Which imaging modality is most sensitive for detecting soft tissue injuries such as rotator cuff tears?

• A. X-ray
• B. Ultrasound
• C. MRI
• D. CT scan

Answer: (C)

Soft tissue injuries around the shoulder, like rotator cuff tears, are best assessed with MRI because it provides exceptional soft-tissue detail in multiple planes, allowing clear visualization of tendons, muscles, and surrounding fluid. MRI can show edema and tendinopathy within the tendons, identify partial-thickness versus full-thickness tears by showing areas of tendon discontinuity, and assess associated changes such as muscle atrophy and fatty infiltration, which affect prognosis and treatment.

Sequences that highlight fluid, especially T2-weighted images with fat suppression, make tears stand out against the surrounding tissues. MR arthrography can further increase sensitivity for partial-thickness tears by distending the joint and outlining small tears with contrast. Other modalities have limitations: X-ray mainly shows bone structure; ultrasound is operator-dependent and may miss deeper or partial tears; CT focuses on bone and offers less soft-tissue detail unless specialized techniques are used. Hence MRI provides the most comprehensive assessment for soft tissue injuries like rotator cuff tears.