Surgical decision making in relation to shoulder surgery is classically comprised of a combination of clinical examination and radiologic imaging. Particularly, the use of MR-imaging has increased significantly in the last decade. MR-images are routinely used separately by orthopaedic surgeons and radiologists the latter generating an MRI report. The aim of this study is to identify the relative value of the MRI report in current shoulder surgeon practices routine and surgical decision making of shoulder disorders.
The study surveyed in August and September 2020 100 shoulder-specialised orthopaedic surgeons of the Canadian Shoulder and Elbow Society (CSES) Orthopaedic Association using an anonymous online survey to help identify the use of MR-imaging and reports in the management of shoulder disorders and the surgical decision process.
Thirty out of 100 (30%) CSES fellowship-trained orthopaedic surgeons participated in the online survey. Orthopaedic surgeons request MRI scans in about 55% of rotator cuff (RC) cases and in 48% of shoulder instability cases. Respondents report 50% of their patients with potential RC pathology arrive with a completed MRI scan at their office. Other disorders (e.g. glenohumeral osteoarthritis, acromioclavicular pathology) arriving with MR-images range from a quarter to a third of the consults. Responses demonstrate that surgical decision making is finalized based on patients’ history and physical examination (70-90%), MRI scans (2.6-18%), MRI reports (0-1.6) or other imaging (3-23%). Ninety percent of respondents would not decide on surgery unless the MR-images were personally reviewed. Respondents feel that MRI scans are overused in 54-90% of cases depending on pathology.
Surgical decision making is based on a combination of factors and varies according to pathology. The results demonstrate that orthopaedic surgeons are comfortable reviewing shoulder MRI scans without necessarily reading the MRI report prior to a surgical decision. MRI scans are becoming an increasingly important part of surgical management in shoulder pathologies but should not be used without assessment of patient history and or physical examination.