Can You Get a CT Scan of a Shoulder?
Yes, CT scans of the shoulder are absolutely performed and are clinically appropriate in multiple specific scenarios, particularly for evaluating fractures, bone loss, and when MRI is contraindicated or limited.
When CT Shoulder Is Usually Appropriate
According to the most recent ACR Appropriateness Criteria (2025), CT shoulder without IV contrast is the preferred imaging modality in these situations 1:
Primary Indications for Shoulder CT:
1. Occult Fracture Detection
- When radiographs are normal or nonspecific but you suspect a fracture, CT provides detailed osseous anatomy with high spatial resolution to identify subtle nondisplaced fractures 1
- CT is equivalent to MRI for this indication, but excels specifically at bone detail
2. Known Fracture Characterization
- CT shoulder without IV contrast is usually appropriate when radiographs show proximal humerus, scapular, or clavicle fractures 1
- CT is superior to MRI for evaluating fracture planes in complex patterns and characterizing proximal humerus fractures 1
- CT is the best modality for identifying and characterizing scapular fracture patterns, including intraarticular extension, angulation, and lateral border offset 1
- Three-dimensional reformatted CT images better visualize scapula fracture displacement and angulation 1
3. Shoulder Instability with Bone Loss Assessment
- CT may be appropriate when MRI assessment of bone loss is limited 1
- CT has historically been used to assess Hill-Sachs and bony Bankart lesions that are frequently underestimated or missed on radiographs 1
- However, MRI has been shown equivalent to CT for assessing glenoid and humeral head bone loss, and CT cannot assess rotator cuff or labroligamentous pathology 1
4. CT Arthrography for Labral Tears
- CT arthrography is usually appropriate when MRI is contraindicated 1
- Provides comparable sensitivity and possibly improved specificity for labral lesions compared to MR arthrography 1
- Can provide improved visualization of osseous abnormalities such as glenoid rim fractures 1
Important Clinical Context
Radiation Considerations
Research demonstrates that ultra-low-dose CT protocols can reduce radiation by over 99% while maintaining adequate image quality for fracture diagnosis 2. Low-dose protocols achieve >70% dose reduction with geometric errors generally <0.5 mm 3.
When CT Is NOT Appropriate
- Rotator cuff tears: MRI or ultrasound are the appropriate modalities 1
- Acute dislocation/instability without bone loss concerns: MRI without contrast is usually appropriate as posttraumatic effusion provides natural contrast 1
- Soft tissue pathology assessment: CT cannot evaluate rotator cuff or labroligamentous injuries 1
Common Pitfall
Do not order CT with IV contrast for shoulder evaluation—there is no relevant literature supporting its use for acute shoulder pain assessment 1. The appropriate protocol is CT without IV contrast.
Special Scenarios
CT may be preferred over MRI when patients have proximal humeral hardware causing MRI susceptibility artifacts 1.