Can a computed tomography (CT) scan of the shoulder be used to diagnose bursitis?

CT Scan for Shoulder Bursitis: Not Recommended

CT scanning is not an appropriate imaging modality for diagnosing shoulder bursitis and should not be requested for this indication. 1

Recommended Imaging Approach

First-Line Imaging: Plain Radiographs

• Always obtain plain radiographs first (anteroposterior views in internal and external rotation, plus axillary or scapula-Y view) to exclude bony abnormalities, fractures, calcific tendinitis, and acromial morphology issues before proceeding to soft tissue imaging. 1

Appropriate Advanced Imaging: MRI or Ultrasound

After non-contributory radiographs, both MRI without contrast and ultrasound are equally appropriate first-line imaging modalities for suspected shoulder bursitis, both rated 9/9 by the American College of Radiology. 1

Choose between MRI and ultrasound based on:

• MRI without contrast advantages: 1

  • Superior visualization of subacromial bursa inflammation
  • Concurrent evaluation of rotator cuff pathology
  • Assessment of muscle atrophy and fatty infiltration

• Ultrasound advantages: 1, 2

  • Real-time dynamic assessment
  • Simultaneous therapeutic injection guidance capability
  • No radiation exposure
  • Lower cost
  • Immediate availability in many settings

Why CT Is Inappropriate

CT shoulder without contrast is rated 1/9 ("usually not appropriate") by the American College of Radiology for evaluating soft tissue pathology like bursitis. 3

• CT is designed for bone evaluation, not soft tissue visualization. 4
• CT cannot adequately visualize bursal inflammation or fluid. 4
• CT adds unnecessary radiation exposure without diagnostic benefit for this indication. 3

Special Circumstance: Suspected Infection

If septic bursitis is suspected clinically, perform bursal aspiration with ultrasound or fluoroscopic guidance (both rated 9/9) for definitive diagnosis. 1

Common Pitfall to Avoid

Do not order CT when soft tissue pathology (bursitis, tendinopathy) is the primary concern—this represents inappropriate imaging that delays diagnosis and exposes patients to unnecessary radiation while providing no useful clinical information. 3, 1