Ultrasound imaging for shoulder injuries: the pros and cons

Case presentations

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.