ACR Appropriateness Criteria® on acute shoulder pain

James N. Wise, Richard H. Daffner, Barbara N. Weissman, Laura Bancroft, D. Lee Bennett, Judy S. Blebea, Michael A. Bruno, Ian Blair Fries, Jon A. Jacobson, Jonathan S. Luchs, William B. Morrison, Charles S. Resnik, Catherine C. Roberts, Mark E. Schweitzer, Leanne L. Seeger, David W. Stoller, Mihra S. Taljanovic

Research output: Contribution to journalReview articlepeer-review

30 Scopus citations


The shoulder joint is a complex array of muscles, tendons, and capsuloligamentous structures that has the greatest freedom of motion of any joint in the body. Acute (<2 weeks) shoulder pain can be attributable to structures related to the glenohumeral articulation and joint capsule, rotator cuff, acromioclavicular joint, and scapula. The foundation for investigation of acute shoulder pain is radiography. Magnetic resonance imaging is the procedure of choice for the evaluation of occult fractures and the shoulder soft tissues. Ultrasound, with appropriate local expertise, is an excellent evaluation of the rotator cuff, long head of the biceps tendon, and interventional procedures. Fluoroscopy is an excellent modality to guide interventional procedures. Computed tomography is an excellent modality for characterizing complex shoulder fractures. Computed tomographic arthrography or fluoroscopic arthrography may be alternatives in patients for whom MR arthrography is contraindicated. A multimodal approach may be required to accurately assess shoulder pathology. The ACR Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

Original languageEnglish (US)
Pages (from-to)602-609
Number of pages8
JournalJournal of the American College of Radiology
Issue number9
StatePublished - Sep 2011
Externally publishedYes


  • Appropriateness Criteria®
  • acute shoulder pain
  • labral tear
  • rotator cuff repair
  • septic arthritis
  • shoulder arthroplasty

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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