Shoulder MRI features with clinical correlations in subacromial pain syndrome: a cross-sectional and prognostic study

Elisabeth Kvalvaag, Masoud Anvar, Anna Cecilia Karlberg, Jens Ivar Brox, Kaia Beck Engebretsen, Helene Lundgaard Soberg, Niels Gunnar Juel, Erik Bautz-Holter, Leiv Sandvik, Cecilie Roe, Elisabeth Kvalvaag, Masoud Anvar, Anna Cecilia Karlberg, Jens Ivar Brox, Kaia Beck Engebretsen, Helene Lundgaard Soberg, Niels Gunnar Juel, Erik Bautz-Holter, Leiv Sandvik, Cecilie Roe

Abstract

Background: Previous studies on shoulder patients have suggested that the prevalence of rotator cuff or bursa abnormalities are weakly related to symptoms and that similar findings are often found in asymptomatic persons. In addition, it is largely unknown whether structural changes identified by magnetic resonance imaging (MRI) affect outcome after treatment for shoulder pain. The purpose of this study was therefore to evaluate the presence of structural changes on MRI in patients with subacromial pain syndrome and to determine to what extent these changes are associated with symptoms and predict outcome after treatment (evaluated by the Shoulder Pain and Disability Index (SPADI)).

Methods: A prospective, observational assessment of a subset of shoulder patients who were included in a randomized study was performed. All participants had an MRI of the shoulder. An MRI total score for findings at the AC joint, subacromial bursa and rotator cuff was calculated. Multiple linear regression analysis was applied to examine the relationship between the MRI total score and the outcome measure at baseline and to examine to what extent the MRI total score was associated with the change in the SPADI score from baseline to the one year follow-up.

Results: There was a weak, inverse association between the SPADI score at baseline and the MRI total score (β = -3.1, with 95% CI -5.9 to -0.34; p = 0.03), i.e. the SPADI score was higher for patients with a lower MRI total score. There was an association between the change in the SPADI score from baseline to the one year follow-up and the MRI total score (β = 8.1, 95% CI -12.3 to -3.8; p < 0.001), with a poorer outcome for patients with a higher MRI total score. Both tendinosis (p = 0.01) and bursitis (p = 0.04) were associated with a poorer outcome after one year.

Conclusions: In this study, MRI findings were significantly associated with the change in the SPADI score from baseline and to one year follow-up, with a poorer outcome after treatment for the patients with higher MRI total score, tendinosis and bursitis on MRI.

Trial registration: Clinicaltrials.gov no NCT01441830 . September 28, 2011.

Keywords: MRI; Patient outcome; Prognosis; Shoulder pain; Subacromial pain syndrome.

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the regional committee for medical and health research ethics (No 2011/755). All participants provided written informed consent.

Consent for publication

Not applicable.

Competing interests

EK received non-personal research grants from Sophies Minde Ortopedi; MA, ACK, JIB, KBE, HLS, NGJ, EB-H, LS and CR declare no competing interests. None of the authors have financial relationships with any organisations that might have an interest in the submitted work.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Oblique coronal PDFS-weighted (a, c, e, g), oblique coronal T2-weighted (b, d, h), and axial PDFS-weighted (f) MRI images in five different patients (a-b, c-d, e-f, g, h) illustrating typical MRI findings assessed in this study. a and b demonstrate tendinosis with thickening and increased intermediate signal within the supraspinatus tendon (black and white arrows). c and d demonstrate partial tears with signal abnormality in the undersurface extending to the intrasubstance in the supraspinatus tendon (black and white arrows). e and f demonstrate calcific tendinosis of the supraspinatus tendon with low density areas (white and black arrows) and edema in tendon and the subjacent bone. In addition there is slightly fluid in the subacromial/subdeltoid bursa. g demonstrates subacromial/subdeltoid bursitis with increased fluid and slightly thickening of the wall (white arrow). h demonstrates AC joint osteoarthritis with prominent undersurface osteophyte formation causing narrowing of the supraspinatus outlet (white arrows)
Fig. 2
Fig. 2
Change in SPADI score from baseline to one year follow up for the patients with zero to four points on the MRI total score, from multiple linear regression analysis

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