A shoulder X-ray is a good first step if your osteopath, doctor or physiotherapist is unsure as to the cause of your pain.
Shoulder X-rays are the initial gold standard investigation in any musculoskeletal problem. Although capable of revealing only gross bony abnormalities, in shoulder impingement syndrome, the “outlet view” of the shoulder may show a bone spur (
) or more commonly
, both responsible for causing impingement.
MRIs are the platinum standard, and more costly but more accurate than the plain X-rays. MRI can show soft tissue injuries involving the muscle, ligaments, cartilage in addition to the bony injury, making way for an accurate diagnosis and further management. In
shoulder impingement syndrome
, in addition to finding out the possible spur on the acromion, the MRI can reveal inflammation, swelling of the bursa or rotator cuff and a
rotator cuff tear
contributing to the problem as well.
The choice depends upon the clinical presentation, preference of the physician, and whether the patient is prepared to pay the extra money. I’ve not seen an insurance company argue if the specialist recommends an MRI.