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ACR Appropriateness Criteria® Shoulder Pain-Atraumatic.

, Kirstin M Small1, Ronald S Adler2

  • 1Brigham & Women's Hospital, Boston, Massachusetts.

Journal of the American College of Radiology : JACR
|November 6, 2018
PubMed
Summary

This review details imaging techniques for diagnosing atraumatic shoulder pain, offering evidence-based guidelines for conditions like rotator cuff disorders and labral tears. It guides appropriate imaging selection for effective shoulder pain management.

Keywords:
AUCAppropriate Use CriteriaAppropriateness CriteriaCTMRIShoulderShoulder jointShoulder painpain

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Area of Science:

  • Musculoskeletal Radiology
  • Diagnostic Imaging
  • Orthopedic Surgery

Background:

  • Shoulder pain is a prevalent cause of musculoskeletal physician visits.
  • Accurate diagnosis of atraumatic shoulder pain relies heavily on appropriate imaging modalities.
  • Identifying the specific etiology is crucial for effective treatment planning.

Purpose of the Study:

  • To review various imaging modalities for atraumatic shoulder pain evaluation.
  • To present evidence-based imaging algorithms for common shoulder conditions.
  • To align with the American College of Radiology Appropriateness Criteria.

Main Methods:

  • Comprehensive review of imaging modalities including radiographs, arthrography, nuclear medicine, ultrasound, CT, and MRI.
  • Focus on specific shoulder pathologies: rotator cuff disorders, labral tears, bursitis, adhesive capsulitis, biceps abnormalities, postoperative tears, and neurogenic pain.
  • Application of established methodologies (RAND/UCLA, GRADE) and expert opinion to develop imaging guidelines.

Main Results:

  • Discussion of the utility of each imaging modality in evaluating atraumatic shoulder pain.
  • Detailed algorithms for selecting the most appropriate imaging for specific shoulder conditions.
  • Incorporation of the American College of Radiology Appropriateness Criteria for clinical decision-making.

Conclusions:

  • Appropriate imaging selection is vital for diagnosing atraumatic shoulder pain.
  • Evidence-based guidelines enhance diagnostic accuracy and treatment planning.
  • The review provides a framework for optimal imaging utilization in shoulder pathology.