Using diagnostic criteria of having 2 or more signs of biceps tendinopathy (contour irregularity, diameter change, or abnormal signal) has a sensitivity of 78% and a specificity of 94% [132]. It has been reported that normal appearing tendons on MRI frequently have histopathologic findings of tendinopathy [133,134]. Biceps tendon subluxation can be diagnosed by displacement of the biceps tendon over the lesser tuberosity [135] and is highly associated with tearing of the subscapularis tendon [136]. MRI has a greater specificity for biceps tendon abnormality if there is a coexisting rotator cuff tear [129,137]. Radiography Shoulder Additional Views There is insufficient evidence to support the use of additional radiographic views in the evaluation of chronic shoulder pain when a biceps tendon abnormality is suspected. US Shoulder Apart from the biceps anchor, the intra-articular and extra-articular portions of the biceps tendon are well seen on routine US imaging. Tendinopathy, tears and rupture, tenosynovitis, subluxation, and frank dislocation are readily assessed [138,139]. Provocative maneuvers may be helpful while observing in real time to assess the degree of subluxation. Chronic Shoulder Pain Variant 7: Chronic shoulder pain. Initial radiographs demonstrate osteoarthritis. Next imaging study. The presence of glenohumeral osteoarthritis on initial radiographs does not typically require additional imaging unless additional pathology is suspected, such as a rotator cuff tear or surgery is a consideration. Bone Scan Shoulder There is insufficient evidence to support the use of bone scan shoulder in the evaluation of chronic shoulder pain when initial radiographs demonstrate osteoarthritis. CT Arthrography Shoulder CT arthrography can be helpful in the preoperative planning of total shoulder arthroplasty in patients with severe glenohumeral arthritis.
Chronic Shoulder Pain PCAs. Using diagnostic criteria of having 2 or more signs of biceps tendinopathy (contour irregularity, diameter change, or abnormal signal) has a sensitivity of 78% and a specificity of 94% [132]. It has been reported that normal appearing tendons on MRI frequently have histopathologic findings of tendinopathy [133,134]. Biceps tendon subluxation can be diagnosed by displacement of the biceps tendon over the lesser tuberosity [135] and is highly associated with tearing of the subscapularis tendon [136]. MRI has a greater specificity for biceps tendon abnormality if there is a coexisting rotator cuff tear [129,137]. Radiography Shoulder Additional Views There is insufficient evidence to support the use of additional radiographic views in the evaluation of chronic shoulder pain when a biceps tendon abnormality is suspected. US Shoulder Apart from the biceps anchor, the intra-articular and extra-articular portions of the biceps tendon are well seen on routine US imaging. Tendinopathy, tears and rupture, tenosynovitis, subluxation, and frank dislocation are readily assessed [138,139]. Provocative maneuvers may be helpful while observing in real time to assess the degree of subluxation. Chronic Shoulder Pain Variant 7: Chronic shoulder pain. Initial radiographs demonstrate osteoarthritis. Next imaging study. The presence of glenohumeral osteoarthritis on initial radiographs does not typically require additional imaging unless additional pathology is suspected, such as a rotator cuff tear or surgery is a consideration. Bone Scan Shoulder There is insufficient evidence to support the use of bone scan shoulder in the evaluation of chronic shoulder pain when initial radiographs demonstrate osteoarthritis. CT Arthrography Shoulder CT arthrography can be helpful in the preoperative planning of total shoulder arthroplasty in patients with severe glenohumeral arthritis.