Although MRI can detect rotator cuff tears associated with proximal humeral fracture [43], any significant rotator cuff tear associated with the humeral head fracture is typically addressed during open reduction and internal fixation of the fracture. However, noncontrast MRI may be useful in assessing rotator cuff integrity in patients with proximal humeral fractures that do not undergo surgical fixation. MR Arthrography Shoulder MR arthrography is not indicated in the acute setting of proximal humeral fractures. In the acute setting of proximal humeral fracture, a significant hemarthrosis is typically present, allowing for adequate distention of the glenohumeral joint for identification of intra-articular pathology on noncontrast MRI. MR arthrography is generally preferred over noncontrast MRI for evaluating soft-tissue injuries in patients with remote proximal humeral fracture and persistent pain [17,19]. FDG-PET/CT Skull Base to Mid-Thigh FDG-PET in combination with CT has been shown to be reliable in differentiating benign from malignant pathologic fractures [27]. FDG-PET/CT can be used to further assess suspected pathologic fractures of the proximal humerus. Bone Scan Shoulder Bone scintigraphy has sensitivity and specificity comparable to MRI in diagnosis of occult bone fractures, and bone scintigraphy can be used to identify other foci of bone involvement in pathologic fractures due to metastatic disease [31,32]. Bone scintigraphy can be used to characterize proximal humerus fractures suspected to be due to metastatic disease. Variant 4: Traumatic shoulder pain. Radiographs show scapula fracture. Next imaging study. There is no consensus on indications for surgical fixation of scapula fractures. In general, isolated scapula body fractures heal well without surgical fixation, although associated rib fractures or higher injury severity score are associated with worse clinical outcomes and may benefit from more aggressive surgical fixation [45].
Shoulder Pain Traumatic PCAs. Although MRI can detect rotator cuff tears associated with proximal humeral fracture [43], any significant rotator cuff tear associated with the humeral head fracture is typically addressed during open reduction and internal fixation of the fracture. However, noncontrast MRI may be useful in assessing rotator cuff integrity in patients with proximal humeral fractures that do not undergo surgical fixation. MR Arthrography Shoulder MR arthrography is not indicated in the acute setting of proximal humeral fractures. In the acute setting of proximal humeral fracture, a significant hemarthrosis is typically present, allowing for adequate distention of the glenohumeral joint for identification of intra-articular pathology on noncontrast MRI. MR arthrography is generally preferred over noncontrast MRI for evaluating soft-tissue injuries in patients with remote proximal humeral fracture and persistent pain [17,19]. FDG-PET/CT Skull Base to Mid-Thigh FDG-PET in combination with CT has been shown to be reliable in differentiating benign from malignant pathologic fractures [27]. FDG-PET/CT can be used to further assess suspected pathologic fractures of the proximal humerus. Bone Scan Shoulder Bone scintigraphy has sensitivity and specificity comparable to MRI in diagnosis of occult bone fractures, and bone scintigraphy can be used to identify other foci of bone involvement in pathologic fractures due to metastatic disease [31,32]. Bone scintigraphy can be used to characterize proximal humerus fractures suspected to be due to metastatic disease. Variant 4: Traumatic shoulder pain. Radiographs show scapula fracture. Next imaging study. There is no consensus on indications for surgical fixation of scapula fractures. In general, isolated scapula body fractures heal well without surgical fixation, although associated rib fractures or higher injury severity score are associated with worse clinical outcomes and may benefit from more aggressive surgical fixation [45].