Does this seem weird to you?

[ghost dog]

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I had a paper review today with the following scenario:

Pt with 1 yr Hx of right shoulder pain following yanking down on a gate with shoulder in an abducted and externally rotated position. Mild / moderate decreased internal rotation. Dx'd with impingement syndrome, short term relief with series of SA injections via Physiatry.

Shoulder X-ray shows acromial osteophytes , ii) acromioclavicular joint osteoarthritis. Ortho decides to operate with an AC resection and bursectomy. A rotator cuff tear is found (and repaired ) at time of surgery.

What I found very strange here - why the heck wasn't an MRI of the shoulder performed prior to surgery, particularly when the pt wasn't responding to conservative Tx ?

Am I missing something here ? Is this a case of stupidity or somethin else ?

 

[lobelsteve]

Cost savings in Canada?

Or the RCT was made up and the surgeon is trying to hit his numbers by April.

 

[Ducttape]

maybe the surgeon was sure that a procedure would benefit the patient. he may have already had suspicions that there was a rotator cuff injury just based on physical exam.

the end result is the same, minus $1000 for the MRI - the patient got the surgery he needed.

 

[facetguy]

maybe the surgeon was sure that a procedure would benefit the patient. he may have already had suspicions that there was a rotator cuff injury just based on physical exam.

the end result is the same, minus $1000 for the MRI - the patient got the surgery he needed.

Orthos do physical exams??? 😉

 

[101N]

I had a paper review today with the following scenario:

Pt with 1 yr Hx of right shoulder pain following yanking down on a gate with shoulder in an abducted and externally rotated position. Mild / moderate decreased internal rotation. Dx'd with impingement syndrome, short term relief with series of SA injections via Physiatry.

Shoulder X-ray shows acromial osteophytes , ii) acromioclavicular joint osteoarthritis. Ortho decides to operate with an AC resection and bursectomy. A rotator cuff tear is found (and repaired ) at time of surgery.

What I found very strange here - why the heck wasn't an MRI of the shoulder performed prior to surgery, particularly when the pt wasn't responding to conservative Tx ?

Am I missing something here ? Is this a case of stupidity or somethin else ?

Not so unheard of in the non-occ med world. Example: straight shooter patient with clear impingement and a type III acromion. Ortho sees and knows that they've got to fix the acromion regardless and figures that they'll also fix any cuff/labral pathology that they find intra-op. Many if not most shoulder surgeons consider the scope, not the MRI, to be the gold standard at identifying pathology.

 

[PMR 4 MSK]

If you ever look at the surgical schedule when a shoulder is on, it's a "possible-ectomy" as in:
possible RCR
possible mumford
possible SAD
possible biceps tenodesis
etc.

They never really know what they are getting into until they poke a scope in there.

MRI is notoriously bad at differentialing tears. High rate of false positives and negatives. Labral tears are often missed when no contrast is used.