ACR Appropriateness Criteria® Shoulder Pain-Atraumatic

Abstract

Shoulder pain is one of the most common reasons for musculoskeletal-related physician visits. Imaging plays an important role in identifying the specific cause of atraumatic shoulder pain. This review is divided into two parts. The first part provides a general discussion of various imaging modalities (radiographs, arthrography, nuclear medicine, ultrasound, CT, and MRI) and their usefulness in evaluating atraumatic shoulder pain. The second part focuses on the most appropriate imaging algorithms for specific shoulder conditions including: rotator cuff disorders, labral tear/ instability, bursitis, adhesive capsulitis, biceps tendon abnormalities, postoperative rotator cuff tears, and neurogenic pain.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org. Dr. Mintz helps to create the registry exam for radiology technologists for the ARRT; he is also the section editor for a journal. Dr. Subhas reports research support from Siemens Healthcare for CT techniques for metal artifact reduction. The other authors have no conflicts of interest related to the material discussed in this article.Disclaimer: The ACR Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists, and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient's clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those examinations generally used for evaluation of the patient's condition are ranked. Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document. The availability of equipment or personnel may influence the selection of appropriate imaging procedures or ...

Correlation Between MRI Findings and Clinical Impairment In Patients With Shoulder Adhesive Capsulitis: A Prospective Study

“…No MRI nding was correlated with CMS, in agreement with Park et al 32 , who showed a correlation of CMS with total arthrography score but not with MRI ndings. Unlike Anh et al 25, we did not nd any correlation between MRI ndings and pain, but we did not rate IGHL enhancement.…”

“…As the estimation of pain duration provided by patients may be imprecise, a pain score system with time intervals was used to limit this potential bias. Since the correlation between MRI ndings and the range of motion each direction is still debated 24,32,35 , only global motion scores were considered. There was no control group, and no systematic clinical or MRI follow-up of the patients included.…”

Magnetic resonance imaging of the shoulder

“…RCT pathology can be due to tears, inflammation, and degeneration. Although imaging modalities like radiographs, ultrasound, and computed tomography (CT) have indications for evaluating the shoulder, MRI is the gold standard according to the American College of Radiology (ACR) appropriateness criteria for assessing both traumatic and atraumatic shoulder pain in suspected rotator cuff disease [ 15 , 16 ]. While radiographs provide an important initial study and ultrasound may be helpful in detecting full-thickness tears for evaluating the shoulder, MRI provides excellent, comprehensive imaging of soft-tissue structures, specifically the rotator cuff and labrum, and is thus the exam of choice.…”

“…Additionally, attrition of the rotator cuff is thought to contribute to glenohumeral joint imbalance, superior migration of the humeral head, and narrowing of the subacromial space [ 38 , 39 ]. Although radiographs and ultrasound can be helpful in evaluating shoulder impingement, MRI gives detailed information about the extra-articular findings that can be a cause or result of shoulder impingement [ 16 ]. Acromial morphology can predispose to impingement.…”

“…The SA-SD bursa is not directly visualised on radiographs, but instead can be indirectly evaluated by looking at the peribursal fat plane. Ultrasound allows for direct evaluation of the bursae and is excellent for image-guided interventions, which can be superior to blind injections in terms of accuracy [ 16 , 91 ]. Although MRI is superior in evaluating soft-tissue structures and nicely depicts the bursae of the shoulder, it is not usually ordered as a first-line modality in patients with suspected bursitis [ 16 ].…”