X-rays
X-rays are always the starting point in evaluating the shoulder. Although they do not show the rotator cuff or other soft tissues, they provide valuable information about the bones and overall alignment of the shoulder.
X-rays help evaluate:
- Bone anatomy and overall shoulder morphology
- Bone quality, including osteoporosis and other chronic bone changes
- Acromion shape and bone spurs that may contribute to impingement
- Narrowing of the space between the humeral head and acromion, which may suggest a large or massive rotator cuff tear
- Arthritis and loss of joint space, particularly on the axillary view
- Signs of prior trauma
In many ways, the X-ray is also a study of exclusion. Arthritis almost always shows up on an X-ray. If the X-rays are relatively normal, attention shifts toward the soft tissues, particularly the rotator cuff and other tendon structures.
MRI
The MRI is the most important imaging study for evaluating the shoulder because the shoulder is primarily a soft tissue joint.
MRI provides detailed information regarding:
- Rotator cuff tears
- Tear size and location
- Tendon quality
- Muscle quality and atrophy
- Arthritis
- Bone edema and cystic changes
- Subtle traumatic injuries
- Labral pathology
- Biceps tendon pathology
MRI studies are usually performed without contrast.
MR Arthrogram
In selected situations, an MR arthrogram is preferred. This involves placing contrast into the shoulder joint before the MRI and is particularly useful for evaluating traumatic injuries, especially in younger patients where the ligament structures are in question. It is also helpful when evaluating a shoulder that has previously undergone surgery.
CT Arthrogram / CT Scan
A CT arthrogram is generally reserved for patients who cannot undergo MRI because of certain implanted devices or other contraindications. A CT arthrogram is effective in determining whether a rotator cuff tear is present. However, it does not provide the same level of detail regarding tendon quality, muscle quality, and other soft tissue structures as an MRI. CT scans are also excellent for evaluating bone anatomy, arthritis, bone healing, and for preoperative planning before shoulder arthroplasty.
Preoperative CT Planning
For patients undergoing shoulder arthroplasty, a specialized CT scan is obtained before surgery. The study is uploaded into planning software that creates a three-dimensional model of the shoulder, allowing precise planning of glenoid component placement prior to surgery.
Before Your Visit
Whenever possible, I encourage new patients to have their primary care provider obtain an MRI of the affected shoulder before their visit. Having an MRI available at the initial appointment often allows me to make a complete assessment, establish a diagnosis, and develop your personalized treatment plan during your first visit.
If your MRI was performed within the Memorial Health System, we will usually be able to access both the actual study and the radiology report. If your MRI was performed outside the Memorial system, it is extremely helpful to bring the physical MRI disc in hand, along with the radiology report.