However, a delay in repair of rotator cuff tears by up to 4 months has not been shown to have adverse outcomes on rotator cuff repair [41], and immediate diagnosis and treatment of soft-tissue injury in the setting of a proximal humerus fracture may not be required. CT Shoulder Nondisplaced fracture planes and complex bony anatomy can result in underappreciation of the extent of proximal humeral fractures on radiographs. Poor agreement between observers has been shown on grading of humeral head fractures on radiographs [10]. CT is the best examination for delineating fracture patterns and has been shown to be equivocal to MRI in identifying nondisplaced fractures, making it the preferred study for characterizing proximal humeral fractures. Contrast is generally not necessary unless there is concern for arterial injury (see Variant 9). 3-D volume-rendered CT images may be obtained to better characterize fracture patterns and humeral neck angulation, which can affect functional outcomes [42]. CT Arthrography Shoulder CT Arthrography Shoulder Arthrography is not routinely performed in conjunction with CT in the evaluation of proximal humeral fractures. In the acute setting, glenohumeral hemarthrosis can obscure soft-tissue structures typically evaluated on CT arthrography, and intra-articular iodinated contrast can obscure intra-articular humerus fracture planes. Because of the high association between humeral head fractures and rotator cuff tears, there may be a role for CT arthrogram in a patient with remote proximal humeral fracture having a suspected rotator cuff tear and contraindication to MRI. MRI Shoulder MRI Shoulder MRI without contrast is inferior to CT in evaluating fracture planes in complex humerus fracture patterns and is, in general, inferior to CT in characterizing proximal humerus fractures.
Shoulder Pain Traumatic PCAs. However, a delay in repair of rotator cuff tears by up to 4 months has not been shown to have adverse outcomes on rotator cuff repair [41], and immediate diagnosis and treatment of soft-tissue injury in the setting of a proximal humerus fracture may not be required. CT Shoulder Nondisplaced fracture planes and complex bony anatomy can result in underappreciation of the extent of proximal humeral fractures on radiographs. Poor agreement between observers has been shown on grading of humeral head fractures on radiographs [10]. CT is the best examination for delineating fracture patterns and has been shown to be equivocal to MRI in identifying nondisplaced fractures, making it the preferred study for characterizing proximal humeral fractures. Contrast is generally not necessary unless there is concern for arterial injury (see Variant 9). 3-D volume-rendered CT images may be obtained to better characterize fracture patterns and humeral neck angulation, which can affect functional outcomes [42]. CT Arthrography Shoulder CT Arthrography Shoulder Arthrography is not routinely performed in conjunction with CT in the evaluation of proximal humeral fractures. In the acute setting, glenohumeral hemarthrosis can obscure soft-tissue structures typically evaluated on CT arthrography, and intra-articular iodinated contrast can obscure intra-articular humerus fracture planes. Because of the high association between humeral head fractures and rotator cuff tears, there may be a role for CT arthrogram in a patient with remote proximal humeral fracture having a suspected rotator cuff tear and contraindication to MRI. MRI Shoulder MRI Shoulder MRI without contrast is inferior to CT in evaluating fracture planes in complex humerus fracture patterns and is, in general, inferior to CT in characterizing proximal humerus fractures.