CT arthrography is comparable to MR arthrography in the diagnosis of Bankart and Hill-Sachs lesions [12], and moderate agreement has been found between readers for diagnosing anterior capsule laxity on CT arthrography. However, CT arthrography has been shown to be inferior to MR arthrography in assessing partial-thickness rotator cuff tears [12], which makes CT arthrography less desirable in older patients with dislocation/instability where rotator cuff tears are common. CT arthrography may be considered in a patient with shoulder dislocation/instability and contraindication to MRI. CT Shoulder Noncontrast CT has historically been performed to assess bone loss in patients with recurrent dislocation or chronic instability. However, recent studies have shown MRI to be equivalent to CT in assessment of glenoid and humeral head bone loss [12,18], which places in question the need for noncontrast CT in the assessment of shoulder instability. Noncontrast CT is also unable to assess rotator cuff and labroligamentous pathology commonly seen in shoulder dislocations/instability. In general, CT should be reserved for patients with a contraindication to MRI or patients in whom MRI assessment of bone loss is limited. US Shoulder There is no defined role for US in the assessment of shoulder dislocation or instability. There is a potential limited role for use of dynamic US in assessing Hill-Sachs lesion engagement [61]. However, this is not common practice, and US has been shown to be inferior to MRI in diagnosing the common structural abnormalities associated with shoulder instability, such as labroligamentous injuries, Hill-Sachs lesions, and partial rotator cuff tears [17]. FDG-PET/CT Skull Base to Mid-Thigh There is no role for FDG-PET/CT in assessment of shoulder instability. Bone Scan Shoulder Bone Scan Shoulder There is no role for bone scintigraphy in assessment of shoulder instability. Variant 7: Traumatic shoulder pain. Radiographs normal.
Shoulder Pain Traumatic PCAs. CT arthrography is comparable to MR arthrography in the diagnosis of Bankart and Hill-Sachs lesions [12], and moderate agreement has been found between readers for diagnosing anterior capsule laxity on CT arthrography. However, CT arthrography has been shown to be inferior to MR arthrography in assessing partial-thickness rotator cuff tears [12], which makes CT arthrography less desirable in older patients with dislocation/instability where rotator cuff tears are common. CT arthrography may be considered in a patient with shoulder dislocation/instability and contraindication to MRI. CT Shoulder Noncontrast CT has historically been performed to assess bone loss in patients with recurrent dislocation or chronic instability. However, recent studies have shown MRI to be equivalent to CT in assessment of glenoid and humeral head bone loss [12,18], which places in question the need for noncontrast CT in the assessment of shoulder instability. Noncontrast CT is also unable to assess rotator cuff and labroligamentous pathology commonly seen in shoulder dislocations/instability. In general, CT should be reserved for patients with a contraindication to MRI or patients in whom MRI assessment of bone loss is limited. US Shoulder There is no defined role for US in the assessment of shoulder dislocation or instability. There is a potential limited role for use of dynamic US in assessing Hill-Sachs lesion engagement [61]. However, this is not common practice, and US has been shown to be inferior to MRI in diagnosing the common structural abnormalities associated with shoulder instability, such as labroligamentous injuries, Hill-Sachs lesions, and partial rotator cuff tears [17]. FDG-PET/CT Skull Base to Mid-Thigh There is no role for FDG-PET/CT in assessment of shoulder instability. Bone Scan Shoulder Bone Scan Shoulder There is no role for bone scintigraphy in assessment of shoulder instability. Variant 7: Traumatic shoulder pain. Radiographs normal.