[Imaging of the shoulder].

Area of Science:

• Radiology
• Orthopedics
• Medical Imaging

Background:

• Accurate shoulder imaging is crucial for diagnosis and treatment planning.
• The selection of imaging modality is guided by clinical presentation, including stability, trauma history, and specific joint tenderness.

Purpose of the Study:

• To outline an evidence-based approach for selecting appropriate shoulder imaging modalities.
• To differentiate imaging strategies for stable versus unstable shoulders and specific joint pathologies.

Main Methods:

• Initial assessment relies on clinical history and patient examination.
• Plain X-rays are the first-line imaging modality for most shoulder conditions.
• Ultrasound is considered for painful, stable shoulders, while MRI is reserved for cases with insufficient ultrasound findings.
• CT-scan or MRI without contrast are used when surgical intervention is considered to assess muscle degeneration.
• For shoulder instabilities, intra-articular contrast-enhanced CT or MRI are recommended to visualize labral lesions and bicipital insertions.
• Specialized views and dynamic maneuvers with X-rays or ultrasound are used for AC joint evaluation.

Main Results:

• Plain X-rays are the initial diagnostic step, with views tailored to clinical findings.
• Ultrasound serves as a secondary imaging tool for stable shoulders, with MRI indicated for inconclusive ultrasound results.
• Advanced imaging like contrast-enhanced CT or MRI is essential for diagnosing shoulder instabilities, labral tears, and bicipital issues.
• Ultrasound is not suitable for evaluating shoulder instabilities.
• Assessment of the acromioclavicular (AC) joint requires dedicated imaging protocols.

Conclusions:

• A systematic approach integrating clinical assessment with appropriate imaging modalities optimizes shoulder diagnosis.
• The choice between X-ray, ultrasound, CT, and MRI is dictated by shoulder stability and suspected pathology.
• Advanced imaging techniques are indispensable for complex shoulder instabilities and surgical planning.