American College of Radiology
ACR Appropriateness Criteria®

Shoulder Pain-Traumatic

Variant 1: Traumatic shoulder pain. Any etiology. 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 15
CT arthrography shoulder Usually not appropriate ☢☢☢☢ 10-30 mSv 1 1 15 0 0 0 0 0 0 0 0
CT shoulder without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 1 1 9 0 3 1 2 0 0 0 0
MR arthrography shoulder Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 14 0 0 0 1 0 0 0 0
MRI shoulder without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 11 0 2 0 1 1 0 0 0
US shoulder Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 12 1 1 1 0 0 0 0 0
CT shoulder without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 1 1 13 1 1 0 0 0 0 0 0
CT shoulder with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 1 1 13 1 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 14 0 0 0 1 0 0 0 0
Tc-99m bone scan shoulder Usually not appropriate ☢☢☢ 1-10 mSv 1 1 14 0 1 0 0 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 15 0 0 0 0 0 0 0 0
Variant 2: Traumatic shoulder pain. Nonlocalized shoulder pain. Negative radiographs. 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 2 3 9
CT arthrography shoulder May be appropriate ☢☢☢☢ 10-30 mSv 5 5 6 0 0 1 6 2 0 0 0
US shoulder May be appropriate (Disagreement) O 0 mSv O 0 mSv [ped] 5 3 3 1 5 1 4 0 2 0 0
MR arthrography shoulder May be appropriate O 0 mSv O 0 mSv [ped] 5 5 0 0 1 0 9 2 3 0 1
CT shoulder without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 3 3 2 3 4 0 5 1 0 1 0
Tc-99m bone scan shoulder Usually not appropriate ☢☢☢ 1-10 mSv 1 1 12 1 1 0 0 0 0 1 0
MRI shoulder without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 11 0 2 0 1 0 1 0 0
CT shoulder without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 1 1 15 0 0 0 0 0 0 0 0
CT shoulder with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 1 1 13 1 1 0 0 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 15 0 0 0 0 0 0 0 0
Variant 3: Traumatic shoulder pain. Radiographs show humeral head or neck fracture. Next imaging study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT shoulder without IV contrast Usually appropriate ☢☢☢ 1-10 mSv 9 9 0 0 0 0 0 0 1 1 13
MRI shoulder without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 6 1 2 0 7 0 0 0 0
CT arthrography shoulder Usually not appropriate ☢☢☢☢ 10-30 mSv 1 1 11 2 0 1 0 1 0 0 0
CT shoulder with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 1 1 13 1 0 1 0 0 0 0 0
CT shoulder without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 1 1 14 0 0 1 0 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 11 1 1 2 0 0 0 0 0
MR arthrography shoulder Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 13 0 0 0 1 1 0 0 0
MRI shoulder without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 12 1 1 0 1 0 0 0 0
Tc-99m bone scan shoulder Usually not appropriate ☢☢☢ 1-10 mSv 1 1 8 2 0 3 1 1 0 0 0
US shoulder Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 9 2 1 2 0 1 0 0 0
Variant 4: Traumatic shoulder pain. Radiographs show scapula fracture. Next imaging study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT shoulder without IV contrast Usually appropriate ☢☢☢ 1-10 mSv 9 9 0 0 0 0 0 0 0 1 14
MRI shoulder without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 4 1 4 2 3 1 0 0 0
CT arthrography shoulder Usually not appropriate ☢☢☢☢ 10-30 mSv 1 1 14 0 1 0 0 0 0 0 0
CT shoulder without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 1 1 14 0 0 1 0 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 11 0 1 3 0 0 0 0 0
CT shoulder with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 1 1 13 1 0 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 13 1 0 1 0 0 0 0 0
Tc-99m bone scan shoulder Usually not appropriate ☢☢☢ 1-10 mSv 1 1 8 3 0 4 0 0 0 0 0
US shoulder Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 14 1 0 0 0 0 0 0 0
MR arthrography shoulder Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 15 0 0 0 0 0 0 0 0
Variant 5: Traumatic shoulder pain. Radiographs show Bankart or Hill-Sachs lesion. 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 1 0 0 0 1 0 0 1 12
MRI shoulder without IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 2 5 3 5
CT arthrography shoulder May be appropriate ☢☢☢☢ 10-30 mSv 6 6 0 1 0 0 5 4 3 2 0
CT shoulder without IV contrast May be appropriate ☢☢☢ 1-10 mSv 6 6 0 0 0 0 6 3 5 2 0
CT shoulder with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 1 1 15 0 0 0 0 0 0 0 0
CT shoulder without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 1 1 15 0 0 0 0 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 15 0 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 11 0 1 1 2 0 0 0 0
Tc-99m bone scan shoulder Usually not appropriate ☢☢☢ 1-10 mSv 1 1 14 0 0 0 0 0 1 0 0
US shoulder Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 13 0 1 0 0 1 0 0 0
Variant 6: Traumatic shoulder pain. Radiographs normal. Physical examination and history consistent with dislocation event or instability. 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 0 14
MRI shoulder without IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 7 7 0 0 0 0 2 3 3 5 2
CT arthrography shoulder May be appropriate ☢☢☢☢ 10-30 mSv 6 6 0 0 0 0 4 4 4 1 2
CT shoulder without IV contrast May be appropriate ☢☢☢ 1-10 mSv 4 4 5 0 2 1 6 0 1 0 0
CT shoulder with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 1 1 12 1 1 0 0 1 0 0 0
CT shoulder without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 1 1 15 0 0 0 0 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 15 0 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 12 0 0 2 0 1 0 0 0
Tc-99m bone scan shoulder Usually not appropriate ☢☢☢ 1-10 mSv 1 1 14 0 0 0 0 0 1 0 0
US shoulder Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 10 0 1 1 2 1 0 0 0
Variant 7: Traumatic shoulder pain. Radiographs normal. Physical examination findings consistent with labral tear. 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 0 1 14
CT arthrography shoulder Usually appropriate ☢☢☢☢ 10-30 mSv 7 7 0 0 0 0 3 3 6 3 0
MRI shoulder without IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 1 2 5 3 3
CT shoulder without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 1 1 11 1 1 1 0 0 1 0 0
US shoulder Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 11 1 2 0 1 0 0 0 0
Tc-99m bone scan shoulder Usually not appropriate ☢☢☢ 1-10 mSv 1 1 14 0 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 12 1 0 0 1 1 0 0 0
CT shoulder without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 1 1 14 1 0 0 0 0 0 0 0
CT shoulder with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 1 1 14 0 1 0 0 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 15 0 0 0 0 0 0 0 0
Variant 8: Traumatic shoulder pain. Radiographs normal. Physical examination findings consistent with rotator cuff tear. 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 2 3 10
MR arthrography shoulder Usually appropriate O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 2 1 4 3 5
US shoulder Usually appropriate O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 1 0 4 5 5
CT arthrography shoulder May be appropriate ☢☢☢☢ 10-30 mSv 6 6 1 0 0 1 2 7 1 3 0
CT shoulder with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 1 1 13 1 1 0 0 0 0 0 0
CT shoulder without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 1 1 14 0 1 0 0 0 0 0 0
CT shoulder without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 1 1 12 1 1 0 0 0 0 1 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 15 0 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 12 1 1 0 1 0 0 0 0
Tc-99m bone scan shoulder Usually not appropriate ☢☢☢ 1-10 mSv 1 1 14 1 0 0 0 0 0 0 0
Variant 9: Traumatic shoulder pain. Radiographs already performed. Physical examination consistent with vascular compromise. Next imaging study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CTA shoulder with IV contrast Usually appropriate ☢☢☢ 1-10 mSv 9 9 1 0 0 0 0 0 0 1 13
Arteriography shoulder Usually appropriate ☢☢☢ 1-10 mSv 7 7 1 0 0 0 4 0 5 1 4
US duplex Doppler shoulder May be appropriate O 0 mSv O 0 mSv [ped] 4 4 5 1 0 3 6 1 0 0 0
CT shoulder without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 1 1 13 0 1 0 1 0 0 0 0
CT shoulder without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 1 1 11 0 2 0 2 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 15 0 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 12 1 1 0 0 0 0 1 0
MRI shoulder without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 13 0 1 1 0 0 0 0 0
Tc-99m 3-phase bone scan shoulder Usually not appropriate ☢☢☢ 1-10 mSv 1 1 12 1 1 0 0 1 0 0 0
CT shoulder with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 1 1 14 0 1 0 0 0 0 0 1
MRA shoulder with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 11 3 1 0 1 0 0 0 0
Variant 10: Traumatic shoulder pain. Radiographs already performed. Neuropathic syndrome (excluding plexopathy). 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 1 3 3 5
Tc-99m bone scan shoulder May be appropriate ☢☢☢ 1-10 mSv 4 4 4 1 1 6 2 2 0 0 0
CT shoulder without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 3 3 5 0 4 3 2 0 1 0 0
CT arthrography shoulder Usually not appropriate ☢☢☢☢ 10-30 mSv 1 1 13 0 2 0 0 0 0 0 0
CT shoulder with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 1 1 9 0 4 0 1 0 0 1 0
CT shoulder without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv 1 1 12 0 1 0 2 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 15 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 0 0 0 0 0
US shoulder Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 11 0 0 1 2 1 0 0 0
MRI shoulder without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 10 3 1 0 2 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.