ACR Appropriateness Criteria Imaging After Shoulder Arthroplasty: Updated 2026

Shoulder arthroplasties, including partial or complete humeral head resurfacing, hemiarthroplasty, conventional total shoulder arthroplasty, and reverse total shoulder arthroplasty, are increasingly being performed for painful shoulder conditions. This document defines best practices for ordering imaging studies based on specific clinical scenarios, which are categorized into different variants. Each variant includes a brief description of the usefulness, advantages, and limitations of various imaging modalities. This document is the result of a comprehensive analysis of the available literature and a thorough review of best imaging practices for each clinical scenario. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.