Accuracy and reliability of MRI-reports to determine which shoulder is symptomatic for workers compensation patients with unilateral symptoms

Emily Boersma; Tom Crijns; Maria Nijhuis-van der Sanden; Michael Edwards; David Ring; Stein Janssen

doi:10.1016/j.jor.2020.03.044

Accuracy and reliability of MRI-reports to determine which shoulder is symptomatic for workers compensation patients with unilateral symptoms

J Orthop. 2020 Mar 27:21:199-202. doi: 10.1016/j.jor.2020.03.044. eCollection 2020 Sep-Oct.

Authors

Emily Boersma¹, Tom Crijns², Maria Nijhuis-van der Sanden³, Michael Edwards¹, David Ring², Stein Janssen⁴

Affiliations

¹ Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Surgery, Nijmegen, the Netherlands.
² Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, 1701 Trinity Street, Austin, TX, 78705, USA.
³ Radboud University Medical Center, Radboud Institute for Health Sciences, Department of IQ Healthcare, Nijmegen, the Netherlands.
⁴ Academic Medical Center, Department of Orthopaedic Surgery, University of Amsterdam, Amsterdam, the Netherlands.

Abstract

Introduction: Shoulder abnormalities on imaging are increasingly common with advancing age.We tested the difference in the accuracy of diagnosing the injured shoulder between surgeons who reviewed MRI reports and who did and did not receive information about the patients.

Methods: Thirty people aged 40 or older that experienced new shoulder symptoms after an event at work had MRI of both shoulders. Members of the Science of Variation Group (SOVG) were invited to review the radiologist's reports and diagnose the symptomatic side. Ninety-seven surgeons participated.

Results: Surgeon observers provided with patient information were not more accurate in diagnosing the symptomatic shoulder (Odds Ratio: 0.90; 95% CI: 0.75 to 1.1; P = 0.29). There was slight agreement between surgeons (kappa = 0.10). The sensitivity and specificity for diagnosing the symptomatic side were 51% (CI: 48%-54%) and 67% (CI: 64%-70%) respectively. A binomial test showed that surgeons indicated the injured shoulder slightly more frequently than expected by random chance (59%; P < 0.001).

Conclusions: Surgeons were only slightly better at indicating the symptomatic side than random chance. Shoulder pain in people aged 40 or older should probably be considered age-related unless there is good objective evidence of acute traumatic pathology.

Level of evidence: Level II, diagnostic study.

Keywords: MRI reports; Reliability study; Shoulder injury; Worker compensation claims.