Scapula fractures involving the glenoid articular surface or glenoid neck may also require surgical fixation. CT Arthrography Shoulder CT Arthrography Shoulder CT arthrography is not routinely performed in the setting of scapula fractures. Intra-articular iodinated contrast can obscure intra-articular fracture lines involving the glenoid neck and articular surface. Acute intra-articular fractures are typically associated with significant hemarthrosis, which can limit evaluation of soft-tissue structures on CT arthrography. MRI Shoulder MRI has limited usefulness in assessing scapular fractures. The thin cortex and sparse medullary cavity of the scapula body can make diagnosis of scapula body fractures difficult on MRI [49]. Typical shoulder-specific coils used for MRI are also unable to cover the entire scapula, requiring use of body coils with a larger field of view, which then results in suboptimal resolution for evaluation of scapular fracture displacement and angulation. MR Arthrography Shoulder There is no role for an MR arthrogram in evaluation of scapula fractures. US Shoulder US Shoulder There is no role for US in evaluation of scapula fractures. FDG-PET/CT Skull Base to Mid-Thigh FDG-PET/CT has been shown to be reliable in differentiating benign from malignant pathologic fractures [27]. FDG-PET/CT can be used to further assess suspected pathologic fractures of the scapula. Bone Scan Shoulder Bone Scan Shoulder 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]. Bone scintigraphy can be used to characterize scapula fractures suspected to be due to metastatic disease. MRI Shoulder Similar to MR arthrography, noncontrast MRI is comparable to CT in evaluating glenoid and humeral head bone loss [12,18]. In general, noncontrast MRI performs well in diagnosing labroligamentous injuries [20,52].
Shoulder Pain Traumatic PCAs. Scapula fractures involving the glenoid articular surface or glenoid neck may also require surgical fixation. CT Arthrography Shoulder CT Arthrography Shoulder CT arthrography is not routinely performed in the setting of scapula fractures. Intra-articular iodinated contrast can obscure intra-articular fracture lines involving the glenoid neck and articular surface. Acute intra-articular fractures are typically associated with significant hemarthrosis, which can limit evaluation of soft-tissue structures on CT arthrography. MRI Shoulder MRI has limited usefulness in assessing scapular fractures. The thin cortex and sparse medullary cavity of the scapula body can make diagnosis of scapula body fractures difficult on MRI [49]. Typical shoulder-specific coils used for MRI are also unable to cover the entire scapula, requiring use of body coils with a larger field of view, which then results in suboptimal resolution for evaluation of scapular fracture displacement and angulation. MR Arthrography Shoulder There is no role for an MR arthrogram in evaluation of scapula fractures. US Shoulder US Shoulder There is no role for US in evaluation of scapula fractures. FDG-PET/CT Skull Base to Mid-Thigh FDG-PET/CT has been shown to be reliable in differentiating benign from malignant pathologic fractures [27]. FDG-PET/CT can be used to further assess suspected pathologic fractures of the scapula. Bone Scan Shoulder Bone Scan Shoulder 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]. Bone scintigraphy can be used to characterize scapula fractures suspected to be due to metastatic disease. MRI Shoulder Similar to MR arthrography, noncontrast MRI is comparable to CT in evaluating glenoid and humeral head bone loss [12,18]. In general, noncontrast MRI performs well in diagnosing labroligamentous injuries [20,52].