As part of your assessment, Mr. Falworth is likely to recommend a number of investigations to clarify your diagnosis and plan or monitor treatment. Thee are different indications for each investigation and therefore the most appropriate investigation will be discussed with you as part of your own specific treatment plan.
X-rays / Radiographs
X-rays are often the most common investigation to be undertaken. They are primarily used to look at the bony structures of your shoulder, however they can also be used to assess the position of your humeral head (ball) in relation to your glenoid (socket), as this can give some indication as to the quality of the surrounding musculature, the rotator cuff. X-rays are often used in the initial assessment of your condition or to monitor conditions such as arthritis or for the postoperative review of a fracture or shoulder replacement.
Ultrasound scans are most commonly used in the assessment and treatment of rotator cuff conditions. They are a very sensitive way of assessing the quality of the musculature around your shoulder and also allow the radiologist to assess your arm dynamically. Assessing your shoulder or elbow as its moving can prove helpful when trying to determine what is the cause of your symptoms. Ultrasound scans are also often combined with an injection, as this allows the radiologist to place local anaesthetic or corticosteroid in the precise location of where your pain is suspected of emanating from. Your response to the injection is then useful in planning any subsequent treatment.
Computer tomography (CT) is a technique in which X-rays and a computer are used to create detailed images of the bony structures of your shoulder or elbow. It is a particularly useful examination when it is used to assess the joint for the presence of osteoarthritis or for managing trauma, such as following a fracture. CT’s can also be very useful in the management of complex shoulder instability, especially when there has been a degree of bone loss that can further complicate any planned reconstructive surgery.
Magnetic resonance imaging (MRI) is a technique that uses strong magnetic fields and radio waves to produce detailed images of the inside of the body. It is particularly useful at looking at the quality of the rotator cuff or when determining if the structures that stabilise the shoulder or elbow have been injured. In such circumstances, a contrast will be injected into the joint before the MRI scan is performed. This helps clarify whether any of the structures have been torn. This is termed an MR arthrogram and is usually considered the gold standard when assessing an unstable shoulder.
Nerve conduction studies
Nerve conduction studies (NCS) can be used when trying to determine if a nerve has been damaged or injured. Such injuries can occur naturally, or following an injury, such as a dislocation. During the test, the nerves are stimulated using electrode patches that are placed on your skin. One electrode stimulates the nerve whist the second records the time taken to reach the second electrode. Damaged nerves usually transmit the impulses more slowly and this can be recorded and compared to the readings of a normal nerve.
The electrical activity in muscles can also prove helpful in the assessment of nerve function. This is recorded in a similar fashion and is termed electromyography (EMG).