Systematic Review Of Shoulder Imaging Abnormalities In Asymptomatic Adult Shoulders (Scrutiny): Abnormalities Of The Acromioclavicular Joint And Subacromial Space


Lasse Rämö, MD, PhD
FINLAND

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Systematic Review Of Shoulder Imaging Abnormalities In Asymptomatic Adult Shoulders (Scrutiny): Abnormalities Of The Acromioclavicular Joint And Subacromial Space

Thomas Ibounig, MD, FINLAND Lasse Rämö, MD, PhD, FINLAND Romi Haas, MD, PhD,, AUSTRALIA Teppo Jarvinen, MD, PhD, FINLAND Sean Docking, Md, PhD,, AUSTRALIA Sharon Sanders, MD, PhD, AUSTRALIA Rachelle Buchbinder, MD, PhD, Prof., AUSTRALIA

Helsinki University Hospital, Helsinki, FINLAND

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Anatomic Location

Shoulder Acromio Clavicular

Diagnosis / Condition

Osteoarthritis Impingement

Patient Populations

Gender Specific Elderly Professional Athletes / Olympians Sport Specific Population

Anatomic Structure

Cartilage Synovial

Diagnosis Method

X-ray MRI Ultrasound

Sports Medicine

Practice Management Epidemiology Sport Specific Injuries Research

Joints

Synovitis

Summary: Imaging abnormalities of the acromioclavicular joint and subacromial space are common in asymptomatic shoulders. In athlete populations, these abnormalities appear to be more prevalent and/or appear at a younger age compared to non-athlete populations of the same age.

Objective

To determine the prevalence of acromioclavicular joint and subacromial space imaging abnormalities in asymptomatic adults. Secondary objectives included comparing a) the prevalence between athletes and non-athletes, and b) the prevalence of imaging abnormalities in adults with and without symptoms from the same or comparable study populations.

Method

We conducted a systematic review of studies examining the prevalence of shoulder imaging abnormalities detected by X-ray, ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) in asymptomatic adults (PROSPERO registration number CRD42018090041). This report focuses on imaging abnormalities of the acromioclavicular joint and the subacromial space. We searched Ovid MEDLINE, Embase, CINAHL and Web of Science from inception to June 2023. Our primary analysis was conducted on data from population-based studies, and we assessed the risk of bias and certainty of evidence using tools tailored for prognostic studies.

Results

Thirty-one studies (4 X-ray, 11 US, 15 MRI, 1 X-ray and MRI) reported useable prevalence data. One study was population-based (20 shoulders), 16 included miscellaneous study populations (2436 shoulders) and 14 included athletes (708 shoulders). The certainty of evidence was very low mainly due to high risk of bias, imprecision, and indirectness of the included studies. Clinical diversity precluded pooling. The population prevalence of acromioclavicular joint abnormalities ranged from 85% based on MRI findings to 95% based on X-ray findings. Prevalence of subacromial bursa abnormalities was reported as 90% (MRI), subacromial space abnormalities as 20% (X-ray), and subacromial calcification as 5% (X-ray).

Conclusion

The population-based prevalence of acromioclavicular joint and subacromial space abnormalities in asymptomatic shoulders is very uncertain, but structural changes were frequently observed in asymptomatic shoulders in both athletes and other study populations. In athlete populations, these abnormalities appear to be more prevalent and/or appear at a younger age compared to non-athlete populations of the same age. The prevalence of AC joint and SA space abnormalities was nearly as high in asymptomatic shoulders as in symptomatic shoulders

Shoulder AC Joint ePosters