Indirect identification of symptomatic rotator cuff tears has been described on FDG-PET/CT by decreased radiotracer activity in the muscles of the torn tendons and increased activity of surrounding shoulder girdle muscles due to muscle recruitment [28,29]. Other soft-tissue injuries, such as labral and cartilage injuries, have not been described using FDG-PET/CT. Bone Scan Shoulder Tc-99m bone scintigraphy is rarely used in assessment of traumatic shoulder pain. Bone scintigraphy demonstrates increased activity in many post-traumatic shoulder pathologies such as fracture, rotator cuff tear, or adhesive capsulitis [30]. Bone scintigraphy as an isolated modality has relatively poor resolution for pathology localization compared with other imaging modalities; however, bone scintigraphy can be performed in conjunction with MRI or CT for better localization of radiotracer activity. Bone scintigraphy has sensitivity and specificity comparable to MRI in diagnosis of occult bone fractures, and bone scintigraphy can be used to identify other foci of bone involvement in pathologic fractures due to metastatic disease [31,32]. Increased radiotracer activity has been associated with symptomatic rotator cuff tears, but bone scintigraphy appearance of other soft- tissue injuries of the shoulder have not been well described [33]. Variant 3: Traumatic shoulder pain. Radiographs show humeral head or neck fracture. Next imaging study. Proximal humerus fractures of the head and neck are relatively common. These fractures have a bimodal age distribution, occurring in young patients as the result of high-energy trauma and older patients with low-energy trauma, such as falls from a standing position. The most commonly used classification for humeral head fractures is the Neer classification system. A complete tear of at least one rotator cuff tendon can be seen in up to 40% of humeral head fractures [40].
Shoulder Pain Traumatic PCAs. Indirect identification of symptomatic rotator cuff tears has been described on FDG-PET/CT by decreased radiotracer activity in the muscles of the torn tendons and increased activity of surrounding shoulder girdle muscles due to muscle recruitment [28,29]. Other soft-tissue injuries, such as labral and cartilage injuries, have not been described using FDG-PET/CT. Bone Scan Shoulder Tc-99m bone scintigraphy is rarely used in assessment of traumatic shoulder pain. Bone scintigraphy demonstrates increased activity in many post-traumatic shoulder pathologies such as fracture, rotator cuff tear, or adhesive capsulitis [30]. Bone scintigraphy as an isolated modality has relatively poor resolution for pathology localization compared with other imaging modalities; however, bone scintigraphy can be performed in conjunction with MRI or CT for better localization of radiotracer activity. Bone scintigraphy has sensitivity and specificity comparable to MRI in diagnosis of occult bone fractures, and bone scintigraphy can be used to identify other foci of bone involvement in pathologic fractures due to metastatic disease [31,32]. Increased radiotracer activity has been associated with symptomatic rotator cuff tears, but bone scintigraphy appearance of other soft- tissue injuries of the shoulder have not been well described [33]. Variant 3: Traumatic shoulder pain. Radiographs show humeral head or neck fracture. Next imaging study. Proximal humerus fractures of the head and neck are relatively common. These fractures have a bimodal age distribution, occurring in young patients as the result of high-energy trauma and older patients with low-energy trauma, such as falls from a standing position. The most commonly used classification for humeral head fractures is the Neer classification system. A complete tear of at least one rotator cuff tendon can be seen in up to 40% of humeral head fractures [40].