What imaging detected pathologies are associated with shoulder symptoms and their persistence? A systematic literature review

Objective: Shoulder symptoms are common and imaging is being increasingly used to help with management. However, the relationship between imaging and symptoms remain unclear. This review aims to understand the relationship between imaging‐detected pathologies, symptoms and their persistence. Methods: A systematic review using Medline, EMBASE, Cochrane and grey literature was conducted to April 2017. The cross‐sectional and longitudinal relationships between imaging‐detected abnormalities and symptoms were analysed and associations qualitatively characterised by a best evidence synthesis based on study design, covariate adjustment and the Grade of Recommendations Assessment, Development and Evaluation (GRADE). Modalities included ultrasound, magnetic resonance imaging (MRI), radiographs, positron emission tomography (PET), bone scintigraphy and computerised tomography (CT). Results: 6569 abstracts were screened and 56 papers were included. 50 studies did not adjust for covariates and 36 analysed individual pathologies only. The majority of studies showed conflicting results. There was no significant association between most imaging features and symptoms amongst high quality, cross‐sectional studies. There was low‐quality evidence that enhancement of the joint capsule on MRI and increased uptake on PET was associated with symptoms in adhesive capsulitis. Based on high‐quality longitudinal studies, enlarging rotator cuff tears were associated with an increased incidence of symptoms. Conclusion: There were conflicting results on the association of imaging features with shoulder symptoms and its persistence. The existing evidence was very low in quality based on the GRADE. Further high quality studies are required to understand the relationship between imaging and shoulder symptoms and determine the appropriate role of imaging in care pathways