Jenelle Beadle, RDMS

Inland Imaging

December 15th, 2014

Normal Shoulder Ultrasound

Biceps Tendon• Palm up and resting on the patient’s leg

• Transducer placed on the anterior shoulder • find the best sonographic window with slight external/internal

rotation

• dynamically evaluate (external/internal rotation) for subluxation or dislocation

• angle transducer as appropriate to avoid anisotropy

Long Biceps TendonTrans Biceps Tendon

Biceps Tendon - Trans

Biceps Tendon - Trans

Biceps Tendon - Trans

Biceps Tendon - Trans

Biceps Tendon - Long

Biceps Tendon - Long

Biceps Tendon - Long

Transverse Humeral Ligament over Synovial Tendon Sheath

Biceps Tendon - Long

Subscapularis Tendon• Palm up and arm externally rotated

• Transducer placed on the anterior shoulder

• find the best sonographic window with slight external/internal rotation

• dynamically evaluate (external/internal rotation) for tears and impingement

• angle transducer as appropriate to avoid anisotropy

Long Subscapularis Trans Subscapularis

Subscapularis Tendon - Long

Musculotendonis junction coming from under the coracoid process

Subscapularis Tendon - Long

Cartilage on the head of the humerus up to the point of insertion

Subscapularis Tendon - Long

Tendon extends medially to the insertion on the lesser tuberosity

Subscapularis Tendon - Long

Anisotropy where tendon fibers turn to insert

Subscapularis Tendon - Long

Subscapularis Tendon - Long

Tendon insert along this flattened area of the lesser tuberosity

Subscapularis Tendon - Long

Subscapularis Tendon - Long

Subscapularis Tendon - Long

Bicipital Groove

Subscapularis Tendon - Trans

Subscapularis Tendon - Trans

Subscapularis Tendon - Trans

Subscapularis Tendon - Trans

Supraspinatus Tendon• hand placed in back pocket with palm facing in

• transducer placed on the anterior shoulder

• scan anterior to posterior from biceps interval to infraspinatus tendon

• dynamically evaluate (external/internal rotation) for tears

• dynamically evaluate (abduction/adduction) for impingement

• angle transducer as appropriate to avoid anisotropy

Long Supraspinatus

Supraspinatus Tendon - Long

Long SupraspinatusNeutral Position

Long SupraspinatusStressed Position

Acromion

Supraspinatus Tendon - Long

Supraspinatus Tendon - Long

Musculotendonis junction coming from under the acromion

Supraspinatus Tendon - Long

Supraspinatus Tendon - Long

Supraspinatus Tendon - Long

Supraspinatus Tendon - Long

Supraspinatus Tendon - Trans

Biceps Interval: biceps tendon should be seen adjacent to the supraspinatus tendon

• any separation here indicates an anterior full thickness supraspinatus tear

BT

Supra

Supraspinatus Tendon - Trans

Biceps Interval: biceps tendon should be seen adjacent to the supraspinatus tendon

• any separation here indicates an anterior full thickness supraspinatus tear

Supraspinatus Tendon - Trans

Supraspinatus Tendon - Trans

Supraspinatus Tendon - Trans

Supraspinatus Tendon - Trans

Infraspinatus Tendon• atiene’s hand placed on contralateral shoulder

• transducer placed on the posterolateral shoulder

• scan anterior to posterior from the supraspinatus tendon to teres minor tendon

• dynamically evaluate (extreme external rotation and abduction) for impingement

• angle transducer as appropriate to avoid anisotropy

Long Supraspinatus

Infraspinatus Tendon - Long

Infraspinatus Tendon - Long

Infraspinatus Tendon - Long

Infraspinatus Tendon - Long

Infraspinatus Tendon - Long

Infraspinatus Tendon - Long

Infraspinatus Tendon - Long

Supraspinatus vs Infraspinatus Tendons - Long

Infraspinatus Tendon - Trans

Infraspinatus Tendon - Trans

Infraspinatus Tendon - Trans

Infraspinatus Tendon - Trans

Acromioclavicular Joint• Assessed for stability and fluid

Acromioclavicular Joint

Acromioclavicular Joint

Acromioclavicular Joint

Posterior Glenohumeral (GH) Joint & Spinoglenoid Notch / Scapular Fossa

Posterior Glenohumeral (GH) Joint

Posterior Glenohumeral (GH) Joint

Labrum

Humeral HeadGlenoidRim

Infraspinatus Musculotendinous Junction

Posterior Glenohumeral (GH) Joint

Spinoglenoid (SG) Notch / Scapular Fossa

Spinoglenoid (SG) Notch / Scapular Fossa

Spinoglenoid (SG) Notch / Scapular Fossa

• “Skeletal Muscle Ultrasound” European Journal Translational Myology 2010; 1 (4): 145-155

• “Ultrasonographic Findings of Musculoskeletal Tissues” J Korean Orthop Assoc. 2013 Oct;48(5):334-341

• “Sonography of Common Tendon Injuries” American Journal of Roentgenology. 2009;193: 607-618

• “Tendon and Ligament Imaging” Br J Radiol. Aug 2012; 85(1016): 1157–1172

• “Imaging of the Bursae” J Clin Imaging Sci 2011; 1:22

• “Ultrasonography of tendon abnormalities” OA Musculoskeletal Medicine 2013 Jun 01;1(2):12

• “Sonography of Lower Limb Muscle Injury” American Journal of Roentgenology. 2004;182: 341-351

• “Full Thickness and Partial Thickness Supraspinatus Tendon Tears” Radiology 2004; 230:234–242

• “Long Head of Biceps Brachii Tendon Evaluation...” AJR 2011; 197:942–948

• “Ultrasound of the Shoulder” JBR–BTR, 2007, 90: 325-337

• Gaitini D. “Shoulder Ultrasonography: Performance and Common Findings” J Clin Imaging Sci 2012; 2: 38-38

• Read J, Perko M. “Ultrasound Diagnosis of Subacromial Impingement for Lesions of the Rotator Cuff” AJUM May 2010; 13 (2): 11-15

References

• http://www.sonoguide.com/soft_tissue.html

• http://www.dynamicultrasound.org/dugphysics.html

• http://www.ultrasoundcases.info/Slide-View.aspx?cat=405&case=1858

• http://www.shoulderdoc.co.uk/article.asp?section=904

• http://www.radiologyassistant.nl/en/p50cf8392cbd97/us-guided-injection-of-joints.html

• http://radiopaedia.org/articles/posterosuperior-impingement-of-th-shoulder

References (continued…)