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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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.
Act On Red Flags, Then Coordinate Care
- If shoulder pain cannot be reproduced on exam or is linked with systemic signs (e.g., cough), suspect non‑musculoskeletal causes.
- Contact the patient's PCP and convey objective findings rather than reflexively ordering imaging yourself.
Image Post‑Trauma Shoulders Promptly
- After trauma with worsening pain or night pain, obtain plain radiographs to rule out fracture or dislocation.
- Note corticosteroid exposure and smoking increase risk of complications and impaired healing.