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Shoulder Pain-Atraumatic
Variant 1: Atraumatic shoulder pain. Initial imaging.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
| Radiography shoulder | Usually appropriate | ☢ <0.1 mSv | 9 | 9 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 16 | ||
| CT arthrography shoulder | Usually not appropriate | ☢☢☢☢ 10-30 mSv | 1 | 1 | 15 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| CT shoulder with IV contrast | Usually not appropriate | ☢☢☢ 1-10 mSv | 1 | 1 | 15 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| CT shoulder without IV contrast | Usually not appropriate | ☢☢☢ 1-10 mSv | 1 | 1 | 13 | 1 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | ||
| CT shoulder without and with IV contrast | Usually not appropriate | ☢☢☢ 1-10 mSv | 1 | 1 | 16 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| X-ray arthrography shoulder | Usually not appropriate | ☢ <0.1 mSv | 1 | 1 | 16 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| MR arthrography shoulder | Usually not appropriate | O 0 mSv | O 0 mSv [ped] | 1 | 1 | 14 | 0 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | |
| MRI shoulder without IV contrast | Usually not appropriate | O 0 mSv | O 0 mSv [ped] | 1 | 1 | 12 | 0 | 0 | 1 | 1 | 2 | 0 | 0 | 0 | |
| MRI shoulder without and with IV contrast | Usually not appropriate | O 0 mSv | O 0 mSv [ped] | 1 | 1 | 14 | 0 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | |
| US shoulder | Usually not appropriate | O 0 mSv | O 0 mSv [ped] | 1 | 1 | 12 | 1 | 1 | 1 | 0 | 1 | 0 | 0 | 0 | |
Variant 2: Atraumatic shoulder pain. Suspect rotator cuff disorders (tendinosis, tear, calcific tendinitis). Initial radiographs normal or inconclusive. Next imaging study.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
| MRI shoulder without IV contrast | Usually appropriate | O 0 mSv | O 0 mSv [ped] | 9 | 9 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 3 | 13 | |
| US shoulder | Usually appropriate | O 0 mSv | O 0 mSv [ped] | 8 | 8 | 1 | 0 | 0 | 0 | 2 | 0 | 3 | 4 | 6 | |
| MR arthrography shoulder | May be appropriate | O 0 mSv | O 0 mSv [ped] | 6 | 6 | 0 | 0 | 2 | 0 | 6 | 5 | 2 | 0 | 1 | |
| CT arthrography shoulder | May be appropriate | ☢☢☢☢ 10-30 mSv | 5 | 5 | 0 | 0 | 0 | 2 | 12 | 2 | 0 | 0 | 0 | ||
| Radiography shoulder additional views | Usually not appropriate | ☢ <0.1 mSv | 2 | 2 | 7 | 5 | 0 | 0 | 3 | 0 | 0 | 0 | 1 | ||
| CT shoulder with IV contrast | Usually not appropriate | ☢☢☢ 1-10 mSv | 1 | 1 | 15 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| CT shoulder without IV contrast | Usually not appropriate | ☢☢☢ 1-10 mSv | 1 | 1 | 10 | 1 | 1 | 0 | 2 | 1 | 1 | 0 | 0 | ||
| CT shoulder without and with IV contrast | Usually not appropriate | ☢☢☢ 1-10 mSv | 1 | 1 | 16 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| X-ray arthrography shoulder | Usually not appropriate | ☢ <0.1 mSv | 1 | 1 | 9 | 1 | 0 | 4 | 1 | 0 | 1 | 0 | 0 | ||
| MRI shoulder without and with IV contrast | Usually not appropriate | O 0 mSv | O 0 mSv [ped] | 1 | 1 | 14 | 0 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | |
Variant 3: Atraumatic shoulder pain. Suspect labral tear and instability. Initial radiographs normal or inconclusive. Next imaging study.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
| MR arthrography shoulder | Usually appropriate | O 0 mSv | O 0 mSv [ped] | 9 | 9 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 3 | 12 | |
| MRI shoulder without IV contrast | Usually appropriate | O 0 mSv | O 0 mSv [ped] | 8 | 8 | 1 | 0 | 0 | 0 | 2 | 1 | 4 | 4 | 4 | |
| CT arthrography shoulder | May be appropriate | ☢☢☢☢ 10-30 mSv | 6 | 6 | 0 | 0 | 0 | 0 | 7 | 8 | 1 | 0 | 0 | ||
| CT shoulder with IV contrast | Usually not appropriate | ☢☢☢ 1-10 mSv | 1 | 1 | 15 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| CT shoulder without IV contrast | Usually not appropriate | ☢☢☢ 1-10 mSv | 1 | 1 | 14 | 0 | 1 | 0 | 0 | 0 | 1 | 0 | 0 | ||
| CT shoulder without and with IV contrast | Usually not appropriate | ☢☢☢ 1-10 mSv | 1 | 1 | 15 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| X-ray arthrography shoulder | Usually not appropriate | ☢ <0.1 mSv | 1 | 1 | 14 | 1 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | ||
| MRI shoulder without and with IV contrast | Usually not appropriate | O 0 mSv | O 0 mSv [ped] | 1 | 1 | 14 | 0 | 2 | 0 | 0 | 0 | 0 | 0 | 0 | |
| US shoulder | Usually not appropriate | O 0 mSv | O 0 mSv [ped] | 1 | 1 | 10 | 1 | 1 | 2 | 2 | 0 | 0 | 0 | 0 | |
| Radiography shoulder additional views | Usually not appropriate | ☢ <0.1 mSv | 1 | 1 | 9 | 4 | 0 | 1 | 0 | 1 | 1 | 0 | 0 | ||
Variant 4: Atraumatic shoulder pain. Suspect bursitis. Initial radiographs normal or inconclusive. Next imaging study.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
| MRI shoulder without IV contrast | Usually appropriate | O 0 mSv | O 0 mSv [ped] | 9 | 9 | 1 | 0 | 0 | 0 | 0 | 0 | 1 | 2 | 12 | |
| US shoulder | Usually appropriate | O 0 mSv | O 0 mSv [ped] | 9 | 9 | 0 | 0 | 0 | 0 | 1 | 0 | 3 | 3 | 9 | |
| CT arthrography shoulder | Usually not appropriate | ☢☢☢☢ 10-30 mSv | 1 | 1 | 14 | 0 | 2 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| CT shoulder with IV contrast | Usually not appropriate | ☢☢☢ 1-10 mSv | 1 | 1 | 14 | 1 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | ||
| CT shoulder without IV contrast | Usually not appropriate | ☢☢☢ 1-10 mSv | 1 | 1 | 14 | 0 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | ||
| CT shoulder without and with IV contrast | Usually not appropriate | ☢☢☢ 1-10 mSv | 1 | 1 | 15 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| X-ray arthrography shoulder | Usually not appropriate | ☢ <0.1 mSv | 1 | 1 | 15 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| MR arthrography shoulder | Usually not appropriate | O 0 mSv | O 0 mSv [ped] | 1 | 1 | 13 | 0 | 1 | 1 | 1 | 0 | 0 | 0 | 0 | |
| MRI shoulder without and with IV contrast | Usually not appropriate | O 0 mSv | O 0 mSv [ped] | 1 | 1 | 15 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | |
Variant 5: Atraumatic shoulder pain. Suspect adhesive capsulitis. Initial radiographs normal or inconclusive. Next imaging study.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
| MRI shoulder without IV contrast | Usually appropriate | O 0 mSv | O 0 mSv [ped] | 9 | 9 | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 4 | 10 | |
| US shoulder | May be appropriate (Disagreement) | O 0 mSv | O 0 mSv [ped] | 5 | 5 | 2 | 0 | 1 | 5 | 4 | 3 | 1 | 0 | 0 | |
| X-ray arthrography shoulder | May be appropriate | ☢ <0.1 mSv | 4 | 4 | 7 | 0 | 1 | 4 | 2 | 1 | 1 | 0 | 0 | ||
| MR arthrography shoulder | Usually not appropriate | O 0 mSv | O 0 mSv [ped] | 2 | 2 | 7 | 2 | 3 | 1 | 3 | 0 | 0 | 0 | 0 | |
| CT arthrography shoulder | Usually not appropriate | ☢☢☢☢ 10-30 mSv | 1 | 1 | 12 | 0 | 1 | 2 | 0 | 0 | 1 | 0 | 0 | ||
| CT shoulder with IV contrast | Usually not appropriate | ☢☢☢ 1-10 mSv | 1 | 1 | 15 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| CT shoulder without IV contrast | Usually not appropriate | ☢☢☢ 1-10 mSv | 1 | 1 | 15 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| CT shoulder without and with IV contrast | Usually not appropriate | ☢☢☢ 1-10 mSv | 1 | 1 | 15 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| MRI shoulder without and with IV contrast | Usually not appropriate | O 0 mSv | O 0 mSv [ped] | 1 | 1 | 13 | 1 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | |
Variant 6: Atraumatic shoulder pain. Suspect biceps tendinitis, bursitis, dislocation or tear. Initial radiographs normal or inconclusive. Next imaging study.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
| MRI shoulder without IV contrast | Usually appropriate | O 0 mSv | O 0 mSv [ped] | 8 | 8 | 1 | 0 | 0 | 0 | 2 | 0 | 5 | 1 | 7 | |
| US shoulder | Usually appropriate | O 0 mSv | O 0 mSv [ped] | 8 | 8 | 0 | 1 | 0 | 0 | 0 | 0 | 5 | 3 | 7 | |
| MR arthrography shoulder | May be appropriate (Disagreement) | O 0 mSv | O 0 mSv [ped] | 5 | 7 | 1 | 0 | 1 | 0 | 3 | 3 | 4 | 3 | 1 | |
| CT arthrography shoulder | Usually not appropriate | ☢☢☢☢ 10-30 mSv | 1 | 1 | 12 | 0 | 1 | 2 | 1 | 0 | 0 | 0 | 0 | ||
| CT shoulder with IV contrast | Usually not appropriate | ☢☢☢ 1-10 mSv | 1 | 1 | 15 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| CT shoulder without IV contrast | Usually not appropriate | ☢☢☢ 1-10 mSv | 1 | 1 | 12 | 0 | 2 | 1 | 0 | 0 | 1 | 0 | 0 | ||
| CT shoulder without and with IV contrast | Usually not appropriate | ☢☢☢ 1-10 mSv | 1 | 1 | 16 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| X-ray arthrography shoulder | Usually not appropriate | ☢ <0.1 mSv | 1 | 1 | 13 | 2 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| MRI shoulder without and with IV contrast | Usually not appropriate | O 0 mSv | O 0 mSv [ped] | 1 | 1 | 13 | 1 | 2 | 0 | 0 | 0 | 0 | 0 | 0 | |
Variant 7: Pain after rotator cuff repair. Initial radiographs normal or inconclusive. Next imaging study.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
| MR arthrography shoulder | Usually appropriate | O 0 mSv | O 0 mSv [ped] | 9 | 9 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 4 | 8 | |
| MRI shoulder without IV contrast | Usually appropriate | O 0 mSv | O 0 mSv [ped] | 8 | 8 | 0 | 0 | 0 | 0 | 0 | 1 | 2 | 6 | 7 | |
| US shoulder | Usually appropriate | O 0 mSv | O 0 mSv [ped] | 8 | 8 | 0 | 0 | 0 | 0 | 0 | 0 | 2 | 12 | 2 | |
| CT arthrography shoulder | May be appropriate | ☢☢☢☢ 10-30 mSv | 6 | 6 | 0 | 0 | 0 | 0 | 8 | 7 | 1 | 0 | 0 | ||
| CT shoulder with IV contrast | Usually not appropriate | ☢☢☢ 1-10 mSv | 1 | 1 | 15 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| CT shoulder without IV contrast | Usually not appropriate | ☢☢☢ 1-10 mSv | 1 | 1 | 13 | 1 | 2 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| CT shoulder without and with IV contrast | Usually not appropriate | ☢☢☢ 1-10 mSv | 1 | 1 | 15 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| X-ray arthrography shoulder | Usually not appropriate | ☢ <0.1 mSv | 1 | 1 | 13 | 0 | 2 | 1 | 0 | 0 | 0 | 0 | 0 | ||
| MRI shoulder without and with IV contrast | Usually not appropriate | O 0 mSv | O 0 mSv [ped] | 1 | 1 | 10 | 2 | 0 | 1 | 2 | 1 | 0 | 0 | 0 | |
Variant 8: Atraumatic shoulder pain. Neurogenic pain (excluding plexopathy). Initial imaging.
| Procedure | Appropriateness Category | SOE | Adult RRL | Peds RRL | Rating | Median | Final Tabulations | ||||||||
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |||||||
| MRI shoulder without IV contrast | Usually appropriate | O 0 mSv | O 0 mSv [ped] | 9 | 9 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 14 | |
| US shoulder | May be appropriate | O 0 mSv | O 0 mSv [ped] | 5 | 5 | 0 | 0 | 0 | 0 | 12 | 4 | 0 | 0 | 0 | |
| CT shoulder without IV contrast | Usually not appropriate | ☢☢☢ 1-10 mSv | 2 | 2 | 8 | 1 | 1 | 1 | 3 | 2 | 0 | 0 | 0 | ||
| Radiography shoulder | Usually not appropriate | ☢ <0.1 mSv | 2 | 2 | 8 | 0 | 2 | 1 | 3 | 1 | 1 | 0 | 0 | ||
| CT arthrography shoulder | Usually not appropriate | ☢☢☢☢ 10-30 mSv | 1 | 1 | 14 | 0 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | ||
| CT shoulder with IV contrast | Usually not appropriate | ☢☢☢ 1-10 mSv | 1 | 1 | 15 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | ||
| CT shoulder without and with IV contrast | Usually not appropriate | ☢☢☢ 1-10 mSv | 1 | 1 | 15 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| X-ray arthrography shoulder | Usually not appropriate | ☢ <0.1 mSv | 1 | 1 | 15 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
| MR arthrography shoulder | Usually not appropriate | O 0 mSv | O 0 mSv [ped] | 1 | 1 | 14 | 0 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | |
| MRI shoulder without and with IV contrast | Usually not appropriate | O 0 mSv | O 0 mSv [ped] | 1 | 1 | 16 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
Please refer to the supporting documentation for a more complete discussion of the concepts and their definitions below.
Final Tabulations:
A histogram of the number of panel members who rated the recommendation as noted in the column heading (ie, 1, 2, 3, …etc.)
Disagree:
The variation of the individual ratings from the median rating indicates panel disagreement on the final recommendation.
References:
Lists the references associated with the recommendation
SQ:
Study Quality (1, 2, 3, 4, Good M or Inadequate M) of the references listed.
RRL:
Information on the Relative Radiation Level (RRL) designations can be found here.