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Many patients with no shoulder pain have MRI findings that show tear


Rates of shoulder surgery are increasing, and it may be partially due to MRI results


The labrum is a piece of cartilage shaped like a cup that's attached to the rim of the shoulder socket. Its function is to secure the shoulder socket and keep the ball of the joint in place during movement, but this cartilage can tear either from an injury or due to the aging process. The result is called a labral tear, which may or may not cause symptoms depending on how severe it is. Labral tears are difficult to diagnose, and the methods used for evaluation like physical exams and MRIs are not very consistent at identifying the injury. Statistics also show that the rate of surgery for labral tears has been increasing over the past decade-especially in middle-aged patients-and that some of them are not experiencing positive outcomes. While it's not completely clear why this has been occurring, one possible explanation is that more patients are being diagnosed with labral tears on their MRI and then being told to consider surgery. To investigate this matter and develop a better understanding of the connection between MRI results and shoulder symptoms, a study was conducted.



Patients with no shoulder pain undergo MRIs


Middle-aged individuals between ages 45-60 without any shoulder pain were recruited and invited to participate in the study, which led to 53 of them being accepted. All participants underwent a physical examination and were asked a series of questions regarding the use of their shoulder in work or sports. Then, each participant had an MRI of their shoulder and two radiologists evaluated the results. A radiologist is a medical professional trained to interpret the findings of imaging tests like MRIs and X-rays, and in this case, they were not given any information about the study subjects to increase the reliability of their evaluations.



Both radiologists find labral tears in at least half of patients


On the whole, results showed that labral tears were fairly common. The first radiologist interpreted 38 (72%) of the MRIs as containing a labral tear, while the second radiologist found labral tears in 29 patients (55%). Further analysis revealed that the two radiologists had a moderate level of reliability between them, and that there was only one area in which their reliability was poor.



Avoid having an MRI and see a physical therapist instead


These findings show that even in middle-aged patients that have no signs of shoulder pain, labral tears are commonly found on MRIs. The unfortunate result of this fact is that a patient with shoulder pain can be told they have a labral tear and then go on to have surgery to repair it, even though their pain may not be related to the tear. One way to avoid this predicament is to see a physical therapist first for any type of shoulder pain. Physical therapists will usually treat the pain immediately with a comprehensive treatment program and will only prescribe tests like MRIs if they find it to be completely necessary. Following this course will help you work towards getting better right away regardless of what's causing your shoulder pain and by keeping you out of the operating room for a labral tear that may not be related to your pain.



-As reported in the January '16 issue of The Orthopaedic Journal of Sports Medicine
July 18, 2018