Imaging Recommendation for Post-Surgical Shoulder Pain with Anterior Scapular Protrusion
You should obtain standard shoulder radiographs immediately, including anteroposterior (AP) views in internal and external rotation plus an axillary or scapular Y-view, as this is the appropriate initial imaging for post-surgical shoulder pain and suspected bony changes. 1
Initial Imaging Approach
Radiography is the preferred and appropriate first-line study for your situation, which involves post-surgical shoulder pain 7 years after scapular bone shaving with new anterior scapular protrusion 1. The American College of Radiology establishes that:
- Standard shoulder radiographs should include at least three views: AP views in internal and external rotation, plus an axillary or scapular Y-view 1
- Upright positioning is critical because shoulder malalignment can be underrepresented on supine radiography 1
- Axillary or scapular Y-views are vital as they prevent misclassification of shoulder pathology that can occur on AP views alone 1, 2
What These X-rays Will Evaluate
Your radiographs will assess for several critical post-surgical complications:
- Recurrent impingement from inadequate bone resection or bone regrowth 1, 3
- Scapular fracture or malunion that could explain the anterior protrusion 1, 4
- Glenohumeral joint alignment and any secondary degenerative changes 1
- Acromial or scapular spine fractures which can occur as late complications from chronic stress 1
When Advanced Imaging May Be Needed
If radiographs are noncontributory but your symptoms persist, MRI without contrast (rated 9/9 by ACR) becomes the next appropriate study 1. MRI is superior for:
- Evaluating rotator cuff integrity and potential tears causing your pain 1
- Assessing soft-tissue impingement including bursal pathology 1, 3
- Detecting labral tears if instability is contributing to symptoms 1
CT should be reserved for detailed bony anatomy assessment if radiographs show concerning findings that require better characterization of fracture patterns or bone morphology 1, 4.
Clinical Context
Your burning pain with overhead motion 7 years post-surgery suggests either:
- Recurrent subacromial impingement from inadequate initial decompression or bone regrowth 3
- Scapular dyskinesis causing altered mechanics and secondary impingement 5
- Internal impingement from altered glenohumeral mechanics post-surgery 6
- Scapular malunion or late fracture explaining the anterior protrusion 4
The anterior scapular protrusion you're palpating is particularly concerning and warrants imaging evaluation, as scapular body malunion can cause severe functional impairment and pain through altered biomechanics and bony impingement 4.
Pitfalls to Avoid
- Do not skip the axillary or Y-view – these are essential and not optional, as they detect pathology missed on standard AP views 1, 2
- Ensure upright positioning during radiography to avoid underestimating malalignment 1
- Do not proceed directly to MRI without radiographs first, as bony pathology must be excluded initially 1