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Examination techniques
Medical examination of the patient

The quickest and most important way of establishing a correct and cost-effective diagnosis is always a competent medical examination of movement sequences, active and passive mobility, strength of the individual muscles, joint stability and the testing of those sites and functions that the patient reports as painful.

It is always amazing just how many clinical conditions and injuries can be diagnosed simply on the basis of a correct examination and, conversely, how many clear pathologies (individual illnesses) are missed as a result of careless, incorrect or omitted physical examinations. Even such technically flawless and sophisticated investigation techniques as MRI, CT, ultrasound or arthroscopy will never be able to replace initial and follow-up examinations by a doctor.

Talking and listening to patients, observing them while they dress and undress and the doctor's professional experience are all vitally important during the initial examination.

Radiological examinations have become a standardised process. Certain defined positions in X-ray examinations enable a reliable diagnosis in many cases, particularly as regards the bony components of the shoulder. Modern techniques such as MRI scanning of the joint are still a long way from replacing traditional radiological investigations. No other method is as effective as the x-ray when it comes to diagnosing fractures, bony joint injuries and sprains.

Computed tomography
Computed tomography, or CT scanning, is likewise based on X-rays and allows the joint to be visualised in sliced sections. CT scans are a particularly accurate way of diagnosing bony changes of the joint. New imaging techniques also deliver 3D representations of the bone, fracture or sprain.

Magnetic resonance imaging (MRI)
MRI represents the state-of-the-art in imaging techniques and is based on the magnetically induced orientation of water molecules. This produces an image of the body which - if the picture quality is good - resembles the illustrations reproduced in anatomy atlases. Muscles, tendons, ligaments, bones, cartilage, fat, etc. are all clearly depicted. This is the best method for identifying tendon tears and other soft tissue injuries, changes in the bone and degenerative changes.
MRI scans of shoulder joints become even more effective when a contrast medium is injected into the joint (known as an "arthro-MRI").

Arthro-MRI of the shoulder

Ultrasound scans
This method is especially cost-effective, fast and, above all, non-invasive. Moreover, an ultrasound scan does not involve any exposure to radiation. On the other hand, its effectiveness depends to a large extent on the individual investigator and it is associated with a relatively large proportion of "incorrect results".

As a screening method however, ultrasound is highly recommended, particularly if it can be carried out by the surgeon handling the case. But the investigator may require hundreds of joint scans to obtain a highly accurate diagnosis.

Arthroscopy of the joint provides a direct view of the interior of the joint and, in the area around the shoulder, in the subacromial space (layer of the bursa beneath the acromion). Arthroscopy is a particularly effective way of investigating the joint ligaments, the joint meniscus and changes to the joint meniscus in terms of both injuries and normal variants. It can also detect changes or injuries to the biceps tendon or bursa, calcium deposits in the rotator cuff, etc.

A further advantage of this technique is the ability to repair certain pathologies (disorders or injuries) during the actual arthroscopy.
In order to achieve good results, however, the examining doctor needs considerable experience in these surgical techniques.
Disadvantages: This is an invasive investigation technique with all the disadvantages of a surgical procedure (general or other type of anaesthesia, intra- and postoperative complications).
Advantages: The lesion is diagnosed and treated in the same session; small skin incisions. Minimal soft tissue injury around the joint resulting in faster rehabilitation.