1

Ultrasound of

Shoulder Anatomy

J. Antonio Bouffard, MDDept. of Orthopaedic Surgery & Sports Medicine

Detroit Medical Center

2021 Virtual Leading Edge

in Diagnostic Ultrasound

May 12, 2021

Topography U/S Anatomy

Shoulder Ultrasound

Linear-Array (7.5 MHz) Curved Linear-Array (5 MHz)

Linear Array – 7.5 MHz Curved Linear – 5 MHz

Transducers

• Anterior

• Superior

• Lateral (Anterior)

• Posterior

Four Shoulder Regions

1. Subscapularis

2. Supraspinatus

3. Infraspinatus

4. Teres minor

Conjoint

Tendon

• Anterior

• Superior

• AnteroLateral

• Posterior

Shoulder Regions

Long Bicipital Tendon

Subscapularis

2

• Anterior

• Superior

• AnteroLateral

• Posterior

Shoulder Regions

Acr-Clav Joint

• Anterior

• Superior

• AnteroLateral

• Posterior

Shoulder Regions

SupraspinatusInfraspinatus

• Anterior

• Superior

• AnteroLateral

• Posterior

Shoulder Regions

Infraspinatus

GlenoHumeral Jt

Labrum

Spinoglenoid Groove

Teres minor

• Anterior

• Superior

• AnteroLateral

• Posterior

Shoulder Anatomy

Shoulder Osteology

Dzung Vu, MD

NSWU, 2002

Greater Tuberosity

Lesser Tuberosity

Bicipital Groove

Humeral Head

Anatomical NeckCoracoidProcess

Anterior Shoulder

Intraarticular

Extraarticular

3

Long Bicipital Tendon & Subscapularis Anterior Structures

Rotator Cuff Interval

SGHL

Superior ShoulderAcromioClavicular Jt

AnteroLateral Shoulder

Greater Tuberosity

The Skeleton of the

Posterior Shoulder

Posterior Osteology

GlenoHumeral Joint

Glenoid Labrum

Posterior Shoulder

4

SpinoGlenoid

Groove

Suprascapular

Nerve

Posterior Shoulder

Suprascapular

Artery

Posterior Shoulder

Suprascapular Notch + Ligament

Teres Minor

Posterior Shoulder

Quadrilateral SpaceSupraspinatus

Posterior Shoulder

Infraspinatus

Posterior Shoulder

Rotator Cuff is

Conjoint Tendon Deltoid

Posterior Shoulder

Clavicular

Acromial

Scapular

5

Shoulder Technique

Long Axis & Short Axis

Long Axis

Short Axis

Short Axis

Long Axis Short Axis

Orthogonal Planes

Short Axis Long Axis

U/S is a tomographic modality like MRI, CT & SPECT

• Anterior

• Superior

• AnteroLateral

• Posterior

Normal Shoulder Ultrasound

6

Long Bicipital Tendon

Short Bicipital Tendon

Hand Supinated on Top of Thigh

Outlet Portion

Distal Portion Outlet Portion: Long Axis

Musculotendinous Junction Pectoralis Major Tendon

7

Long Bicipital Tendon: Short-Axis Anisotropy Artifact

Toggle

Maneuver

Subscapularis

PROBE

Rest Ext Rotation

Subscapularis: Dynamic Maneuver Subscapularis:short axis view

Multi-Pennate MuscleAlternating Muscle-Tendon

8

Acromioclavicular Joint

• Anterior

• Superior

• AnteroLateral

• Posterior

Normal Shoulder Ultrasound

Supraspinatus Hyperextension

Internal RotationDr. Jeffery Crass Maneuver

Supraspinatus Supraspinatus-Infraspinatus

• Skin

• Deltoid Muscle

• SASD Bursa

• Cuff Tendon

• Footprint

• Hyaline Cartilage

• Subchondral Plate

• Enthesis

• Greater Tuberosity

• Lateral Shelf

9

Supraspinatus – Short Axis

• Skin

• Deltoid Muscle

• SASD Bursa

• Cuff Tendon

• (Footprint)

• Hyaline Cartilage

• Subchondral Plate

• Enthesis

• (Greater Tuberosity)

• (Lateral Shelf)

Short Axis View of Cuff

Acromial Level

Tuberosity Level

“Jeffrey Crass MD” “William Middleton MD”

Rotator Cuff Interval

• Anterior

• Superior

• AnteroLateral

• Posterior

Normal Shoulder Ultrasound

10

• Anterior

• Superior

• AnteroLateral

• Posterior

Normal Posterior Shoulder Ball & Socket Maneuver

External & Internal Rotation Glenohumeral Joint

Internal-External Rotation

Spinoglenoid NotchLong Axis

Subacromial Impingement

• Topographical Spots

• Bony Acoustic Landmarks

• Shoulder Anatomy

• Routine Protocol: Dynamic

Conclusions

Thank you for

joining