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Assessment & Imaging

Clinical evaluation and imaging protocols for shoulder pathology, focusing on glenoid morphology and soft tissue integrity to guide surgical planning.

Overview

Accurate assessment of spinal and shoulder pathologies requires a nuanced selection of imaging modalities tailored to specific clinical questions. For lumbar spinal stenosis, MRI underestimates canal cross-sectional area compared to CT, necessitating a multimodal approach to ensure accurate diagnosis [1]. Clinicians must understand the distinct indications, advantages, and disadvantages of radiographs, CT, and MRI to safely manage spinal disorders [6]. Similarly, while MRI is the preferred strategy over ultrasound for detecting symptomatic full-thickness supraspinatus tears based on cost-effectiveness, the final decision for an imaging center often depends on available resources and workflow [44].

In the context of joint injuries and arthroplasty, CT serves as the gold standard for evaluating sternoclavicular joint injuries and is the most reliable method for closed reduction of posterior dislocations until further research establishes alternatives [2, 18]. For glenohumeral osteoarthritis, CT underestimates rotator cuff pathology, making the combined use of CT and MRI essential for preoperative planning [13]. Post-operative assessment for shoulder arthroplasty patients with pain or limited range of motion warrants additional X-rays, CT scans, or diagnostic tests as clinically indicated [3]. However, routine PACU radiographs without specific indications may yield poor-quality images and do not alter care [12].

Specific morphological assessments also dictate modality choice. Clinicians may utilize either MRI or CT to evaluate glenoid morphology, version, and humeral head subluxation [7]. For hip arthroscopy, MRI should be obtained at the discretion of the treating clinician based on specific criteria rather than being mandated by insurers [5]. Optimal care for proximal humeral fractures may require new imaging modalities rather than new classification systems [10]. Finally, the SHART (shoulder hyperabduction radiological test) should be integrated into conventional preoperative imaging techniques to enhance diagnostic precision [48].

Anatomy & Pathophysiology

The shoulder possesses the most motion of any joint in the human body [31], a function highly dependent on unique anatomy and biomechanical properties [31]. In normal active arm abduction, the humeral head moves from an inferior position to the center of the glenoid, with kinematic variability decreasing significantly as abduction increases [42]. Glenohumeral internal rotation measurements are taken with the shoulder in abduction to maximize accuracy and objectivity [82].

Alterations of scapular kinematics in symptomatic subjects are multifactorial [32]. While scapular exercises in a clinical model of fatigue resulted in superior migration of the humeral head and alterations in shoulder kinematics on radiographic analysis in healthy subjects [50], kinematic analysis of patients with rotator cuff tears shows unexpected inferior translation of the humeral head rather than superior translation [59]. Active motion remains an important determinant of patient-assessed shoulder function [60].

Acromial projection allows for reproducible, non-invasive dynamic video motion capture of the scapula [75]. The critical shoulder angle was unaffected by demographic factors [74], and the present study revealed the glenohumeral geometry in the normal Japanese population [73]. Effective stretching positions for the posterior shoulder capsule were determined by evaluating elastic characteristics in various glenohumeral elevation planes and angles [68].

Findings do not support that abnormal passive shoulder motions precede development of impingement syndrome [76], and the impact of 30 years' high-level rock climbing on the shoulder is not related to any restriction in shoulder function [78]. Discrepancy in two-dimensional computed tomography scan analysis for coracoid graft positioning is mainly explained by the difficulty in orienting the glenoid in the sagittal plane before any other parameter is measured [71]. Two-dimensional-pose based estimates of shoulder range of motion were consistent with visual estimates for most movements, though discrepancies existed at specific range of motion levels and between observers [72].

Novel 3D volumetric measurement modality may provide a more accurate preoperative assessment of rotator cuff pathology and global shoulder function [79]. Both open and arthroscopic repair of anterosuperior rotator cuff tears with subscapularis involvement significantly improved shoulder function and are relatively safe procedures [80]. Data showed no difference in scapular notching at 1-year follow-up despite previous biomechanical predictions that inferiorly tilting the glenosphere might reduce inferior scapular neck impingement [66].

Classification

MRI vs. CT: MRI underestimates lumbar spinal canal cross-sectional area compared to CT in patients with lumbar spinal stenosis [1]. A multimodal approach leveraging both MRI and CT is recommended to ensure the most accurate assessment of lumbar spinal stenosis [1]. CT diagnostics allowed a significantly better assessment of relevant structures than conventional diagnostics in proximal humeral fractures [11].

Goutallier: A simplification of the Goutallier MRI classification system is proposed to account for variability in interobserver and intraobserver reliability [30].

SLAP Lesions: Classification of superior labrum anterior to posterior lesions using magnetic resonance arthrography resulted in significant disagreement between and within raters [33].

Walch: The modified Walch classification represents an improvement over the original classification for glenohumeral arthritis [36]. Automated computer-based analysis of CT scans may be needed to further improve the value of the modified Walch classification [36].

Glenoid Bone Loss: A new classification of glenoid bone loss has good intra- and inter-observer reliability [43]. There is good correlation between the results of glenoid bone loss classification by plain radiographs and CT images [43].

Acromial Morphology: The acromial morphology classification system is an unreliable method to assess the acromion [45]. The acromial index shows no association with the presence of rotator cuff disease [45].

Proximal Humerus Fractures: Optimum patient care for proximal humeral fractures might require the development of new imaging modalities rather than new classification systems [10]. Artificial intelligence-driven classification of proximal humerus fractures on plain radiographs is insufficient for clinical implementation despite rigorous training methodology [47].

Saphenoid Fractures: The 'long axis' measurement for acute scaphoid fracture assessment has clear potential benefits over traditional classification systems [69].

Saphenoid Ligament: An MRI-based sMCL classification system validates the location of high-grade superficial medial collateral ligament tears with excellent reliability [58].

Glenohumeral Instability: The FEDS system for classifying glenohumeral instability contains 16 categories that are clinically significant [62].

Other Considerations: The quality of MRI images and their usefulness are markedly affected by the type of equipment employed [15]. High-field-strength MRI systems typically provide superior image quality compared to low-field-strength open systems [15]. Clinical scores using a single MRI image slice do not represent 3-dimensional muscle measurements for fatty infiltration and muscle atrophy [57].

Clinical Presentation

Initial evaluation of spinal pathology requires careful modality selection, as MRI underestimates lumbar spinal canal cross-sectional area compared to CT [1]. Clinicians must correlate MRI findings with medical history and clinical presentation when assessing lumbo-sacral nerve root compromise [9]. Specific indications, advantages, and disadvantages exist for radiographs, CT, MRI, and other techniques depending on the spinal pathology [6]. For hip pathology, conventional radiographs remain critical for initial evaluation, while MRI provides superior soft-tissue contrast for intra- and extra-articular assessment [16]. Radiographic evaluation is vital to the diagnostic workup of hip pain, with AP pelvic and false-profile views revealing the most information about acetabular pathology [37]. Lateral views better delineate anatomic deformities of the proximal femur in hip radiographic evaluation [37].

In shoulder assessment, plain radiographs rarely alter the diagnosis or affect management in the setting of atraumatic shoulder pain, particularly in patients younger than 50 years [14]. The clinical utility of the lateral scapular view in the initial evaluation of nontraumatic shoulder conditions may need to be reassessed [40]. For patients experiencing pain or limited range of motion following primary anatomic or reverse total shoulder arthroplasty, ongoing assessment using additional X-rays, computed tomography scans, or other diagnostic tests is recommended [3]. A treating clinician may choose to utilize either an MRI or a CT to assess glenoid morphology, glenoid version, and humeral head subluxation [7]. Clinicians should be aware of common anatomic findings on MRI when considering diagnostic and treatment planning for unilateral shoulder pain [8]. Needle diagnostic arthroscopy has better ability to rule in a diagnosis but slightly worse ability to rule out a diagnosis compared with MRI for the shoulder [39].

For sternoclavicular joint injuries, computed tomography is the imaging modality of choice [2]. Timely recognition and treatment of sternoclavicular joint injuries are essential to prevent devastating consequences [2]. The prevalence of osteoarthritis of the sternoclavicular joint on computed tomography should be taken into consideration when using a CT scan to assess a patient with symptomatic SCJ pathology [17]. In proximal humeral fractures, CT diagnostics allowed a significantly better assessment of relevant structures than conventional diagnostics [11], suggesting optimum patient care might require the development of new imaging modalities rather than new classification systems [10].

Diagnostic reliance varies by anatomical region and pathology. Radiologic investigations have a tertiary role in diagnosis of the anterolateral complex, and clinicians must rely on thorough history and physical examination rather than MRI alone [4]. MRI for hip arthroscopy should be obtained at the discretion of the treating clinician based on specific clinical criteria rather than being mandated by insurers [5]. Surgery and histologic examination for elastofibroma dorsi should be performed only when there are significant symptoms or when MRI findings are controversial [34]. Results regarding variations of MRI findings in asymptomatic elbows can help guide clinicians in interpreting MRI findings and differentiating age-related variations from true pathology [38]. Finally, the quality of MRI images and their usefulness are markedly affected by the type of equipment employed, with high-field-strength systems typically providing superior image quality compared to low-field-strength open systems [15].

Investigations

Plain radiography: Conventional radiographs remain critical for the initial evaluation of hip pathology [16] and are appropriate initial imaging studies for most knee conditions [35]. For shoulder assessment, the critical shoulder angle (CSA) on plain radiographs has good diagnostic performance for rotator cuff tears [21] and is associated with rotator cuff tears and shoulder osteoarthritis [41]. Radiographs provide better reproducibility and accuracy for CSA measurement compared to MRI [41]. However, radiographs and MRI scans had substantial limitations and inconsistency between raters in evaluating common markers of hip osteoarthritis [52]. For glenoid wear, the inter-rater agreement between x-ray images and consensus MRI for Walch classification is fair-to-moderate, and the reliability of x-ray for glenoid wear assessment is lower than previously reported reliability using CT scans [46].

MRI: MRI provides superior soft-tissue contrast for intra- and extra-articular assessment of hip pathology [16] and should be obtained at the discretion of the treating clinician based on specific clinical criteria rather than being mandated by insurers for hip arthroscopy [5]. Clinicians should be aware of common anatomic findings on MRI when considering diagnostic and treatment planning for unilateral shoulder pain [8]. MRI provides CT-equivalent measurements of glenoid retroversion, concavity, and BSSR after anterior shoulder dislocation [19] and serves as a viable modality for assessing key bony stability parameters, potentially reducing the need for supplemental CT in many clinical scenarios [19]. However, MRI underestimates lumbar spinal canal cross-sectional area compared to CT in patients with lumbar spinal stenosis [1]. Preoperative MRI scanning identifies a group of patients who have more advanced degenerative joint disease than the clinical assessment and the plain radiographs suggest [55].

CT: Computed tomography is the imaging modality of choice for evaluation of sternoclavicular joint injuries [2] and is the gold standard and most reliable method for closed reduction of posterior sternoclavicular dislocations [18]. A treating clinician may choose to utilize either an MRI or a CT to assess glenoid morphology, glenoid version, and humeral head subluxation [7]. Measurements of glenoid defect can be done with 3D CT scans as well as MRI [53], and differences between 3D CT and 3D MRI regarding surface area and glenoid apposition are small and likely not clinically significant [54]. Advanced imaging techniques, including CT and three-dimensional reconstructions, augment the information obtained from plain radiographs to guide treatment decisions for acetabular fractures [51].

Other Considerations: Radiologic investigations have a tertiary role in diagnosis, and clinicians must rely on thorough history and physical examination rather than MRI alone [4]. A multimodal approach leveraging both MRI and CT is recommended to ensure the most accurate assessment of lumbar spinal stenosis [1]. Specific indications, advantages, and disadvantages exist for radiographs, CT, MRI, and other techniques depending on the spinal pathology [6]. Advanced imaging such as CT, MRI, and nuclear medicine provide enhanced detail for specific soft tissue, bone, and implant assessments of the knee [35]. Consensus was reached for five elements in the x-ray report, twenty in the MRA report, nine in the CT report, and two elements regarding MRA views and settings for anterior shoulder instability [56].

Treatment

Non-Operative

Conservative management is a viable option for specific pathologies; a patient with a persistent avulsion of the teres major tendon on MRI became asymptomatic with conservative management and experienced no subsequent functional impairment during pitching [85]. For symptomatic atraumatic sternoclavicular joint (SCJ) instability confirmed by MRI that has failed appropriate nonoperative treatment, surgical augmentation may be considered, though nonoperative care remains the initial step [91].

Operative

Imaging Modality Selection: The choice of imaging depends on the specific pathology and clinical question. For lumbar spinal stenosis, MRI underestimates the spinal canal cross-sectional area compared to CT, necessitating a multimodal approach leveraging both modalities to ensure the most accurate assessment [1]. In contrast, computed tomography is the imaging modality of choice for evaluation of sternoclavicular joint injuries, where timely recognition and treatment are essential to prevent devastating consequences [2]. For glenohumeral osteoarthritis, CT underestimates rotator cuff pathology, making the combined use of CT and MRI recommended for preoperative planning [13]. Conversely, MRI provides CT-equivalent measurements of glenoid retroversion, concavity, and BSSR after anterior shoulder dislocation, supporting its use as a viable modality for assessing key bony stability parameters and potentially reducing the need for supplemental CT [19]. Clinicians may choose either an MRI or a CT to assess glenoid morphology, glenoid version, and humeral head subluxation [7]. For patients experiencing pain or limited range of motion following primary anatomic or reverse total shoulder arthroplasty, ongoing assessment using additional X-rays, CT scans, or other diagnostic tests is recommended [3]. MRI should be obtained at the discretion of the treating clinician based on specific clinical criteria rather than being mandated by health care insurers for hip arthroscopy [5]. Plain radiographs rarely alter the diagnosis or affect management in the setting of atraumatic shoulder pain, particularly in patients younger than 50 years [14]. Routine PACU radiographs in the absence of a specific indication may result in poor-quality images after shoulder arthroplasty [12], and the lack of clinically meaningful change from routine radiography does not justify the per-patient expense, as almost all postoperative radiographs were read as normal and did not alter postoperative management in routine primary total shoulder arthroplasty [87]. Routine radiographs provide low utility in guiding the course of treatment for asymptomatic pediatric patients following surgery for scoliosis [81]. A non-contrast shoulder MRI obtained in the community setting after non-dislocating shoulder trauma has a moderate sensitivity for most intraarticular pathologies when interpreted by musculoskeletal radiologists [88]. Shoulder ultrasonography performed by orthopedic surgeons increases efficiency in the diagnosis of rotator cuff tears, and the efficacy of determination of rotator cuff tears increases after the introduction of shoulder ultrasonography [61]. The critical shoulder angle (CSA) on plain radiographs has good diagnostic performance for diagnosing rotator cuff tears [21]. Three-dimensional CT imaging is effective and reproducible in determining Hill-Sachs lesion size [49]. Significant differences in bone loss measurement between imaging modality, measurement method, and observers may lead to differences in treatment in up to 34% of cases [20]. Harmonizing imaging acquisition is important for obtaining consistent quantitative imaging features to study tumor imaging phenotype [65]. Quantitative methods need to be considered to increase diagnostic safety for supraspinatus muscle fat measurement, though spectroscopic MR measurement is currently only available in an experimental setting [70]. An understanding of available spine imaging modalities is critical to safely and effectively manage spinal disorders, with specific indications, advantages, and disadvantages existing for radiographs, CT, MRI, and other techniques depending on the spinal pathology [6]. Orthopaedic surgeons should develop a systematic approach to interpreting the entire image and create a discrete plan with radiologists on managing incidental findings on radiographs [89].

Preoperative Planning & Decision Axes: The Glenoid Track concept assessment method is encouraged as a routine part of the preoperative evaluation of all patients under consideration for arthroscopic anterior stabilization [92]. A standardized composite scoring system that combines clinical, imaging, and patient-reported outcomes is needed to determine ideal surgical candidacy and evaluate postoperative outcomes for hip cartilage restoration procedures [67]. Future studies should attempt to identify factors that predict which patients might not respond to nonoperative management and might benefit from early surgical intervention to help reduce costs associated with rotator cuff tear evaluation [84]. Clinical results showed improvements in scores and decreased pain, especially with new repair, in rugby players undergoing shoulder stabilization for glenohumeral instability [63]. Undertaking an augmented capsular plication on patients with symptomatic atraumatic SCJ instability confirmed by MRI imaging that have failed appropriate nonoperative treatment provides a satisfactory result with regard to clinical outcomes and joint stability [91]. The use of ultrasound guidance significantly improves the success rate in acromioclavicular joint injection, and ultrasound guidance is recommended for therapeutic ACJ injections in routine clinical practice [64].

Complications

Imaging Modality Selection and Diagnostic Accuracy: Diagnostic accuracy varies significantly by joint and pathology. For lumbar spinal stenosis, MRI underestimates spinal canal cross-sectional area compared to CT [1], whereas for sternoclavicular (SCJ) joint injuries, CT is the modality of choice to prevent devastating consequences [2]. In SCJ pathology, the prevalence of osteoarthritis on CT must be considered when assessing symptomatic patients [17]. For anterolateral complex injuries, radiologic investigations play a tertiary role; clinicians must rely on thorough history and physical examination rather than MRI alone [4]. Similarly, MRI is not a reliable tool for predicting symptomatic acromioclavicular arthritis [22], and clinicians should correlate MRI findings with medical history and clinical presentation for lumbo-sacral nerve root compromise [9]. In glenohumeral instability, significant differences in bone loss measurement between imaging modalities, methods, and observers may alter treatment in up to 34% of cases [20]. For proximal humerus fracture sequelae, CT scans are more specific than radiographs [93].

Postoperative Surveillance and Follow-up: Routine immediate postoperative radiographs rarely identify unknown complications after shoulder arthroplasty, with a detection rate of only 0.2% [77]. However, ongoing assessment using additional X-rays, CT scans, or other diagnostic tests is recommended for patients experiencing pain or limited range of motion following primary anatomic and reverse total shoulder arthroplasty [3]. Following complex spine surgery, CT scanning is used frequently for follow-up, with prevalence increasing more than two-fold from 6 months to 5 years post-surgery [23]. In posterior lumbar interbody fusion, 18F-fluoride PET/CT performed six weeks postoperatively provides prognostic information on bony fusion at one year [29]. Sequential 3-dimensional CT analysis of implant position after total shoulder arthroplasty raises concern for glenoids at risk of loosening [26].

Limitations of Radiographic Protocols: Radiographic quality and utility are often compromised by technical limitations. A large number of missing or inadequate radiographs led to repeat radiation exposure in patients with adolescent idiopathic scoliosis [83]. Even with a longitudinal protocol, most radiographs are of insufficient quality for Critical Shoulder Angle measurement [86]. All parameters related to history, physical exam, and imaging should be considered according to the patient's age and the number of dislocation episodes for traumatic anterior shoulder instability [25]. Successful care begins with arriving at the proper diagnosis through a thorough history, complete physical examination, and appropriate imaging modalities [24].

Other Considerations: Clinicians should be aware of common anatomic findings on MRI in individuals with unilateral shoulder pain when considering diagnostic and treatment planning [8]. The integrity of the Kaplan fibers should be routinely reviewed on MRI scans [27]. Sole assessment of recurrent dislocation to define natural history and treatment rationale is inadequate, and conclusions regarding treatment recommendations cannot be made from a study that did not compare treatment methods [28].

Recovery

Light activity (weeks): The timeline for resuming light activities such as desk work, driving, and light activities of daily living is not explicitly defined in the provided evidence base. However, successful care for neurologic and musculoskeletal problems begins with arriving at the proper diagnosis through a thorough history, complete physical examination, and appropriate imaging modalities [24]. For patients experiencing pain or limited range of motion following primary anatomic or reverse total shoulder arthroplasty, ongoing assessment using additional X-rays, CT scans, or other diagnostic tests is recommended to guide activity progression [3].

Full activity (months): Patients who underwent coracoclavicular and acromioclavicular ligament reconstruction with a double-bundle semitendinosus autograft and cortical buttons achieved significant improvement in shoulder function without complications related to clinical symptoms after a mean follow-up interval of 31.7 months [97]. Clinical outcomes of reverse total shoulder arthroplasty at a minimum follow-up of 1 year were similar in high- and lower-risk groups regarding baseplate screw penetration [95]. Imaging results showed no significant difference in cuff integrity between single-row and double-row rotator cuff repair groups in patients with any tear size at 6-month and minimum 2-year follow-up [94].

Complete recovery / outcome plateau (months): Muscle atrophy and fatty infiltration are irreversible phenomena that continue even after successful rotator cuff repair, though they do not have a significant influence on the functional outcome at short-term follow-up [90]. Late progression from normal to abnormal or from mild to more severe disease in metal-on-metal total hip replacements is not common and takes place over several years [98]. Patients with a preoperative duration of symptomatic medial knee overload or arthritis of two years or greater do not experience inferior patient-reported outcomes or clinical outcomes than patients with a symptom duration of less than 2 years at mid-term follow-up after high tibial osteotomy [100].

Rehabilitation protocol: The immediate postoperative time point should be considered as the baseline to monitor the true changes of fatty infiltration after arthroscopic rotator cuff repair [99]. For patients with recurrent dislocation, the sole assessment of recurrent dislocation to define natural history and treatment rationale is inadequate, and conclusions regarding treatment recommendations cannot be made from a study that did not compare treatment methods [28]. Sequential 3-dimensional CT analysis of implant position following total shoulder arthroplasty raises concern for glenoids at risk of loosening, though further follow-up is needed to determine the long-term clinical impact of these findings [26].

Functional milestones: The Musculoskeletal Function Assessment Questionnaire was more responsive than the SF-36 and more efficient in measuring changes in function between baseline and follow-up values [96]. 18F-fluoride PET/CT six weeks after posterior lumbar interbody fusion provides prognostic information on bony fusion at one year [29].

Other Considerations: MRI underestimates lumbar spinal canal cross-sectional area compared to CT in patients with lumbar spinal stenosis, and a multimodal approach leveraging both MRI and CT is recommended to ensure the most accurate assessment [1]. Computed tomography is the imaging modality of choice for evaluation of sternoclavicular joint injuries [2]. Radiologic investigations have a tertiary role in diagnosis of anterolateral complex injuries, and clinicians must rely on thorough history and physical examination rather than MRI alone [4]. Clinicians should always correlate the findings of MRI with the patients' medical history and clinical presentation when assessing lumbo-sacral nerve root compromise [9]. MRI scans are not a reliable tool for predicting symptomatic acromioclavicular arthritis, and surgical decision-making for acromioclavicular arthritis should rely on focused history and clinical examination rather than MRI scans [22]. CT scanning is used frequently for follow-up imaging evaluation following complex spine surgery, with the prevalence increasing more than two-fold from 6 months to 5 years post-surgery [23]. All parameters related to history taking, physical exam, and imaging studies for traumatic anterior shoulder instability should be considered according to the patient's age and the number of dislocation episodes [25]. The integrity of the Kaplan fibers should be routinely reviewed on MRI scans [27].

Key Evidence

  • [L4] A multimodal approach leveraging both imaging modalities is recommended to ensure the most accurate assessment. (10.1186/s13018-025-05653-y)
  • [L4] For patients experiencing pain or limited range of motion, ongoing assessment using additional X-rays, computed tomography scans, or other diagnostic tests is recommended for effective monitoring. (10.1016/j.jse.2024.11.010)
  • [Commentary] Radiologic investigations have a tertiary role in diagnosis, and clinicians must rely on thorough history and physical examination rather than MRI alone. (10.1016/j.arthro.2020.01.040)
  • [L5] The author concludes that MRI should be obtained at the discretion of the treating clinician based on specific clinical criteria rather than being mandated by insurers. (10.1016/j.arthro.2022.04.009)
  • [L4] Based on these data, a treating clinician may choose to utilize either an MRI or a CT to assess these parameters. (10.1177/1758573218768507)
  • [L3] Clinicians should be aware of the common anatomic findings on MRI when considering diagnostic and treatment planning. (10.1016/j.jse.2019.04.001)
  • [L1] Therefore, clinicians should always correlate the findings of MRI with the patients' medical history and clinical presentation in clinical decision making. (10.1186/s12891-016-1236-z)
  • [L4] Optimum patient care might require the development of new imaging modalities rather than new classification systems. (10.2106/00004623-199609000-00012)
  • [L2] CT diagnostics allowed a significantly better assessment of relevant structures than conventional diagnostics. (10.1186/1471-2474-10-33)
  • [L3] Routine PACU radiographs, in the absence of a specific indication, may result in poor-quality images. (10.1007/s11999-012-2551-9)
  • [L3] The authors recommend the combined use of CT and MRI for preoperative planning. (10.1016/j.jse.2018.02.034)
  • [L2] Plain radiographs rarely alter the diagnosis or affect management in the setting of atraumatic shoulder pain, particularly in patients younger than 50 years. (10.5435/jaaos-d-16-00884)
  • [L5] The quality of images and their usefulness are markedly affected by the type of equipment employed, with high-field-strength systems typically providing superior image quality compared to low-field-strength open systems. (10.2106/00004623-199706000-00019)
  • [L3] This should be taken into consideration when using a CT scan to assess a patient with symptomatic SCJ pathology. (10.1016/j.jse.2016.04.029)
  • [L4] CT is the gold standard, making this the most reliable method until further research establishes other modalities. (10.1016/j.jse.2011.07.015)
  • [L3] These findings support MRI as a viable modality for assessing key bony stability parameters, potentially reducing the need for supplemental CT in many clinical scenarios. (10.1016/j.jse.2026.03.004)
  • [L3] The significant differences in bone loss measurement between imaging modality, measurement method, and observers may lead to differences in treatment in up to 34% of cases. (10.1016/j.arthro.2019.06.025)
  • [L1] CSA on plain radiographs has good diagnostic performance for RCTs. (10.1007/s00167-018-5247-1)
  • [L3] Surgical decision-making should rely on focused history and clinical examination rather than MRI scans. (10.1177/1758573217724080)
  • [L3] CT scanning is used frequently for follow-up imaging evaluation following complex spine surgery, with prevalence increasing more than two-fold from 6 months to 5 years post-surgery. (10.1186/s12891-017-1420-9)
  • [L2] All parameters related to history taking, physical exam and imaging studies should be considered according to the patient's age and the number of dislocation episodes. (10.1002/ksa.70336)
  • [L2] These findings raise concern for glenoids at risk of loosening, but further follow-up is needed to determine the long-term clinical impact of these findings. (10.1016/j.jse.2017.12.012)
  • [L5] The integrity of the Kaplan fibers should be routinely reviewed on MRI scans. (10.1177/0363546520919986)
  • [Letter] The sole assessment of recurrent dislocation to define natural history and treatment rationale is inadequate, and conclusions regarding treatment recommendations cannot be made from a study that did not compare treatment methods. (10.1177/0363546510379343)
  • [L2] 18F-fluoride PET/CT six weeks after PLIF provides prognostic information on bony fusion at one year. (10.1186/s13018-025-05814-z)
  • [L2] A simplification of the MRI classification system is proposed that takes into consideration the variability determined by this study. (10.1177/0363546512452714)
  • [L4] Alterations of scapular kinematics in symptomatic subjects are multifactorial. (10.1016/j.jse.2015.04.007)
  • [L4] Classification using MRa resulted in significant disagreement between and within raters. (10.1016/j.jseint.2024.06.009)
  • [L4] Surgery and histologic examination should be performed only when there are significant symptoms or when MRI findings are controversial. (10.1016/j.jse.2012.02.005)
  • [L4] Although the modified Walch classification represents an improvement over the original classification, automated computer-based analysis of CT scans may be needed to further improve the value of this classification. (10.1016/j.jse.2018.09.021)
  • [L4] Results can help guide clinicians in interpreting MRI findings and differentiating age-related variations from true pathology. (10.1016/j.jse.2019.05.006)
  • [L2] It had better ability to rule in a diagnosis but slightly worse ability to rule out a diagnosis compared with MRI. (10.1016/j.arthro.2021.03.006)
  • [L3] The clinical utility of the lateral scapular view may need to be reassessed in this setting. (10.1016/j.xrrt.2022.01.001)
  • [L3] Radiographs provide better reproducibility and accuracy for CSA measurement compared to MRI. (10.1007/s00167-015-3587-7)
  • [L4] The humeral head moves from an inferior position to the center of the glenoid during active arm abduction, with kinematic variability decreasing significantly as abduction increases. (10.1016/j.jse.2007.05.018)
  • [L4] It has good intra- and inter-observer reliability, as well as good correlation between the results of classification by plain radiographs and CT images. (10.1302/0301-620x.98b3.36664)
  • [L2] The results indicate that MRI is the preferred strategy based on cost-effectiveness criteria, although the decision between MRI and ultrasound for an imaging center is likely to be dependent on additional factors, such as available resources and workflow. (10.1016/j.jse.2017.07.012)
  • [L3] The acromial morphology classification system is an unreliable method to assess the acromion, and the acromial index shows no association with the presence of rotator cuff disease. (10.1016/j.jse.2011.09.028)
  • [L3] The inter-rater agreement between x-ray images and consensus MRI is fair-to-moderate, which is lower than previously reported reliability using CT scans. (10.1016/j.jse.2017.03.014)
  • [L3] Despite rigorous training methodology based on CT imaging with multi-rater consensus to serve as the reference standard, artificial intelligence-driven classification is insufficient for clinical implementation. (10.1302/0301-620x.106b11.bjj-2024-0264.r1)
  • [L2] We suggest adding the SHART test to conventional preoperative imaging techniques. (10.1007/s00167-011-1438-8)
  • [L5] The 3D CT imaging is effective and reproducible in determining lesion size. (10.1016/j.jse.2017.09.007)
  • [L5] In the context of a clinical model of fatigue, these scapular exercises resulted in superior migration of the humeral head and alterations in shoulder kinematics on radiographic analysis in healthy subjects. (10.1016/j.jse.2008.09.010)
  • [L5] Advanced imaging techniques, including CT and three-dimensional reconstructions, augment the information obtained from plain radiographs to guide treatment decisions. (10.5435/jaaos-d-15-00666)
  • [L3] Radiographs and MRI scans had substantial limitations and inconsistency between raters in evaluating common markers of hip osteoarthritis. (10.1177/03635465231167866)
  • [L5] Measurements can be done with 3D CT scans as well as MRI. (10.1016/j.jse.2007.02.115)
  • [L4] Differences between 3D CT and 3D MRI were small and likely not clinically significant. (10.1177/03635465231157430)
  • [L2] Preoperative MRI scanning identifies a group of patients who have more advanced degenerative joint disease than the clinical assessment and the plain radiographs suggest. (10.1016/j.arthro.2008.10.020)
  • [L5] Consensus was reached for five elements in the x-ray report, twenty in the MRA report, nine in the CT report, and two elements regarding MRA views and settings. (10.1016/j.jseint.2024.03.012)
  • [L2] Clinical scores using a single image slice do not represent 3-dimensional muscle measurements. (10.1016/j.arthro.2015.06.035)
  • [L3] This study validates an MRI-based sMCL classification system for locating high-grade sMCL tears with excellent reliability. (10.1177/03635465251330005)
  • [L5] Kinematic analysis of patients with rotator cuff tears shows unexpected inferior, rather than superior, translation of the humeral head; this paradox challenges conventional thought, but limitations addressed by the authors temper the results and leave the question open for future study. (10.1016/j.arthro.2015.12.031)
  • [L3] Active motion was an important determinant of patient-assessed shoulder function. (10.1016/j.jse.2015.07.011)
  • [L4] The efficacy of determination of rotator cuff tears will also increase after the introduction of shoulder ultrasonography. (10.1186/s13018-017-0565-4)
  • [L4] There are 16 categories within the FEDS classification that are clinically significant. (10.1016/j.jse.2018.08.014)
  • [L4] Clinical results showed improvements in scores and decreased pain, especially with new repair. (10.1016/j.jse.2021.03.119)
  • [L5] The use of US guidance significantly improves the success rate in ACJ injection, and we recommend it for therapeutic ACJ injections in routine clinical practice. (10.1016/j.jse.2011.11.036)
  • [L4] Our findings highlight the importance of harmonizing imaging acquisition for obtaining consistent QIFs to study tumor imaging phenotype. (10.1371/journal.pone.0166550)
  • [L3] Despite previous biomechanical studies' predictions that inferiorly tilting the glenosphere might reduce inferior scapular neck impingement and subsequent scapular notching, our data showed no difference at 1-year follow-up. (10.1016/j.jse.2010.11.026)
  • [Commentary] The review demonstrates the importance of further evaluating the clinical utility of various cartilage restoration procedures in the hip and highlights the need for a standardized composite scoring system that combines clinical, imaging, and patient-reported outcomes to determine ideal surgical candidacy and evaluate postoperative outcomes. (10.1016/j.arthro.2023.06.058)
  • [L5] These positions were determined by evaluating elastic characteristics in various glenohumeral elevation planes and angles. (10.1016/j.jse.2020.08.021)
  • [L4] The 'long axis' measurement has clear potential benefits over traditional classification systems which should be explored in future clinical research. (10.1186/s12891-018-2236-y)
  • [L3] Quantitative methods need to be considered to increase diagnostic safety, though spectroscopic MR measurement is currently only available in an experimental setting. (10.1186/s12891-016-1216-3)
  • [L3] This discrepancy is mainly explained by the difficulty in orienting the glenoid in the sagittal plane before any other parameter is measured. (10.1016/j.jse.2016.12.067)
  • [L5] 2D-pose based estimates of shoulder ROM were consistent with visual estimates for most movements, though discrepancies existed at specific ROM levels and between observers. (10.1016/j.jseint.2025.05.026)
  • [L4] The present study revealed the glenohumeral geometry in the normal Japanese population. (10.1016/j.jse.2015.08.003)
  • [L5] The critical shoulder angle was unaffected by demographic factors. (10.1016/j.jse.2014.10.021)
  • [L4] Acromial projection allows for reproducible, non-invasive dynamic video motion capture of the scapula. (10.1111/sae.12008)
  • [L3] Our findings do not support that abnormal passive shoulder motions precede development of impingement syndrome. (10.1016/j.jse.2007.09.001)
  • [L4] The radiology reports of routine immediate postoperative radiographs rarely identified postoperative complications (0.2%). (10.1016/j.jse.2022.10.027)
  • [L3] However, it is not related to any restriction in shoulder function. (10.1016/j.jse.2020.12.017)
  • [L4] These findings suggest that the novel 3D volumetric measurement modality may provide a more accurate preoperative assessment of RC pathology and global shoulder function. (10.1177/2325967123s00073)
  • [L3] Both techniques significantly improved shoulder function and are relatively safe procedures. (10.1016/j.jse.2019.09.035)
  • [L4] Routine radiographs provide low utility in guiding the course of treatment for asymptomatic pediatric patients following surgery for scoliosis. (10.2106/jbjs.l.01357)
  • [L3] On the basis of this finding, we now take glenohumeral internal rotation measurements with the shoulder in abduction and use a goniometer to maximize accuracy and objectivity. (10.1016/j.jse.2013.12.015)
  • [L4] A large number of missing or inadequate radiographs led to repeat radiation exposure in this cohort. (10.5435/jaaos-d-17-00142)
  • [L4] To help reduce costs, future studies should attempt to identify the factors that predict which patients might not respond to nonoperative management and might benefit from early surgical intervention. (10.1016/j.jse.2013.08.003)
  • [L4] The patient became asymptomatic with conservative management despite persistent avulsion of the teres major tendon on MRI, experiencing no subsequent functional impairment during pitching. (10.1177/03635465990270012401)
  • [L2] Even with a longitudinal protocol, most radiographs are of insufficient quality for CSA measurement. (10.1007/s11999-017-5249-1)
  • [L4] The lack of clinically meaningful change from routine radiography does not justify the per-patient expense, as almost all postoperative radiographs were read as normal and did not alter postoperative management. (10.1016/j.jse.2016.11.035)
  • [L4] A non-contrast shoulder MRI obtained in the community setting after non-dislocating shoulder trauma has a moderate sensitivity for most intraarticular pathologies when interpreted by musculoskeletal radiologists. (10.1007/s00167-014-3102-6)
  • [L3] Orthopaedic surgeons should develop a systematic approach to interpreting the entire image and create a discrete plan with radiologists on managing incidental findings. (10.5435/jaaos-d-19-00236)
  • [L4] Muscle atrophy and fatty infiltration are irreversible phenomena that continue even after successful repair; however, they do not have a significant influence on the functional outcome at short-term follow-up after cuff repair. (10.1016/j.jse.2020.03.040)
  • [L4] Undertaking an augmented capsular plication on patients with symptomatic atraumatic SCJ instability confirmed by MRI imaging that have failed appropriate nonoperative treatment provides a satisfactory result with regard to clinical outcomes and joint stability. (10.1016/j.jse.2025.06.003)
  • [L3] This method of assessment is encouraged as a routine part of the preoperative evaluation of all patients under consideration for arthroscopic anterior stabilization. (10.2106/jbjs.15.01099)
  • [L2] Computed tomography scan was more specific than radiographs in the assessment of proximal humerus fracture sequelae. (10.1177/17585732221150785)
  • [L2] However, the imaging results showed no significant difference in cuff integrity in both groups in patients with any tear size at 6-month and minimum 2-year follow-up. (10.1016/j.arthro.2011.07.003)
  • [L3] However, the clinical outcomes of RTSA at a minimum follow-up of 1 year were similar in the high- and lower-risk groups. (10.1016/j.jse.2021.10.024)
  • [L3] It was more responsive than the SF-36 and more efficient in measuring changes in function between baseline and follow-up values. (10.2106/00004623-199709000-00006)
  • [L4] Patients who underwent the index procedure achieved significant improvement in shoulder function without complications related clinical symptom after a mean follow-up interval of 31.7 months. (10.1016/j.jse.2024.01.019)
  • [L4] Late progression from normal to abnormal or from mild to more severe disease is not common and takes place over several years. (10.1302/0301-620x.95b8.31377)
  • [L3] The immediate postoperative time point should be considered as the baseline to monitor the true changes of fatty infiltration after repair. (10.1007/s00167-017-4604-9)
  • [L4] Patients with a preoperative duration of symptomatic medial knee overload/arthritis of two years or greater do not experience inferior PRO or clinical outcomes than patients with a symptom duration of less than 2 years at mid-term follow-up. (10.1016/j.jisako.2022.03.003)

See Also

References

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[2] 19. Epidemiology, Clinical Evaluation, Imaging, and Classification of Sternoclavicular Joint Injuries. n.d..

[3] Utility of radiographs for asymptomatic patients following primary anatomic and reverse total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.11.010

[4] Editorial Commentary: Magnetic Resonance Imaging Evaluation of the Anterolateral Complex—Is Seeing Really Believing?. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2020. DOI: 10.1016/j.arthro.2020.01.040

[5] Editorial Commentary: Routine Preoperative Magnetic Resonance Imaging for Hip Arthroscopy Is Wasting Health Care Dollars and Delaying Surgical Intervention: Decision Making Should Be at the Discretion of the Health Care Provider Not Mandated by Health Care Insurers. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2022.04.009

[6] Chapter 22 Imaging of the Spine. 2019.

[7] Interobserver and intraobserver comparison of imaging glenoid morphology, glenoid version and humeral head subluxation. Shoulder & Elbow. 2018. DOI: 10.1177/1758573218768507

[8] Bilateral magnetic resonance imaging findings in individuals with unilateral shoulder pain. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2019.04.001

[9] Accuracy of magnetic resonance imaging in detecting lumbo-sacral nerve root compromise: a systematic literature review. BMC Musculoskeletal Disorders. 2016. DOI: 10.1186/s12891-016-1236-z

[10] Evaluation of the Neer System of Classification of Proximal Humeral Fractures with Computerized Tomographic Scans and Plain Radiographs. The Journal of Bone & Joint Surgery*. 1996. DOI: 10.2106/00004623-199609000-00012

[11] Indications for computed tomography (CT-) diagnostics in proximal humeral fractures: a comparative study of plain radiography and computed tomography. BMC Musculoskeletal Disorders. 2009. DOI: 10.1186/1471-2474-10-33

[12] Immediate Postoperative Radiographs After Shoulder Arthroplasty Are Often Poor Quality and Do Not Alter Care. Clinical Orthopaedics & Related Research. 2013. DOI: 10.1007/s11999-012-2551-9

[13] Computed tomography underestimates rotator cuff pathology in patients with glenohumeral osteoarthritis. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2018.02.034

[14] Routine Plain Radiographs in the Setting of Atraumatic Shoulder Pain: Are They Useful?. Journal of the American Academy of Orthopaedic Surgeons. 2018. DOI: 10.5435/jaaos-d-16-00884

[15] Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Magnetic Resonance Imaging of the Shoulder†. The Journal of Bone & Joint Surgery*. 1997. DOI: 10.2106/00004623-199706000-00019

[16] Chapter 58 Imaging of the Hip. 2019.

[17] The prevalence of osteoarthritis of the sternoclavicular joint on computed tomography. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.04.029

[18] Use of an O-arm intraoperative computed tomography scanner for closed reduction of posterior sternoclavicular dislocations. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2011.07.015

[19] MRI Provides CT-Equivalent Measurements of Glenoid Retroversion, Concavity, and BSSR After Anterior Shoulder Dislocation. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.03.004

[20] Does Bone Loss Imaging Modality, Measurement Methodology, and Interobserver Reliability Alter Treatment in Glenohumeral Instability?. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2020. DOI: 10.1016/j.arthro.2019.06.025

[21] High performance of critical shoulder angle for diagnosing rotator cuff tears on radiographs. Knee Surgery, Sports Traumatology, Arthroscopy. 2018. DOI: 10.1007/s00167-018-5247-1

[22] Magnetic resonance imaging scans are not a reliable tool for predicting symptomatic acromioclavicular arthritis. Shoulder & Elbow. 2017. DOI: 10.1177/1758573217724080

[23] Utilization of CT scanning associated with complex spine surgery. BMC Musculoskeletal Disorders. 2017. DOI: 10.1186/s12891-017-1420-9

[24] Chapter 47 Spine Evaluation, Clinical Examination, and Imaging. 2020.

[25] Age‐ and time‐specific management of traumatic anterior shoulder instability: The 2024 ESSKA‐ESA formal consensus. Part 1: History taking, physical exam and imaging studies. Knee Surgery, Sports Traumatology, Arthroscopy. 2026. DOI: 10.1002/ksa.70336

[26] Sequential 3-dimensional computed tomography analysis of implant position following total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2017.12.012

[27] Visualization of Proximal and Distal Kaplan Fibers Using 3-Dimensional Magnetic Resonance Imaging and Anatomic Dissection. The American Journal of Sports Medicine. 2020. DOI: 10.1177/0363546520919986

[28] Letter to the Editor. The American Journal of Sports Medicine. 2010. DOI: 10.1177/0363546510379343

[29] 18F-fluoride PET/CT as an early predictor of bony fusion after posterior lumbar interbody fusion– a prospective study. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-05814-z

[30] Interobserver and Intraobserver Reliability of the Goutallier Classification Using Magnetic Resonance Imaging. The American Journal of Sports Medicine. 2012. DOI: 10.1177/0363546512452714

[31] Chapter 23 Shoulder Anatomy and Biomechanics, Clinical Evaluation, Imaging. 2020.

[32] 3D scapular orientation on healthy and pathologic subjects using stereoradiographs during arm elevation. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.04.007

[33] Inter-rater and intrarater reliability of superior labrum anterior to posterior lesion classification using magnetic resonance arthrography. JSES International. 2024. DOI: 10.1016/j.jseint.2024.06.009

[34] Sensitivity and positive predictive value of magnetic resonance imaging in the diagnosis of elastofibroma dorsi: review of fourteen cases. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2012.02.005

[35] Chapter 47 Radiographic Evaluation and Surgical Anatomy of the Knee. 2019.

[36] Intraobserver and interobserver reliability of the modified Walch classification using radiographs and computed tomography. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2018.09.021

[37] Chapter 41 Radiographic Evaluation of the Hip. 2019.

[38] Variations of magnetic resonance imaging findings in asymptomatic elbows. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2019.05.006

[39] Needle Diagnostic Arthroscopy and Magnetic Resonance Imaging of the Shoulder Have Comparable Accuracy With Surgical Arthroscopy: A Prospective Clinical Trial. Arthroscopy. 2021. DOI: 10.1016/j.arthro.2021.03.006

[40] Utility of lateral scapular radiographs in initial evaluation of nontraumatic shoulder conditions. JSES Reviews, Reports, and Techniques. 2022. DOI: 10.1016/j.xrrt.2022.01.001

[41] The critical shoulder angle is associated with rotator cuff tears and shoulder osteoarthritis and is better assessed with radiographs over MRI. Knee Surgery, Sports Traumatology, Arthroscopy. 2015. DOI: 10.1007/s00167-015-3587-7

[42] Determination of in vivo glenohumeral translation using fluoroscopy and shape-matching techniques. Journal of Shoulder and Elbow Surgery. 2008. DOI: 10.1016/j.jse.2007.05.018

[43] A new classification of glenoid bone loss to help plan the implantation of a glenoid component before revision arthroplasty of the shoulder. The Bone & Joint Journal. 2016. DOI: 10.1302/0301-620x.98b3.36664

[44] Cost-effectiveness of magnetic resonance imaging versus ultrasound for the detection of symptomatic full-thickness supraspinatus tendon tears. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2017.07.012

[45] Relationship of radiographic acromial characteristics and rotator cuff disease: a prospective investigation of clinical, radiographic, and sonographic findings. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2011.09.028

[46] Can glenoid wear be accurately assessed using x-ray imaging? Evaluating agreement of x-ray and magnetic resonance imaging (MRI) Walch classification. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2017.03.014

[47] Detection, classification, and characterization of proximal humerus fractures on plain radiographs. The Bone & Joint Journal. 2024. DOI: 10.1302/0301-620x.106b11.bjj-2024-0264.r1

[48] SHART: shoulder hyperabduction radiological test. Knee Surgery, Sports Traumatology, Arthroscopy. 2011. DOI: 10.1007/s00167-011-1438-8

[49] Three-dimensional computed tomography measurement accuracy of varying Hill-Sachs lesion size. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2017.09.007

[50] Radiographic analysis of commonly prescribed scapular exercises. Journal of Shoulder and Elbow Surgery. 2009. DOI: 10.1016/j.jse.2008.09.010

[51] Radiographic Evaluation of Acetabular Fractures: Review and Update on Methodology. Journal of the American Academy of Orthopaedic Surgeons. 2018. DOI: 10.5435/jaaos-d-15-00666

[52] MRI Does Not Improve Inter- or Intrarater Reliability for Hip Arthritis Grading Systems. The American Journal of Sports Medicine. 2023. DOI: 10.1177/03635465231167866

[53] Quantification of a glenoid defect with three-dimensional computed tomography and magnetic resonance imaging: A cadaveric study. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2007.02.115

[54] Distal Clavicle Autograft Versus Traditional and Congruent Arc Latarjet Procedures: A Comparison of Surface Area and Glenoid Apposition With 3-Dimensional Computed Tomography and 3-Dimensional Magnetic Resonance Imaging. The American Journal of Sports Medicine. 2023. DOI: 10.1177/03635465231157430

[55] The Accuracy of Magnetic Resonance Imaging Scanning and Its Influence on Management Decisions in Knee Surgery. Arthroscopy. 2009. DOI: 10.1016/j.arthro.2008.10.020

[56] Substantial variability in what is considered important in the radiological report for anterior shoulder instability: a Delphi study with Dutch musculoskeletal radiologists and orthopedic surgeons. JSES International. 2024. DOI: 10.1016/j.jseint.2024.03.012

[57] Assessments of Fatty Infiltration and Muscle Atrophy From a Single Magnetic Resonance Image Slice Are Not Predictive of 3‐Dimensional Measurements. Arthroscopy. 2015. DOI: 10.1016/j.arthro.2015.06.035

[58] Tear Location of Superficial Medial Collateral Ligament Tears: Validation of a Magnetic Resonance Imaging–Based Classification System. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465251330005

[59] Editorial Commentary: Results of Biplanar Fluoroscopy With 3‐Dimensional Analysis in Patients With Rotator Cuff Tears Challenge the Concept of Superior Translation of the Humeral Head and Must Be Interpreted With Caution. Arthroscopy. 2016. DOI: 10.1016/j.arthro.2015.12.031

[60] Measurement of active shoulder motion using the Kinect, a commercially available infrared position detection system. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.07.011

[61] Shoulder ultrasonography performed by orthopedic surgeons increases efficiency in diagnosis of rotator cuff tears. Journal of Orthopaedic Surgery and Research. 2017. DOI: 10.1186/s13018-017-0565-4

[62] Epidemiology of the Frequency, Etiology, Direction, and Severity (FEDS) system for classifying glenohumeral instability. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2018.08.014

[63] Magnetic Resonance Arthrography Findings in Rugby Players Undergoing Shoulder Stabilization for Glenohumeral Instability. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2021.03.119

[64] The influence of ultrasound guidance in the rate of success of acromioclavicular joint injection: an experimental study on human cadavers. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2011.11.036

[65] Assessing Agreement between Radiomic Features Computed for Multiple CT Imaging Settings. PLOS ONE. 2016. DOI: 10.1371/journal.pone.0166550

[66] A radiographic analysis of the effects of glenosphere position on scapular notching following reverse total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2010.11.026

[67] Editorial Commentary: Standardized Evaluation of Cartilage Damage and Restoration in Hip Arthroscopy Requires Consideration of Clinical, Imaging, and Patient-Reported Outcomes. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2024. DOI: 10.1016/j.arthro.2023.06.058

[68] Effective stretching positions for the posterior shoulder capsule as determined by shear wave elastography. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2020.08.021

[69] A new acute scaphoid fracture assessment method: a reliability study of the ‘long axis’ measurement. BMC Musculoskeletal Disorders. 2018. DOI: 10.1186/s12891-018-2236-y

[70] Comparing the MRI-based Goutallier Classification to an experimental quantitative MR spectroscopic fat measurement of the supraspinatus muscle. BMC Musculoskeletal Disorders. 2016. DOI: 10.1186/s12891-016-1216-3

[71] Is the two-dimensional computed tomography scan analysis reliable for coracoid graft positioning in Latarjet procedures?. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.12.067

[72] How do visual and smartphone camera-based shoulder ranges of motion compare?. JSES International. 2025. DOI: 10.1016/j.jseint.2025.05.026

[73] Three-dimensional anthropometric analysis of the glenohumeral joint in a normal Japanese population. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.08.003

[74] The influence of radiographic viewing perspective and demographics on the critical shoulder angle. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2014.10.021

[75] Measuring Scapular Movement Using Three-Dimensional Acromial Projection. Shoulder & Elbow. 2013. DOI: 10.1111/sae.12008

[76] Kinematic evaluation of the Hawkins and Neer sign. Journal of Shoulder and Elbow Surgery. 2008. DOI: 10.1016/j.jse.2007.09.001

[77] Routine immediate postoperative radiographs rarely identify unknown complications after shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2022.10.027

[78] Impact of 30 years’ high-level rock climbing on the shoulder: an magnetic resonance imaging study of 31 climbers. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2020.12.017

[79] Paper 48: Association of 3D MRI Volumetric Assessment of Rotator Cuff Pathology with Preoperative Patient Reported Outcomes. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/2325967123s00073

[80] Retrospective review of open and arthroscopic repair of anterosuperior rotator cuff tears with subscapularis involvement: a single surgeon's experience. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.09.035

[81] Utility of Postoperative Radiographs for Pediatric Scoliosis. Journal of Bone and Joint Surgery. 2014. DOI: 10.2106/jbjs.l.01357

[82] Accuracy and reliability testing of two methods to measure internal rotation of the glenohumeral joint. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2013.12.015

[83] Radiographic Resource Utilization in the Initial Referral and Evaluation of Patients With Adolescent Idiopathic Scoliosis. Journal of the American Academy of Orthopaedic Surgeons. 2018. DOI: 10.5435/jaaos-d-17-00142

[84] The costs associated with the evaluation of rotator cuff tears before surgical repair. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2013.08.003

[85] Magnetic Resonance Imaging Appearance of Teres Major Tendon Injury in a Baseball Pitcher. The American Journal of Sports Medicine. 1999. DOI: 10.1177/03635465990270012401

[86] Does the Critical Shoulder Angle Correlate With Rotator Cuff Tear Progression?. Clinical Orthopaedics & Related Research. 2017. DOI: 10.1007/s11999-017-5249-1

[87] Utility of postoperative radiography in routine primary total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.11.035

[88] Moderate value of non‐contrast magnetic resonance imaging after non‐dislocating shoulder trauma. Knee Surgery, Sports Traumatology, Arthroscopy. 2014. DOI: 10.1007/s00167-014-3102-6

[89] Prevalence of Incidental Benign and Malignant Lesions on Radiographs Ordered by Orthopaedic Surgeons. Journal of the American Academy of Orthopaedic Surgeons. 2020. DOI: 10.5435/jaaos-d-19-00236

[90] Does change in occupancy ratio and fatty infiltration of the supraspinatus influence functional outcome after single-row rotator cuff repair? A magnetic resonance imaging–based study. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.03.040

[91] Augmented anterior capsular plication for type II atraumatic anterior sternoclavicular joint instability refractory to nonoperative treatment based on structural anatomic MRI findings. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.06.003

[92] Clinical Validation of the Glenoid Track Concept in Anterior Glenohumeral Instability. Journal of Bone and Joint Surgery. 2016. DOI: 10.2106/jbjs.15.01099

[93] Computed tomography improves the diagnostic accuracy but not the interobserver reliability of the Boileau classification of proximal humerus fracture sequelae. Shoulder & Elbow. 2023. DOI: 10.1177/17585732221150785

[94] Clinical Outcome and Imaging of Arthroscopic Single‐Row and Double‐Row Rotator Cuff Repair: A Prospective Randomized Trial. Arthroscopy. 2011. DOI: 10.1016/j.arthro.2011.07.003

[95] Three-dimensional analysis of baseplate screw penetration in reverse total shoulder arthroplasty: risk of iatrogenic suprascapular neuropathy by screw violation. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2021.10.024

[96] Comparison of the Musculoskeletal Function Assessment Questionnaire with the Short Form-36, the Western Ontario and McMaster Universities Osteoarthritis Index, and the Sickness Impact Profile Health-Status Measures. The Journal of Bone and Joint Surgery (American Volume)*. 1997. DOI: 10.2106/00004623-199709000-00006

[97] Coracoclavicular and acromioclavicular ligament reconstruction with a double-bundle semitendinosus autograft and cortical buttons for chronic acromioclavicular joint dislocations: clinical and imaging outcomes. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2024.01.019

[98] Serial magnetic resonance imaging of metal-on-metal total hip replacements. The Bone & Joint Journal. 2013. DOI: 10.1302/0301-620x.95b8.31377

[99] Changes of fatty infiltration according to the immediate postoperative time point in magnetic resonance imaging after arthroscopic rotator cuff repair. Knee Surgery, Sports Traumatology, Arthroscopy. 2017. DOI: 10.1007/s00167-017-4604-9

[100] Preoperative symptom duration does not affect clinical outcomes after high tibial osteotomy at a minimum of 2-year follow-up. Journal of ISAKOS. 2022. DOI: 10.1016/j.jisako.2022.03.003

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e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.