Imaging of the Unstable Shoulder

Paolo Baudi1, *, Manuela Rebuzzi2, Giovanni Matino1, Fabio Catani1
1 Department of Othopaedics and Traumatology Modena and Reggio Emilia University – Modena Hospital – Italy Via del Pozzo, 71 – 41124 Modena (Italy)
2 Department of Othopaedics and Traumatology Piacenza Hospital – Italy Via Taverna, 49 – 29121 Piacenza (Italy)

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© 2017 Paolo et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Othopaedics and Traumatology, Modena and Reggio Emilia University – Modena Hospital – Italy, Via del Pozzo, 71 – 41124 Modena (Italy), Tel: +39 059 422 5941, Fax +39 059 422 4313; E-Mail:



Unstable shoulder can occur in different clinical scenarios with a broad spectrum of symptoms and presentations: first-time (or recurrent) traumatic acute shoulder anterior dislocation or chronic anterior instability after repeated dislocations.

Imaging in unstable shoulder is fundamental for choosing the right treatment preventing recurrence.

The goal of imaging depends on clinical scenario and patient characteristics.


Careful selection and evaluation of the imaging procedures is therefore essential to identify, characterize and quantify the lesions. Proper imaging in unstable shoulder cases is critical to the choice of treatment to prevent recurrence, and to plan surgical intervention.


In acute setting, radiographs have to roughly detect and characterize the bone defects present. At about 7 days, it is recommended to perform a MR to demonstrate lesions to labrum and/or ligaments and bone defects: in acute setting, the MRA is not necessary, because of effusion and hemarthrosis that behave as the contrast medium.

In recurrence, it is fundamental not only to detect lesions but characterize them for planning the treatment. The first study to do is the MRI (with a magnetic field of at least 1.5 Tesla), and if possible MRA, above all in younger patients. Then, on the basis of the pathologic findings as bipolar lesion or severity of bone defects, CT can be performed. PICO method on 2D or 3D CT is helpful if you need to study a glenoid bone loss, with the “en face view” of glenoid, while a 3D CT reconstruction with the humeral head “en face view” is the gold standard to assess an Hill-Sachs lesion.


The clinical diagnoses of anterior shoulder instability can be different and acknowledgement of imaging findings is essential to guide the treatment choice.

Imaging features are quite different in chronic than in acute scenario. This requires appropriate indications of many different imaging techniques.

Keywords: Unstable shoulder, Shoulder imaging, Recurrent shoulder dislocation, Bone defect, PICO method, Hill-Sachs, Bankart lesion.