A standard axillary view can demonstrate posterior subluxation of the humeral head and abnormal glenoid morphology in patients with severe osteoarthritis [145-147]. A measurement of the critical shoulder angle can be drawn on routine AP radiographs by measuring the angle between a line along the glenoid surface and a line from the inferior glenoid to the lateral acromial margin; patients with a higher measurement may be at high risk of having a full thickness rotator cuff tear [148]. US Shoulder Although secondary signs of osteoarthritis such as osteophytes, joint effusion, and intra-articular bodies can be seen with US [142], it is not typically performed for this indication. Variant 8: Chronic shoulder pain. History of prior rotator cuff repair. Suspect rotator cuff disorders or subacromial subdeltoid bursitis. 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 with a history of prior rotator cuff repair when rotator cuff disorder or subacromial subdeltoid bursitis is suspected. CT Arthrography Shoulder As in the native shoulder, CT arthrography can be used to evaluate for rotator cuff tear after surgery. In patients with metal in the shoulder, CT arthrography can be beneficial in detecting supraspinatus tears that may be obscured by metal artifact [73]. Gadolinium contrast can potentially be drawn up into a mixture with iodinated contrast at the time of the arthrogram procedure, thus allowing for a shift from MRI to CT if artifact on MRI precludes evaluation. 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 with a history of prior rotator cuff repair when rotator cuff disorder or subacromial subdeltoid bursitis is suspected.
Chronic Shoulder Pain PCAs. A standard axillary view can demonstrate posterior subluxation of the humeral head and abnormal glenoid morphology in patients with severe osteoarthritis [145-147]. A measurement of the critical shoulder angle can be drawn on routine AP radiographs by measuring the angle between a line along the glenoid surface and a line from the inferior glenoid to the lateral acromial margin; patients with a higher measurement may be at high risk of having a full thickness rotator cuff tear [148]. US Shoulder Although secondary signs of osteoarthritis such as osteophytes, joint effusion, and intra-articular bodies can be seen with US [142], it is not typically performed for this indication. Variant 8: Chronic shoulder pain. History of prior rotator cuff repair. Suspect rotator cuff disorders or subacromial subdeltoid bursitis. 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 with a history of prior rotator cuff repair when rotator cuff disorder or subacromial subdeltoid bursitis is suspected. CT Arthrography Shoulder As in the native shoulder, CT arthrography can be used to evaluate for rotator cuff tear after surgery. In patients with metal in the shoulder, CT arthrography can be beneficial in detecting supraspinatus tears that may be obscured by metal artifact [73]. Gadolinium contrast can potentially be drawn up into a mixture with iodinated contrast at the time of the arthrogram procedure, thus allowing for a shift from MRI to CT if artifact on MRI precludes evaluation. 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 with a history of prior rotator cuff repair when rotator cuff disorder or subacromial subdeltoid bursitis is suspected.