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Imaging the shoulder

Nuffield Orthopaedic Centre and Oxford Radcliffe Hospital, Oxford, UK

• Plain films are useful as an initial screening test for patients with shoulder pain.
  
• Ultrasound and MRI are most suitable techniques for diagnosing rotator cuff disease.
  
• Ultrasound is suitable for providing flexible access for instant access clinics.
  
• MR arthrography or CT arthrography is required for investigating instability.
  

Imaging plays a major role in the investigation of shoulder pain. Impingement syndrome is primarily a clinical diagnosis but imaging is useful in assessing the degree of damage to the rotator cuff. Ultrasound is a cheap and effective method of excluding full thickness tear. MRI is also accurate for rotator cuff tears but is not often requires if ultrasound expertise are available. Ultrasound is also the more sensitive technique for detecting calcific tendinitis. MRI is, however, the technique of choice for most other complex shoulder problems and for patients with normal plain films and non-specific pain. Monoarthropathies, tumours and osteonecrosis will all be detected by MRI. MR arthrography is usually reserved for the assessment of shoulder instability.