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Diagnostic Accuracy of Mri/Mra in Detecting Subscapularis Tears of Patients Scheduled For Rotator Cuff Surgery: A Mini- Systematic Review

Volume 2 - Issue 4

Kandel M*, Stibane A and Kandel E

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    • Department of Physiotherapy, Physiotherapy Institute, Switzerland

    *Corresponding author: Michel Kandel, Physiotherapy-Institute, Staatsstrasse 46, 9463 Oberriet, Switzerland

Received: February 13, 2018;   Published: February 20, 2018

DOI: 10.26717/BJSTR.2018.02.000779

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Abstract

Background: Subscapularis tears often occur in combination with various shoulder problems. Untreated, they can lead to persisted symptoms even after rotator cuff surgery. Clinical tests, magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) are being used to evaluate subscapularis integrity. Reviews regarding publications till 2012, however, show poor sensitivity in detecting subscapularis tears prior to surgery. Recent technological development might have led to improvement.

Method: A mini systematic review of the PubMed database of the last 5 years was made. Studies comparing MRI/MRA (index tests) to open- and arthroscopic surgical findings (reference test) and recording different types of subscapularis tears were included. Methodological appraisal was performed using QUADAS 2.

Results: In four retrospective studies, comprising 811 patients who underwent shoulder surgery, 264 subscapularis tears were identified by arthroscopy (prevalence 32.6%). The sensitivity for detecting full thickness tears varied from 93% to 100%. The sensitivity for detecting partial tears varied from 54% to 81%. There were high concerns regarding the index test bias and applicability in 3 of 4 studies. The lack of consensus in the classification of subscapularis tears led to a high level of heterogeneity in these studies and made it impossible to pool data.

Conclusion: Despite the technological improvements in the last five years, the sensitivity of detecting subscapularis tears in patients scheduled for rotator cuff surgery remains challenging. Only diagnoses of bigger subscapularis tears reach a good accuracy in MRI/MRA.

Abbreviations:MRI: Magnetic Resonance Imaging; MRA: Magnetic Resonance Arthrography; TP: True Positives; TN: True Negatives; FP: False Positives; FN: False Negatives

Abstract| Introduction| Methods| Results| Discussion| Limitations of this Review| Conclusion| References|