Is clinical evaluation alone sufficient for the diagnosis of a Bankart lesion without the use of magnetic resonance imaging?

BACKGROUND: Imaging modalities such as magnetic resonance arthrogram (MRA) offer great utility in diagnosing Bankart lesions but they are associated with a high degree of intra and interobserver variability. This study aims to evaluate the diagnostic accuracy of clinical evaluation and imaging modalities in Bankart lesions such as magnetic resonance imaging (MRI) and MRA of the shoulder.

METHODS: Between February 2004 to January 2015, a retrospectively review of the surgical records at a tertiary hospital identified a total of 250 patients treated with a shoulder arthroscopy for Bankart repair. All patients were thoroughly investigated preoperatively in which a detailed history were obtained, relevant physical examinations were performed (Load and Shift/Anterior Apprehension test) and pre-operative radiographs taken. Some patients subsequently underwent either an MRI or an MRA scan if the initial clinical evaluation was equivocal.

RESULTS: Anterior Shoulder Apprehension test and the Load and Shift test identified 214 of 227 Bankart tears, with a sensitivity of 94% [95% confidence interval (CI), 90-97%]. MRI correctly identified 23 of 26 Bankart tears, with a sensitivity of 89% (95% CI, 70-98%). Out of the five superior labrum anterior-posterior (SLAP) tears identified on MRI, only three were confirmed during arthroscopic surgery. MRA correctly identified 84 of 89 Bankart tears, for a sensitivity of 94% (95% CI, 87-98%).

CONCLUSIONS: In our study, we report that clinical evaluation with focused history-taking and anterior apprehension, load and shift clinical examination can diagnose anterior shoulder instability as reliably as MR imaging. For patients with equivocal clinical findings, MR imaging can aid in the diagnosis.