US image-guided injection with local anesthetic and corticosteroid into the subacromial-subdeltoid bursa has been shown to result in improvement in pain and range of motion in patients with rotator cuff symptoms [20,21]. Subacromial bursal injections are used by some as a diagnostic tool to evaluate for rotator cuff pathology [22], although the diagnostic utility of this approach is unclear in the literature. Glenohumeral joint injection has been found to not have significant diagnostic utility for patients with suspected rotator cuff tear [23]. MR Arthrography Shoulder MR arthrography provides greater sensitivity and specificity compared to conventional MRI in evaluating partial thickness articular surface tears [24-26]. Partial bursal and purely intrasubstance tears should have similar rates of detection on conventional MRI and MR arthrography because the diagnosis is dependent on the same fluid-sensitive sequences [27]. Extension of intra-articular gadolinium into the subacromial subdeltoid bursa can sometimes differentiate a high-grade partial tear from a full thickness tear [28]. However, the advantages of MR arthrography over conventional MRI for detecting rotator cuff tear must be weighed against the invasive nature of the arthrogram procedure [29]. Arthrograms with saline have been shown in some studies to have similar accuracy for rotator cuff tear as those performed with dilute gadolinium [30,31]. Some authors suggest that adding an abduction external rotation imaging position to an MR arthrogram improves the accuracy in diagnosing partial articular surface tears [32,33], although this positioning is often omitted because of patient discomfort. Chronic Shoulder Pain MRI Shoulder Without and With IV Contrast IV injection of gadolinium can be used to enhance the highly vascular synovium producing an indirect arthrogram effect [34].
Chronic Shoulder Pain PCAs. US image-guided injection with local anesthetic and corticosteroid into the subacromial-subdeltoid bursa has been shown to result in improvement in pain and range of motion in patients with rotator cuff symptoms [20,21]. Subacromial bursal injections are used by some as a diagnostic tool to evaluate for rotator cuff pathology [22], although the diagnostic utility of this approach is unclear in the literature. Glenohumeral joint injection has been found to not have significant diagnostic utility for patients with suspected rotator cuff tear [23]. MR Arthrography Shoulder MR arthrography provides greater sensitivity and specificity compared to conventional MRI in evaluating partial thickness articular surface tears [24-26]. Partial bursal and purely intrasubstance tears should have similar rates of detection on conventional MRI and MR arthrography because the diagnosis is dependent on the same fluid-sensitive sequences [27]. Extension of intra-articular gadolinium into the subacromial subdeltoid bursa can sometimes differentiate a high-grade partial tear from a full thickness tear [28]. However, the advantages of MR arthrography over conventional MRI for detecting rotator cuff tear must be weighed against the invasive nature of the arthrogram procedure [29]. Arthrograms with saline have been shown in some studies to have similar accuracy for rotator cuff tear as those performed with dilute gadolinium [30,31]. Some authors suggest that adding an abduction external rotation imaging position to an MR arthrogram improves the accuracy in diagnosing partial articular surface tears [32,33], although this positioning is often omitted because of patient discomfort. Chronic Shoulder Pain MRI Shoulder Without and With IV Contrast IV injection of gadolinium can be used to enhance the highly vascular synovium producing an indirect arthrogram effect [34].