Is the Apprehension Test Sufficient for the Diagnosis of Anterior Shoulder Instability in Young Patients without Magnetic Resonance Imaging (MRI)?

<p><b>INTRODUCTION</b>The purpose of this study is to compare the sensitivities and positive predictive values (PPV) of the anterior apprehension test and magnetic resonance imaging (MRI) in the diagnosis of anterior labral tears in young patients with shoulder instability and to determine if surgery could be carried out without this investigation in selected patients.</p><p><b>MATERIALS AND METHODS</b>We undertook a retrospective study of 168 patients aged between 15 and 30 years with a history of shoulder dislocation and compared the sensitivities and the PPV of the apprehension test with both MRI and magnetic resonance arthrograms (MRA) in the diagnosis of a Bankart lesion. The radiological investigations were interpreted by general practice radiologists and specialised musculoskeletal radiologists. All patients had their diagnosis confirmed by shoulder arthroscopy.</p><p><b>RESULTS</b>Our results showed that the apprehension test was highly reliable when it was positive with a PPV of 96%. It was more sensitive than MRI in the diagnosis of a Bankart lesion. The clinical test was significantly better when a musculoskeletal radiologist interpreted the MRI. The MRA interpreted by a musculoskeletal radiologist had the highest rates of sensitivity in detecting Bankart lesions. The figure was similar to that for the apprehension test. There was no difference in the PPVs among the clinical test, the MRI and the MRA read by the 2 categories of radiologists.</p><p><b>CONCLUSION</b>We conclude that a routine MRI may be unnecessary in evaluating a young patient with clinically evident anterior shoulder instability if the apprehension test is positive. A MRA that can be interpreted by a musculoskeletal radiologist will be the next best investigation if the clinical test is negative or equivocal.</p>

Clinics in diagnostic imaging (163). Transient lateral patellar dislocation with trochlear dysplasia

A 14-year-old girl presented with left knee pain and swelling after an injury. Magnetic resonance (MR) imaging showed a transient lateral patellar dislocation with patellar osteochondral fracture, medial patellofemoral ligament tear and underlying femoral trochlear dysplasia. Open reduction and internal fixation of the osteochondral fracture, plication of the medial patellar retinaculum and lateral release were performed. As lateral patellar dislocation is often clinically unsuspected, an understanding of its characteristic imaging features is important in making the diagnosis. Knowledge of the various predisposing factors for patellar instability may also influence the choice of surgical management. We also discuss signs of acute injury and chronic instability observed on MR imaging, and the imaging features of anatomical variants that predispose an individual to lateral patellar dislocation. Treatment options and postsurgical imaging appearances are also briefly described.

Double outlet right ventricle with infective endocarditis

Double outlet right ventricle (DORV) is an uncommon congenital heart disease with a poor prognosis. We report a rare case of a girl with untreated DORV who survived until adolescence, but then developed infective endocarditis with florid complications and succumbed to it. Although infective endocarditis is seldom encountered in children in developed countries, a high index of suspicion is required for those with congenital heart disease. The roles of cross-sectional imaging are demonstrated, including the usefulness of magnetic resonance imaging not only in evaluating congenital heart disease, but also in detecting incidental lesions in the extracardiac structures.