Diagnostic Imaging of the Shoulder

Original Editor - Naomi O'Reilly

Top Contributors - Naomi O'Reilly, Kim Jackson, Rucha Gadgil, Admin, Wanda van Niekerk and Lucinda hampton  

Introduction

Diagnostic Imaging can be a useful resource for musculoskeletal conditions and where used appropriately can be an invaluable tool for physiotherapists. Imaging such as MRI, X-ray, CT Scans, and Bone Scans are prime examples of practical diagnostic imaging that facilitates accurate diagnosis, prognosis, intervention, and assessment of injuries and dysfunction that physiotherapists' address daily. Unnecessary imaging will not only potentially squander financial resources and increase potential for premature surgery, but may also lead to increase failure of conservative physiotherapy treatment as a result of patient expectations following diagnostic imaging e.g. perception that if a tear is there then physiotherapy has no role to play, so it is key to understand and recognise when imaging is appropriate. While there are a number of studies which indicate diagnostic imaging is underutilized such as x-rays identifying fractures or bone scans identifying osteoporosis, there are also many more studies which suggest over utilization of imaging, such as X-rays or MRI for acute and uncomplicated shoulder pain. While a thorough history and physical examination are the most important instruments in evaluating shoulder pain, musculoskeletal imaging can be an important adjunct. We will review the options and principles of shoulder investigations as they can be a critical element in efficient management in some cases of shoulder pain. There are many different types of imaging and each type is used for a specific purpose. For shoulder related problems the main forms of imaging include X-rays, Ultrasound, CT and MRI Scans.

Imaging Options

X-Ray

Arthrography

Ultrasound

MRI

Summary

Imaging findings such as tendon tears and bursal thickening, often diagnosed as bursitis, are as common in individuals with no shoulder pain, as they are in those with shoulder pain. One study suggest as much as 96% of individuals without any shoulder pain or loss of function were found to have imaging changes, such as tears, and bursal thickening. This suggests that what can be seen in imaging is not always the cause of the problem, and in many cases imaging findings do not tell you what structure is specifically causing the pain.

References