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ACR Appropriateness Criteria® on acute shoulder pain
James N Wise1, Richard H Daffner, Barbara N Weissman
1University of Kentucky, Lexington, Kentucky, USA. jnwise@hotmail.com
Journal of the American College of Radiology : JACR
|September 6, 2011
Summary
Acute shoulder pain evaluation relies on imaging. Radiography is foundational, while MRI excels for occult fractures and soft tissues, and ultrasound is ideal for rotator cuff assessment.
Area of Science:
- Orthopedics
- Radiology
- Sports Medicine
Background:
- The shoulder joint offers extensive mobility but is susceptible to acute pain from various structures.
- Acute shoulder pain (<2 weeks) can involve the glenohumeral joint, rotator cuff, acromioclavicular joint, and scapula.
Purpose of the Study:
- To outline evidence-based imaging guidelines for acute shoulder pain.
- To detail the appropriate use of various imaging modalities for shoulder pathology assessment.
Main Methods:
- Review of current medical literature from peer-reviewed journals.
- Application of a modified Delphi consensus methodology by a multidisciplinary expert panel.
- Development of the ACR Appropriateness Criteria® for shoulder conditions.
Main Results:
- Radiography is the initial imaging modality for acute shoulder pain.
- Magnetic resonance imaging (MRI) is preferred for occult fractures and soft tissue evaluation.
- Ultrasound is effective for rotator cuff and biceps tendon assessment; fluoroscopy guides interventions; CT aids complex fractures.
Conclusions:
- A multimodal imaging approach is often necessary for accurate shoulder pathology assessment.
- The ACR Appropriateness Criteria® provide evidence-based guidance for imaging and treatment selection.
- Expert opinion supplements evidence when definitive data is lacking.
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