Shoulder imaging: what is the best modality?

Specific pathologies of the shoulder include instabilities in young patient s and tendinopathies in older patients. The choice of imaging modality depe nds on the information expected from each technique. In case of instability, plain films demonstrate bone abnormalities such as H ill Sachs and/or Bankart lesions. Arthro-CT or arthro-MRI need not be in all cases but can provide additional information performed about the intraa rticular structures and the glenoid labrum. The rotator cuff is initially evaluated by plain films which demonstrate an atomical conditions resulting in impingement syndrome as well as indirect s igns of tendinopathy. Direct visualization of tendons may be achieved by US , arthro-CT, arthro-MRI. US is a dynamic, non invasive and accurate techniq ue for evaluation of rotator cuff tear bur is very operator-dependent. Arth ro-CT is more reproductive and reveals accurately partial tear as well as a nterior tears involving biceps or subscapularis tendons. MRI is very useful to visualize the rotator cuff and adjacent bony structures. Nevertheless, MRI is st II limited by its cost, accessibility and variable quality.