Shoulder radiographs and cautionary tales

Dear Editor, I read with interest recent research into the management of shoulder dysfunction that showed increases use of ultrasound by general practitioners in investigating shoulder pain, in preference to an initial radiograph. The authors cite a paper suggesting radiographs have little diagnostic value in some presentations of shoulder pain. The study involved emergency departments rather than general practices, which may limit it's generalisability. Also, the limited utility of radiographs in this paper extended to a subgroup of patients who had not fallen, had no swelling, and has experienced rest pain. Murtagh describes the shoulder as 'notorious for diagnostic traps'. Reliance on imaging should not replace a thorough history and examination.