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Nicholas Nacey, Fox MG, Blankenbaker DG, Chen D, Frick MA, Jawetz ST, Mathiasen RE, Raizman NM, Rajkotia KH, Said N, Stensby JD, Subhas N, Surasi DS, Walker EA, Chang EY. ACR Appropriateness Criteria® Chronic Shoulder Pain: 2022 Update. J Am Coll Radiol 2023; 20:S49-S69. [PMID: 37236752 DOI: 10.1016/j.jacr.2023.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Chronic shoulder pain is an extremely common presenting complaint. Potential pain generators include the rotator cuff tendons, biceps tendon, labrum, glenohumeral articular cartilage, acromioclavicular joint, bones, suprascapular and axillary nerves, and the joint capsule/synovium. Radiographs are typically the initial imaging study obtained in patients with chronic shoulder pain. Further imaging may often be required, with modality chosen based on patient symptoms and physical examination findings, which may lead the clinician to suspect a specific pain generator. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Nicholas Nacey
- Panel Vice-Chair, University of Virginia Health System, Charlottesville, Virginia.
| | | | - Donna G Blankenbaker
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Doris Chen
- Stanford University, Stanford, California, Primary care physician
| | | | | | - Ross E Mathiasen
- University of Nebraska Medical Center, Omaha, Nebraska; American College of Emergency Physicians
| | - Noah M Raizman
- The Centers for Advanced Orthopaedics, George Washington University, Washington, District of Columbia; American Academy of Orthopaedic Surgeons
| | - Kavita H Rajkotia
- University of Michigan Health System, Ann Arbor, Michigan; Committee on Emergency Radiology-GSER
| | - Nicholas Said
- Duke University Medical Center, Durham, North Carolina
| | | | | | - Devaki Shilpa Surasi
- The University of Texas MD Anderson Cancer Center, Houston, Texas; Commission on Nuclear Medicine and Molecular Imaging
| | - Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, and Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Eric Y Chang
- Specialty Chair, VA San Diego Healthcare System, San Diego, California
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