shoulder joints) with habitual shoulder dislocation of traumatic origin. The age of the examined persons ranged from 13 to 17 years.
 Magnetic resonance, clinical, arthroscopic, and statistical methods of research were employed in this work. The arthroscopic method was considered as a reference research method for assessing the sensitivity and specificity of clinical examination and magnetic resonance imaging. Sensitivity and specificity were evaluated, followed by an assessment of the prognoses of positive and negative results for MRI data and clinical research methods.
 RESULTS: The MRI data was characterized by a significantly greater sensitivity and specificity in detecting lesions (95.4% and 71.4%) than those of clinical examination (79.1% and 60%). Thus, MRI is better at detecting damage to the fibrous-cartilaginous lip in traumatic instability in adolescents than clinical examination.
 CONCLUSIONS: In our opinion, for the most reliable preoperative planning of surgical treatment of children, a full-fledged clinical examination should be used and data from instrumental research methods should be included, considering the advantages and disadvantages of each method.