Imaging tests for shoulder injuries are used to guide management by either confirming or negating the provisional clinical diagnosis. Although no single imaging strategy will successfully cover all clinical situations, plain x-ray and ultrasound together could reasonably be regarded as the initial investigations of choice for many situations encountered in general practice.
In each of the following scenarios, which imaging tests would you request?
Case A: A 55-year-old jogger presents complaining of persistent shoulder pain that developed after a recent fall. On physical examination there is mild supraspinatus wasting and a painful arc.
Case B: A 23-year-old professional downhill skier presents with an 18-month history of episodic shoulder pain. On physical examination there is a painful abduction arc as well as a positive apprehension sign and relocation manoeuvre. Abduction strength is good. A history of ski injury producing significant shoulder pain that eventually settled without investigation two years ago is elicited.
Case C: A 42-year-old woman presents with a six-month history of worsening shoulder pain without a significant injury or other precipitating event. On physical examination there is mild generalised rotator cuff and joint tenderness with a multidirectional pattern of end-range glenohumeral joint pain and motion restriction.