So, when you go into your physician with complaints of longstanding shoulder pain, he may or may not recommend imaging of the shoulder. The fact of the matter is much of shoulder pain can be diagnosed without any x-rays. However, there are some times with an initial evaluation that x-rays are needed.
When we think about this imaging, physicians can simply go through the following process. Plain x-rays – the old fashioned x-rays – will give you good information about the bones. Is there any arthritis? Is there any bone fractures? In deed, in one of the fairly common problems called calcific tendonitis, one of the tendons becomes calcified and essentially starts to turn to bone and that can be picked up on x-rays. Certainly cancer, tumors, all these things, if they involve the bone, can be picked up on plain x-rays. If the tumors are cancer, or not within the bone, then they basically escape the attention of plain films.
Magnetic Residence Imaging, or MRI, is technology that’s been around since the early 80s and it is the best way we have to look at soft tissues. So that will show any tumors that are not involved in the bone. They will show more importantly and much, much, much more commonly abnormalities in the tendon, inflammation in the tendon, rupture of the tendon, they will reveal bone fractures that are not seen on plain x-rays and that does happen up to 10% of the time. They essentially give the most information available cutting without into the shoulder and looking at it.
Ultrasound is a new modality, and it is very useful. You do need to understand its limitations. Ultrasound will basically tell you how someone superspinatis tendon is. Now, keep in mind, the superspinatis tendon is where most of the problems originate with the rotator cuff. And many times, we will get an ultrasound if we want to find out if its’ worth while to try to treat someone conservatively. Basically, if a superspinatis tendon is just showing partial tears or inflammation or swelling, then this person will likely get better without any type of surgery. Even moderate tears can shown on ultrasound, can very frequently be healed without surgery; however, if there is a complete tear in the tendon then there is actually retraction on both sides – so there is basically a separation between the tear – there’s not a great place for physical therapy in my opinion. So, the ultrasound is a one trick pony, but it can be quite practical and can give us a dream life if we really push the non-surgical rehabilitation aggressively.