Radiography Shoulder Additional Views The rotator cuff tendons cannot be directly assessed radiographically, regardless of the view. Secondary findings of rotator cuff tear such as a high-riding humeral head or changes at the greater tuberosity can be seen on standard radiographic views. There have been several reports assessing special views for the evaluation of potential impingement from the anterior acromion. Outlet views can be used to determine acromial shape and have been shown to be more accurate than a single-slice MRI [43]. The Rockwood and cassette tilt views are angled frontal projections that can be used to detect anterior acromial osteophytes [44]. The subacromial subdeltoid bursa is a soft- tissue potential space and is not directly visualized on radiographs. There is a peribursal fat plane between the rotator cuff tendons and the deltoid muscle; however, obliteration of the peribursal fat stripe is not a specific indicator of shoulder pathology and may be seen in normal subjects [42]. US Shoulder US has been found to have a high accuracy in assessing rotator cuff disease [38,45], including the subscapularis tendon [46]. Meta-analyses have found a sensitivity of US ranging from 85% to 95% and a specificity ranging from 72% to 92%, which is similar to noncontrast MRI and slightly lower than MR arthrography [24,47]. Fatty infiltration within the rotator cuff muscles can be adequately demonstrated with US [48]. US may; however, be less accurate than MRI in measuring tear size and the degree of retraction in larger tears [49]. US allows excellent evaluation of the bursae situated about the shoulder, particularly the subacromial subdeltoid bursa [50]. Color flow imaging can demonstrate hyperemia in cases of bursitis with a significant inflammatory component [51]. Variant 3: Chronic shoulder pain. Radiographs demonstrate calcific tendinopathy or calcific bursitis. Next imaging study.
Chronic Shoulder Pain PCAs. Radiography Shoulder Additional Views The rotator cuff tendons cannot be directly assessed radiographically, regardless of the view. Secondary findings of rotator cuff tear such as a high-riding humeral head or changes at the greater tuberosity can be seen on standard radiographic views. There have been several reports assessing special views for the evaluation of potential impingement from the anterior acromion. Outlet views can be used to determine acromial shape and have been shown to be more accurate than a single-slice MRI [43]. The Rockwood and cassette tilt views are angled frontal projections that can be used to detect anterior acromial osteophytes [44]. The subacromial subdeltoid bursa is a soft- tissue potential space and is not directly visualized on radiographs. There is a peribursal fat plane between the rotator cuff tendons and the deltoid muscle; however, obliteration of the peribursal fat stripe is not a specific indicator of shoulder pathology and may be seen in normal subjects [42]. US Shoulder US has been found to have a high accuracy in assessing rotator cuff disease [38,45], including the subscapularis tendon [46]. Meta-analyses have found a sensitivity of US ranging from 85% to 95% and a specificity ranging from 72% to 92%, which is similar to noncontrast MRI and slightly lower than MR arthrography [24,47]. Fatty infiltration within the rotator cuff muscles can be adequately demonstrated with US [48]. US may; however, be less accurate than MRI in measuring tear size and the degree of retraction in larger tears [49]. US allows excellent evaluation of the bursae situated about the shoulder, particularly the subacromial subdeltoid bursa [50]. Color flow imaging can demonstrate hyperemia in cases of bursitis with a significant inflammatory component [51]. Variant 3: Chronic shoulder pain. Radiographs demonstrate calcific tendinopathy or calcific bursitis. Next imaging study.