Chapter 98 describes indications, technique, and imaging findings of shoulder arthrography. Shoulder arthrography is commonly performed in routine clinical practice for MR arthrography (MRA), typically in younger patients. The main indications include evaluation of shoulder instability and postoperative rotator cuff. Other indications include fluoroscopic guidance for therapeutic injections or therapy for adhesive capsulitis. CT arthrography (CTA) may also be performed for evaluation of total shoulder arthroplasty (TSA) loosening and conversion from anatomic to reverse TSA. Contrast should be easy to inject and disperse throughout the joint. Abnormal communication between the glenohumeral joint and subacromial-subdeltoid and subcoracoid bursae is diagnostic of a full-thickness rotator cuff tear unless the contrast is accidentally injected into the bursa. However, in the setting of prior rotator cuff repair, contrast may extend into the bursa even in the absence of re-tear because the cuff is not watertight. Contrast extension into the glenoid labral substance is diagnostic of labral tear.
