At times US may have difficulty distinguishing calcific deposits from heterotopic ossification because both can result in dense shadowing at US. US can be used if there is concern for concomitant rotator cuff tendon tear and may be a better modality than MRI in this situation given the difficulty of distinguishing calcium from normal tendon at MRI. Variant 4: Chronic shoulder pain. Suspect labral pathology or shoulder instability. Initial radiographs normal or inconclusive. Next imaging study. Bone Scan Shoulder There is insufficient evidence to support the use of bone scan shoulder in the evaluation of chronic shoulder pain when labral pathology or shoulder instability is suspected. CT Arthrography Shoulder CT arthrograms have been shown to be an accurate modality in the assessment of shoulder instability because of its depiction of osseous, cartilaginous, and labroligamentous injuries [18,72]. Labral evaluation in the postoperative setting may be better with CT arthrography than MRI in patients with metallic suture anchors [73] and has been used to evaluate for healing after superior labrum anterior-to-posterior (SLAP) repair [74]. Dual-energy CT arthrography has a similar diagnostic performance as MR arthrography [75]. Although CT arthrography aids in the evaluation of underlying soft tissues, the injected contrast may limit evaluation of the underlying osseous structures, and cortical fragments in the injected contrast solution often have a similar attenuation to cortical bone [76]. Other limitations include the need for an invasive arthrography procedure and poor assessment of bone marrow edema [72]. CT Shoulder With IV Contrast There is insufficient evidence to support the use of CT shoulder with IV contrast in the evaluation of chronic shoulder pain when labral pathology or shoulder instability is suspected.
Chronic Shoulder Pain PCAs. At times US may have difficulty distinguishing calcific deposits from heterotopic ossification because both can result in dense shadowing at US. US can be used if there is concern for concomitant rotator cuff tendon tear and may be a better modality than MRI in this situation given the difficulty of distinguishing calcium from normal tendon at MRI. Variant 4: Chronic shoulder pain. Suspect labral pathology or shoulder instability. Initial radiographs normal or inconclusive. Next imaging study. Bone Scan Shoulder There is insufficient evidence to support the use of bone scan shoulder in the evaluation of chronic shoulder pain when labral pathology or shoulder instability is suspected. CT Arthrography Shoulder CT arthrograms have been shown to be an accurate modality in the assessment of shoulder instability because of its depiction of osseous, cartilaginous, and labroligamentous injuries [18,72]. Labral evaluation in the postoperative setting may be better with CT arthrography than MRI in patients with metallic suture anchors [73] and has been used to evaluate for healing after superior labrum anterior-to-posterior (SLAP) repair [74]. Dual-energy CT arthrography has a similar diagnostic performance as MR arthrography [75]. Although CT arthrography aids in the evaluation of underlying soft tissues, the injected contrast may limit evaluation of the underlying osseous structures, and cortical fragments in the injected contrast solution often have a similar attenuation to cortical bone [76]. Other limitations include the need for an invasive arthrography procedure and poor assessment of bone marrow edema [72]. CT Shoulder With IV Contrast There is insufficient evidence to support the use of CT shoulder with IV contrast in the evaluation of chronic shoulder pain when labral pathology or shoulder instability is suspected.