top of page
shoulder-mri-accuracy.jpg

Imaging

I do x-rays on lots of my patients because, if you ask for the right images and you know what you are looking for, then they provide an enormous amount of useful information that, taken in conjunction with your history and examination, often allows me to make a diagnosis there and then.

X-rays are excellent for things like fractures and dislocations but are also very good for showing arthritis in the ball and socket joint and AC Joint; calcification in the tendon; signs of a massive rotator cuff tear and subtle signs of tendonitis and for showing subacromial hooks and spurs.
They aren’t very high tech but they are very useful.

X-Ray

23507-elbow-x-ray.jpg
MRI
Image by Accuray

The MRI (magnetic resonance imaging) scan is the one most people will gave heard about and it is a very popular and effective way of looking at the ligaments and tendons in the shoulder.
I do use MRI scans but am moving more towards Ultra-Sound scannning because the MRI is a static scan i.e. you are just lying flat in the scanner whereas the USS allows the radiologist to move the arm around and mimic the positions that cause your pain.

MRI in conjunction with an arthrogram is very effective in looking at instability problems such as dislocations, labral tears and SLAP lesions.
In an MRI Arthrogram, a shot of a special dye is injected into the gleno-humeral joint (using the Ultra-sound machine or moving x-ray machine to make sure it goes in the right place) before you have the scan itself. The reason for putting the fluid into the joint is that it will get into any gaps, splits or tears and emphasise them whereas they could be missed on normal MRI.

MRI Scan

Many of you will know about ultra-sound scans (USS) because its the way medics check on babies as they develop in the womb. What you may not know is that USS are becoming very useful in making a diagnosis in shoulder problems.
There are quite a few benefits of an USS: there is no radiation as in an x-ray or CT scan and you don’t have to worry about claustrophobia like with an MRI scan.
The best thing about it though is that it is dynamic scan. That means the radiologist will be able to move your shoulder around whilst doing the scan so they can get it into the position that actually makes your shoulder painful and see what is rubbing or catching or torn. They can also do steroid injections into specific areas or areas that are more difficult to inject into such as along the biceps tendon or into the ball and socket joint.

The most important thing with an USS scan is the experience of the radiologist and, to a lesser but still quite relevant extent, the quality of the equipment. There are only a few specially trained and experienced shoulder scanning radiologists around – it is not something that every radiologist can do – so it can mean traveling to get to the best person or waiting a bit for the scan. In the last few years the quality of the scanners has improved dramatically so the probes they use are much more sensitive and the images are very much better.

Ultra-Sound Scan

Image by Elen Sher
bottom of page