A 55-year-old woman presents to the office with a 2-month history of right shoulder pain...

The presentation is consistent with rotator cuff tendinopathy or subacromial impingement. The painful arc between 30°–120° with preserved passive ROM suggests this. Ultrasound is the preferred initial imaging modality due to its availability, safety, and ability to visualize soft tissues dynamically.

Toronto Notes 2023 – Orthopedics, “Shoulder Pathologies” Section:

“In rotator cuff injuries or impingement syndromes, initial imaging with musculoskeletal ultrasound is appropriate. It can identify tendinopathy, partial tears, or subacromial bursitis.”

MCCQE1 Objectives (Surgery > 84-7: Musculoskeletal Pain):

“Candidates should initiate workup for rotator cuff or impingement syndromes with ultrasound as the first-line test, reserving more invasive or costly procedures for unresolved or complex cases.”

CT (A) is used for bony detail, not soft tissues. Arthroscopy (C) is invasive and therapeutic. Arthrography (D) is outdated and largely replaced by MRI or ultrasound.

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