Postoperative imaging of the shoulder: Rotator cuff, instability, arthroplasty

The use of imaging after shoulder surgery should be considered carefully and should provide a real benefit for the patient. It is not a routine request. Currently, there is no consensus on imaging indications for patients showing good postoperative progress, without complications and with satisfactory functional outcomes. In cases of unfavorable progress, the indications are clearer. Conventional radiography remains essential, and when combined with ultrasound, forms the first-line approach. Second-line imaging techniques, such as CT scans or MRI, are selected based on the type of surgery performed, the patient's clinical context, and the diagnostic and/or therapeutic questions the surgeon is addressing. In France, CT scans, although easily accessible, involve "controlled" radiation exposure and can produce artifacts with metallic implants. MRI, which provides excellent visualization of soft tissues without radiation, can also present a risk of artifacts, although recent technological advances have mitigated this issue. CT arthrography is commonly used in France, whereas MRI arthrography is underutilized, despite being effective. Scintigraphy has very limited indications. Performing an ultrasound exam requires specific training and has a learning curve. It can be valuable in the hands of a trained orthopedic surgeon, used as an extension of the clinical examination and referred to as "echoscopy". However, a specialized musculoskeletal radiologist can often provide a more accurate dynamic diagnosis compared to static cross-sectional imaging. Thus, any imaging request should result from collaboration between surgeons and radiologists, and be tailored to the available resources, which can vary across different healthcare regions. LEVEL OF EVIDENCE: V: expert opinion.