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Imaging Evaluation

X-ray films are an integral part of the work up and necessary to gain additional information. The views that are the most valuable are anterior-posterior (AP) view, supraspinatous outlet view, and axillary lateral. A 15-degree cephalic view of the AC joint, and an AP view with humeral internal rotation can also be helpful.

It is essential to evaluate acromial morphology and thickness on the outlet film. The AC joint is closely evaluated for bony pathology (best seen on the AP or 15 degree cephalic). Arthritis of the glenohumeral joint and the presence of an os acromiale are best seen on the axillary lateral.

Magnetic resonance imaging (MRI) examination can be helpful to rule out associated pathology. It can give an excellent picture of the rotator cuff tendons and presence of tendonosis, partial, or complete tear. It is also useful for looking at the rotator cuff muscles and the presence or absence of fatty infiltration.

Within the shoulder joint, the biceps tendon, labrum, and chondral surfaces can be assessed. The osseous anatomy can be further evaluated for edema secondary to contusions and for the presence of avascular necrosis.

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