Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Mar-Apr;51(2):81-86.
doi: 10.1590/0100-3984.2016.0226.

Magnetic resonance arthrography of the shoulder: a painful procedure?

Paulo César Xavier do Nascimento  1 , André Maltez Amaral  2 , João Ricardo Maltez de Almeida  3
Affiliations

Magnetic resonance arthrography of the shoulder: a painful procedure?

Paulo César Xavier do Nascimento et al. Radiol Bras. 2018 Mar-Apr.

Abstract
in English, Portuguese

Objective: To compare the pain expected to that effectively caused by magnetic resonance arthrography of the shoulder and, secondarily, to describe a simplified approach to the technique for articular access.

Materials and methods: We prospectively evaluated 40 participants who used a visual analog scale and a simplified categorical scale to indicate the level of pain expected and that experienced after the procedure, comparing the two with the Wilcoxon matched-pairs test. We also determined gender-related differences in pain conditions using the Mann-Whitney U test. In addition, we described a modified technique involving radiographic localization and the use of standard puncture needles for articular access.

Results: Analysis of the visual analog scales showed that the pain experienced was less than had been expected, with median scores of 1.75 and 3.75, respectively (p < 0.001). The level of pain expected was higher among women than among men, with median scores of 8.0 and 3.0, respectively (p = 0.014), as was the level of pain experienced, with median scores of 3.0 and 1.5, respectively (p = 0.139). The overall categorical evaluation corroborated that difference (p = 0.03). Articular access with the modified technique was successful in all patients.

Conclusion: Magnetic resonance arthrography of the shoulder is less painful than patients expect. In addition, digital radiographic guidance combined with the use of standard puncture needles appears to improve the efficiency of the method.

Objetivo: Comparar a expectativa de dor com a efetivamente produzida em procedimentos de artrorressonância do ombro e, secundariamente, descrever abordagem simplificada da técnica de acesso articular.

Materiais e métodos: Avaliamos, prospectivamente, 40 participantes, que assinalaram a sua expectativa álgica e a dor pós-procedimento em escalas visual analógica e categórica simplificada, que foram comparadas por meio de teste pareado de Wilcoxon. Também determinamos a diferença do quadro doloroso por gênero, com aplicação do teste U de Mann-Whitney. Descrevemos, ainda, técnica de localização radiográfica e emprego de agulhas simples de punção para acesso articular.

Resultados: A análise das escalas visuais analógicas demonstrou que a dor experimentada foi inferior à esperada (medianas de 1,75 e 3,75, respectivamente; p < 0,001). As mulheres tinham expectativa de dor superior aos homens (medianas de 8,0 e 3,0; p = 0,014), assim como maior dor experimentada (medianas de 3,0 e 1,5; p = 0,139), respectivamente. Avaliação categórica global corroborou tal tendência (p = 0,03). O acesso articular, empregando técnica adaptada, foi obtido com sucesso em todos os pacientes.

Conclusão: A artrorressonância do ombro é menos dolorosa do que se imagina. Adicionalmente, a orientação radiográfica digital aliada ao emprego de agulhas simples de punção aumentam a eficiência do método.

Keywords: Arthrography; Magnetic resonance imaging; Pain; Shoulder; Visual analog scale.

PubMed Disclaimer

Figures

Figure 1
Figure 1
The VAS, arranged horizontally, the leftmost point corresponding to the absence of pain and the rightmost point corresponding to the greatest pain ever felt.
Figure 2
Figure 2
Digital radiograph of the shoulder (A) showing the ideal place for joint puncture (circle), over the upper third of the humeral head, near the glenohumeral joint. Injection of the iodinated contrast medium (B), via a dual-lumen port, confirming access to the joint.
Figure 3
Figure 3
Graphic showing the pain expected and that experienced immediately after the procedure, by participant, based on the VAS markings.
Figure 4
Figure 4
Line graph showing a reduction in the pain index immediately after the procedure, with a slight upward trend at 4 h thereafter.
Figure 5
Figure 5
Box plot of the difference between the VAS scores for the pain expected (PreP VAS scores) and for the pain experienced immediately after the examination (ImmPostP VAS scores), by gender, showing no significant difference between the men and women in terms of the median score.
See this image and copyright information in PMC

References

    1. Turtelli CM. Avaliação do ombro doloroso pela radiologia convencional. Radiol Bras. 2001;34:241–245.
    1. Luime JJ, Koes BW, Hendriksen IJ, et al. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004;33:73–81. - PubMed
    1. Mitchell C, Adebajo A, Hay E, et al. Shoulder pain: diagnosis and management in primary care. BMJ. 2005;331:1124–1128. - PMC - PubMed
    1. Honda E, Aihara AY, Natour J, et al. Artro-ressonância do ombro na instabilidade anterior. Rev Bras Reumatol. 2006;46:214–218.
    1. de Jesus JO, Parker L, Frangos AJ, et al. Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: a meta-analysis. AJR Am J Roentgenol. 2009;192:1701–1707. - PubMed

LinkOut - more resources