Imaging for shoulder pain

Mild shoulder pain without trauma often improves over a few weeks with relative rest, anti-inflammatories, and physical therapy. Imaging is appropriate when:

• A specific injury caused immediate pain or loss of motion
• You cannot lift the arm against gravity (concern for full-thickness rotator cuff tear)
• Pain persists beyond four to six weeks despite conservative care
• There is significant night pain or weakness
• A dislocation has occurred or recurrent instability is suspected

ACR Appropriateness Criteria support starting with an X-ray for most adult shoulder pain to evaluate bony anatomy, alignment, and degenerative changes before moving to soft-tissue imaging.

Shoulder X-ray is the standard first study. It shows alignment, fractures, osteoarthritis, and calcific tendinitis.

Shoulder MRI evaluates the rotator cuff (supraspinatus, infraspinatus, subscapularis, teres minor), the biceps tendon, the labrum, the joint capsule, and any bursitis or cartilage damage. It's the standard for working up persistent shoulder pain or suspected rotator cuff tears.

Shoulder ultrasound is a dynamic, real-time study that's excellent for evaluating the rotator cuff and biceps tendon. It uses no radiation, costs less than MRI, and allows side-by-side comparison with the other shoulder during the exam.

Shoulder MR arthrogram is the test of choice for suspected labral tears (SLAP tears, Bankart lesions), shoulder instability, or after prior surgery. A small amount of contrast is injected into the joint to outline the labrum and capsule.

A shoulder MRI evaluates:

• All four rotator cuff tendons for partial- or full-thickness tears, tendinopathy, retraction, and atrophy of the muscles
• The long head of the biceps tendon for tear, dislocation, or tendinopathy
• The glenoid labrum (with an arthrogram for best detail)
• The acromioclavicular joint and acromion shape
• The subacromial bursa for bursitis
• Cartilage of the glenohumeral joint

Rotator cuff tendinopathy — wear and inflammation of the cuff tendons. Most cases respond to physical therapy.

Partial- or full-thickness rotator cuff tear — degenerative tears are very common with age; not all require surgery. Acute traumatic full-thickness tears in active patients often do.

Subacromial impingement — irritation of the cuff tendons under the acromion. Often coexists with bursitis.

Labral tear (SLAP, Bankart) — usually related to throwing or an instability event. MR arthrography is the best study.

Adhesive capsulitis (frozen shoulder) — diffuse capsular thickening and pain on every motion. MRI helps exclude other causes.

Acromioclavicular arthritis — common cause of pain over the top of the shoulder, often combined with cuff pathology.

Reports return within a day for routine studies. Most shoulder problems are managed nonoperatively with physical therapy, NSAIDs, and selective steroid injections. Surgical referral is reasonable for symptomatic full-thickness cuff tears in active patients, recurrent instability, and labral tears that fail rehabilitation.

Bring the prescription and ID. Shoulder MRI takes about 30 minutes; arthrography adds 30 minutes. Ultrasound takes 20 to 30 minutes. Call 800-558-2223 for a transparent self-pay quote.