How to Order an MRI of the Left Upper Extremity from Elbow to Shoulder
Order separate MRI studies for each anatomical region: "MRI Left Elbow without contrast" AND "MRI Left Shoulder without contrast" to ensure complete coverage from the elbow to the top of the shoulder.
Ordering Strategy
The anatomical region you're describing spans two distinct joint complexes that require separate imaging protocols:
Order Two Separate Studies
- MRI Left Elbow without contrast - This captures the elbow joint, distal humerus, proximal radius/ulna, and surrounding soft tissues 1, 2
- MRI Left Shoulder without contrast - This captures the glenohumeral joint, rotator cuff, proximal humerus, and associated structures 1, 3
Why Separate Studies Are Necessary
- Standard MRI protocols are optimized for specific anatomical regions with dedicated coil positioning and imaging sequences 4
- The shoulder requires anatomically shaped surface coils positioned in the periphery of the magnetic field for optimal spatial resolution 4
- Elbow MRI uses different pulse sequences and positioning to evaluate the thin cartilage, collateral ligaments, and neurovascular structures 5, 6
- Attempting to image both regions in a single study would compromise image quality and diagnostic accuracy 4
Clinical Ordering Details
For the Elbow Study
- Order as: "MRI Left Elbow without IV contrast" 1, 2
- Indication: Specify the clinical concern (e.g., pain, trauma, suspected ligament injury, nerve entrapment) 1
- Key sequences obtained: T1-weighted, T2-weighted, and fat-suppressed sequences in multiple planes 5, 7
For the Shoulder Study
- Order as: "MRI Left Shoulder without IV contrast" 1, 2
- Indication: Specify the clinical concern (e.g., rotator cuff pathology, impingement, instability) 1
- Standard imaging planes: Axial, oblique coronal, and oblique sagittal sequences 4
Important Considerations
When Contrast Is NOT Needed
- Non-contrast MRI is sufficient for most soft tissue injuries, ligament tears, tendon pathology, and bone marrow edema 2, 5
- T2-weighted sequences without contrast adequately demonstrate joint effusions and associated pathology 2
When to Consider MR Arthrography Instead
- For the shoulder: If specifically evaluating for labral tears, capsular injuries, or subtle rotator cuff pathology, MR arthrography may be more accurate than conventional MRI 6
- For the elbow: MR arthrography at 3T is more accurate than non-contrast MRI for detecting collateral ligament injuries, particularly ulnar collateral ligament tears 1
- However, start with non-contrast MRI unless there is high clinical suspicion for these specific injuries 1, 2
Common Pitfalls to Avoid
- Don't order "MRI Left Arm" - This is non-specific and may result in inadequate imaging or confusion about which anatomical region to scan 1
- Don't assume one study covers both regions - The humerus shaft between elbow and shoulder is not routinely imaged with standard joint protocols 5, 4
- Don't add unnecessary contrast - Non-contrast MRI is usually appropriate for initial evaluation and avoids the cost and potential risks of gadolinium administration 1, 2
- Specify laterality clearly - Always indicate "Left" to prevent wrong-site imaging 1