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 it 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 2: Traumatic shoulder pain. Nonlocalized shoulder pain. Negative radiographs. Next imaging study. Appropriately positioned radiographs can exclude shoulder dislocation and most displaced fractures as the etiology for post-traumatic shoulder pain. In the setting of normal shoulder radiographs, the most common causes of post-traumatic shoulder pain are soft-tissue injuries such as rotator cuff and labral tears. MRI Shoulder Noncontrast MRI is a reasonable imaging study in the setting of acute nonlocalized traumatic shoulder pain and noncontributory radiographs. In the acute trauma setting, noncontrast MRI may be preferred to MR arthrography, as acute intra-articular pathology will typically produce significant joint effusion for assessment of intra-articular soft-tissue structures. MRI is the preferred imaging modality in assessing extra-articular soft-tissue traumatic pathology such as capsular and ligament tears [34,35]. MRI is also sensitive for diagnosing bone marrow contusion and has been shown to be beneficial in assessing shoulder physeal injuries in pediatric patients [36,37]. MR Arthrography Shoulder MR arthrography has been found to be superior to noncontrast MRI in the diagnosis of labroligamentous and partial-thickness rotator cuff tears [17,19].
Shoulder Pain Traumatic PCAs. 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 it 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 2: Traumatic shoulder pain. Nonlocalized shoulder pain. Negative radiographs. Next imaging study. Appropriately positioned radiographs can exclude shoulder dislocation and most displaced fractures as the etiology for post-traumatic shoulder pain. In the setting of normal shoulder radiographs, the most common causes of post-traumatic shoulder pain are soft-tissue injuries such as rotator cuff and labral tears. MRI Shoulder Noncontrast MRI is a reasonable imaging study in the setting of acute nonlocalized traumatic shoulder pain and noncontributory radiographs. In the acute trauma setting, noncontrast MRI may be preferred to MR arthrography, as acute intra-articular pathology will typically produce significant joint effusion for assessment of intra-articular soft-tissue structures. MRI is the preferred imaging modality in assessing extra-articular soft-tissue traumatic pathology such as capsular and ligament tears [34,35]. MRI is also sensitive for diagnosing bone marrow contusion and has been shown to be beneficial in assessing shoulder physeal injuries in pediatric patients [36,37]. MR Arthrography Shoulder MR arthrography has been found to be superior to noncontrast MRI in the diagnosis of labroligamentous and partial-thickness rotator cuff tears [17,19].