MRI Arthogram

[Mortal_Lessons]

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Is anterior shoulder instability a reason to order one of these if an X-ray shows the shoulder bones intact?

 

[SOUNDMAN]

yes. x-rays show bones, MRI soft tissue very well.

Although the diagnosis of instability is made many times on history and physical exam alone, MRI/arthrogram can show a labral tear or other pathology that could be lending the shoulder to instability. However if you just have a sloppy capsule that is causing the instability, many times the MRI/arthrogram may appear normal, or have a large amount of redundancy of the inferior capsule seen sometimes on the MRI/arthrogram.

 

[Mortal_Lessons]

If MRI/arthogram shows tear or some sort of pathology associated with soft tissue damage, how likely is surgery?

 

[Tired]

If MRI/arthogram shows tear or some sort of pathology associated with soft tissue damage, how likely is surgery?

Which "soft tissue"?

 

[Mortal_Lessons]

Which "soft tissue"?

Labral tear causing occasional "feeling" of instability, though upon examination, there is no shoulder instability. Does this person need surgery?

 

[Tired]

Labral tear causing occasional "feeling" of instability, though upon examination, there is no shoulder instability. Does this person need surgery?

Unfortunately I don't think it's quite that simple. Depends on the type and degree of the tear seen, the symptoms the patient describes, the degree of interference with his/her life, willingness to have surgery, and specific physical exam findings to ensure that the MRI results correlate with the clinical findings. So hard to answer a question like that over the internet, even for the experienced attendings. That's why medical advice isn't given here (of course, I'm assuming you're asking a hypothetical question).

 

[SOUNDMAN]

What Tired Said....ditto

 

[OrthoMDPHD]

Looking for a SLAP tear.

 

[Mortal_Lessons]

Yes, this is hypothetical. MRI/arthogram indicates labral tear spanning posterior labrum from superior to inferior, so I'm pretty sure it's not a SLAP but something similar.