Shoulder imaging. A review

Plain radiography still remains the primary imaging method for most shoulder disorders. A good evaluation should include adequate radiographs that provide substantial information about bone and joint pathology. Two anteroposterior projections complemented with a third view fulfill the requirements of two mutually orthogonal images. The third view can be the elevation view or either the axillary or Y-view. Additional projections are used depending on the clinical history and settings. Arthrography is almost the golden standard in the diagnosis of rotator cuff tears. Ultrasound is capable of enabling diagnosis of rotator cuff tears and other soft tissue lesions. The demanding technique requires a dedicated radiologist devoted to musculoskeletal examinations. Of the advanced imaging modalities CT depicts detailed bony images and, combined with arthrography, intra-articular pathology. MR is best suited for soft tissue lesions as well as bone marrow lesions. The choice of an advanced study should be considered according to the clinical history, the clinical findings and the results of the radiography. Undirected use of multiple hightech examinations is unnecessarily costly and may yield ambiguous information.