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Radiologic evaluation of the painful shoulder

Shahla Modarresi, MD
Cecilia Matilda Jude, MD
Section Editors
Robert H Shmerling, MD
Karl B Fields, MD
Deputy Editor
Monica Ramirez Curtis, MD, MPH


The complex anatomy and physiology of the shoulder, the most mobile and unstable joint, requires choosing proper imaging studies for different clinical scenarios. The imaging modalities and recommendations for selecting appropriate studies in different clinical situations are discussed in this review. The history and physical examination, which are necessary to develop a differential diagnosis prior to the selection of imaging tests, are presented separately. (See "Evaluation of the patient with shoulder complaints".)

A general review of imaging tests that are used in the evaluation of bone and joint pain, including the physical principles underlying their usefulness, is presented separately. (See "Imaging techniques for evaluation of the painful joint".)


A variety of imaging studies are available that are appropriate in different circumstances. These are listed in the table (table 1) and are discussed in more detail below:

Plain film radiography — Plain film radiography is the first imaging modality for virtually all shoulder pathology. Radiographs are often the only imaging study necessary for the evaluation of acute shoulder trauma, calcific tendonitis, arthritis, and osteolysis of distal clavicle (in athletes) [1].

Computerized tomography — Computerized tomography (CT) is usually reserved for evaluation of fracture/fracture-dislocation or for a prosthetic shoulder. CT can demonstrate fracture complexity, displacement, and angulation. The ability to visualize images in the axial, sagittal, and coronal planes and in three-dimensional format can help in interpretation and preoperative planning [2].


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Literature review current through: Sep 2016. | This topic last updated: Nov 6, 2015.
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