The importance of surgeon judgment in obtaining early magnetic resonance imaging to prevent delays in care for acute subacromial injury: a retrospective comparative cohort study

Abstract

Background: The purpose of this study was to evaluate the role of initial assessment of acute subacromial injury by an orthopaedic surgeon to identify surgical lesions that would benefit from early imaging. Methods: Patients with subacromial injury were identified. Patients who had MRI ordered at the initial visit for suspicion of a surgical lesion comprised the study group. The remaining patients were treated conservatively. Results: A total of 367 patients were identified; 298 (81%) underwent conservative treatment, 84 of whom had later MRI, and 69 (19%) had an MRI ordered initially. In the early MRI group, 31 (44.9%) underwent surgery an average of 85 days from presentation compared to 38 (12.8%) in the conservative group who underwent surgery 140 days from presentation (P=0.019). MRI scan review revealed that 41/69 (59.4%) patients in the early MRI group had full-thickness rotator cuff tear compared with 33/84 (39.3%) in the conservative group with MRI (P=0.020). Partial-thickness tears were noted in 8/69 (11.6%) in the early MRI group. In the conservative group that subsequently had MRI, 17/84 (20.2%) had a partial-thickness tear. Conclusions: Nearly 60% of patients undergoing initial MRI based on orthopaedic surgeon judgment had a full-thickness rotator cuff tear, significantly more than patients treated conservatively upon initial evaluation. Patients who first undergo conservative treatment for suspected acute subacromial injury experience a significant delay both in MRI and surgical intervention. Surgeon judgment is an important factor in the decision to obtain MRI in acute subacromial injury to prevent delays in care. Level of Evidence: Level III.