The E3 Rehab Podcast 221. Shoulder Pain: To Image or Not To Image? w/ Paul Salamh
Oct 7, 2025
Paul Salamh, a clinician-researcher and educator at the University of Indianapolis, joins Chris Hughen to explore shoulder pain and the complex role of imaging. They discuss the overutilization of imaging and when it's appropriate to use X-rays, MRIs, and other modalities. Paul highlights vital red flags for non-musculoskeletal issues and the nuances of recognizing shoulder dislocations, including often missed posterior dislocations. He also addresses the management of rotator cuff pain and the importance of clear communication of diagnoses to patients.
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Imaging Overuse Drives Poor Clinical Reasoning
- Clinicians overutilize shoulder imaging partly to save time and avoid complex clinical reasoning.
- Paul Salamh warns this creates false narratives and reduces thorough patient conversations.
Choose Imaging Based On Clinical Question
- Use radiographs for suspected fracture, dislocation, or gross osseous pathology after trauma.
- Reserve MRI/US for targeted questions and interpret findings in the clinical context to avoid misattribution.
Explain Imaging Findings In Context
- Always contextualize imaging results for patients by explaining prevalence of asymptomatic findings.
- Use analogies (e.g., 'wrinkles on the inside') to prevent misattributing age-related changes to pain.