In the acute trauma setting, however, noncontrast MRI may be preferred to MR arthrography because acute intra-articular pathology will typically produce significant joint effusion for assessment of intra-articular soft-tissue structures. MRI is the preferred imaging modality in assessing extra-articular soft-tissue traumatic pathology such as capsular and ligament tears [34,35]. MRI is also sensitive for diagnosing bone marrow contusion and has been shown to be beneficial in assessing shoulder physeal injuries in pediatric patients [36,37]. US Shoulder US has limited usefulness in patients with traumatic shoulder pain that cannot be localized to the rotator cuff or biceps tendon. In the post-traumatic setting, US has been shown to detect abnormalities, including proximal humeral fractures [25]; however, recent studies on US performed for nonspecific shoulder pain have had conflicting results. US for persistent shoulder pain after trauma has been found to diagnose significant pathology, primarily fractures and rotator cuff tears, in 90% of patients [25]. However, 40% of patients presenting with nonspecific shoulder pain were found to have no significant pathology on US [38]. Additionally, US has been demonstrated to be inferior to MRI in assessment of labroligamentous, osseous, and rotator cuff pathology [17]. US can be considered as a screening tool in patients with persistent nonspecific shoulder pain after trauma, particularly in an older patient population in whom rotator cuff tears are more common. However, a low threshold should be maintained for performing additional imaging in the setting of a noncontributory shoulder US examination. CT Shoulder CT Shoulder CT has virtually no usefulness in diagnosing common traumatic soft-tissue injuries such as rotator cuff tears, labroligamentous injuries, and muscle tears.
Shoulder Pain Traumatic PCAs. In the acute trauma setting, however, noncontrast MRI may be preferred to MR arthrography because acute intra-articular pathology will typically produce significant joint effusion for assessment of intra-articular soft-tissue structures. MRI is the preferred imaging modality in assessing extra-articular soft-tissue traumatic pathology such as capsular and ligament tears [34,35]. MRI is also sensitive for diagnosing bone marrow contusion and has been shown to be beneficial in assessing shoulder physeal injuries in pediatric patients [36,37]. US Shoulder US has limited usefulness in patients with traumatic shoulder pain that cannot be localized to the rotator cuff or biceps tendon. In the post-traumatic setting, US has been shown to detect abnormalities, including proximal humeral fractures [25]; however, recent studies on US performed for nonspecific shoulder pain have had conflicting results. US for persistent shoulder pain after trauma has been found to diagnose significant pathology, primarily fractures and rotator cuff tears, in 90% of patients [25]. However, 40% of patients presenting with nonspecific shoulder pain were found to have no significant pathology on US [38]. Additionally, US has been demonstrated to be inferior to MRI in assessment of labroligamentous, osseous, and rotator cuff pathology [17]. US can be considered as a screening tool in patients with persistent nonspecific shoulder pain after trauma, particularly in an older patient population in whom rotator cuff tears are more common. However, a low threshold should be maintained for performing additional imaging in the setting of a noncontributory shoulder US examination. CT Shoulder CT Shoulder CT has virtually no usefulness in diagnosing common traumatic soft-tissue injuries such as rotator cuff tears, labroligamentous injuries, and muscle tears.