어깨초음파스캔 정상소견및증례imedimp4.castcity.net/kacu/20190609/hara1/02.pdf ·...

어깨 초음파 스캔(정상 소견 및 증례)

창원경상대학교병원

김현옥

Contents

List Structures

1 Normal anatomy of shoulder joint

2 Biceps tendon

3 Subscapularis tendon

4 Supraspinatus tendon

5 Infraspinatus tendon

6 A-C joint

7 Cases

Normal Anatomy of Shoulder Joint

Diagnostic Ultrasound Musculoskeletal ELSEVIER


1 2

3

Rotator cuff muscle

Rotator cuff musclesMuscle Origin on

scapulaAttachment onhumerous

Function

Infraspinatusmuscle

Infraspinatusfossa

Posterior facet of the GT

Externally rotates the arm

Supraspinatusmuscle

Supraspinatusfossa

Superior and middle facet of the GT

Abducts the arms

Subscapularismuscle

Subscapularfossa

Lesser tuberosity or humeral neck

Internally rotates the humerus

Teres minor muscle

Middle half oflateral border

Inferior facet of the GT Externally rotates the arm

Basic View

• 1. Biceps tendon (long head)- transverse/longitudinal

• 2. Subscapularis tendon- transverse/longitudinal

• 3. Supraspinatus tendon- transverse/longitudinal

• 4. infraspinatus tendon- transverse/longitudinal

Biceps tendon

Biceps tendon

Acta Radiol. 2013 Feb 1;54(1):83-8. doi: 10.1258/ar.2012.120353.

Biceps tendon, short head

Biceps tendon, long head

https://www.google.co.kr/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwjRyYX2r_XeAhVFXLwKHWjsBq8QjRx6BAgBEAU&url=https://www.researchgate.net/figure/nsertion-of-the-subscapularis-SSC-coracohumeral-ligament-and-supraspinatus-SSP-on_fig3_232649229&psig=AOvVaw0bNtgSbtTJI8kQRkAD7ojQ&ust=1543435621934604

Biceps tendon: transeverse

Fundamentals of Musculoskeletal Ultrasound

비등방성(anisotropy)


Biceps tendon: longitudinal


Lesser tubercle

Deltoid muscle

Subscapularis tendon

Subscapularis tendon: longitudinal


Lesser tubercle


Subscapularis tendon: transverse


Hyperechoic tendon bundle

Hypoechoic muscle (arrowheads)

Supraspinatus tendon

Supraspinatus tendon (Neutral position)


Acromion

Greater tubercle

Humeral head

Supraspinatus tendon

Deltoid

Humeral head

Supraspinatus evaluation: Crass Position

Supraspinatus tendon (longitudinal)


Deltoid

Supraspinatus tendon (longitudinal)



Supraspinatus tendon (transeverse)

https://cbsnewyork.files.wordpress.com/2017/05/rotatorcuff.jpg

Supraspinatus tendon (transeverse)


Deltoid

Supraspinatus and infraspinatus junction

(open arrow)

Supraspinatus tendon(arrow)

Practical Musculoskeletal Ultrasound

Supraspinatus and infraspinatus junction

Infraspinatus tendon

Infraspinatus tendon: transverse

www.med.umich.edu

GL

deltoid m.

Infraspinatus

www.med.umich.edu

GL

Infraspinatus

Infraspinatus tendon: Longitudinal

Infraspinatus tendon: normal view

www.med.umich.edu

Transverse view Longitudinal view

Acromioclavicular joint

Acromioclavicular joint

Practical Musculoskeletal Ultrasound

Supraspinatus tears

Supraspinatus tendon tear

• Supraspiantus: initial abduction (no rotation)

- involved in 95% of rotator cuff tears (alone or with adjacent infraspinatus or subscaplaris tendon tear)

• Painful arc of motion: pain with active range of motion between 60~120° of abduction is associated with rotator cuff disease

• Passive range of motion (+) : rotator cuff disease VS adhesive capsulitis

• Empty can test

https://www.clinicalkey.com


• Supraspinatus tendon tear (by tear thickness)

• Partial-thicknessBursal

Articular

Intrasubstance (intratendinosus)

• Full-thickness


• Ultrasound findings

1) Tendon thinning

2) Cortical irregularity

3) Joint effusion and bursal fluid

4) Cartilage interface sign

Supraspinatus tendon tear: articular type


Contact with the articular surface (arrow) Cortical irregularity of the

greater tubercle (arrowhead)

Well defined anechoic disruption of the tendon fiber

(curved arrow)

Supraspinatus tendon tear: bursal tear


Supraspinatus tendon tear: intrasubstance tear


Supraspinatus tendon tear : full thickness tear, focal


Cartilage interface sign (arrowheads)

Subdeltoid bursa(open arrow)



Articular tear



Bursal tear

Supraspinatus tendon tear : full thickness tear


Full thickness, complete tear

Anechoic disruption of the tendon fiber(curved arrow)

Proximal tendon retraction(arrow)

Supraspinatus tendinosis

• Tendinosis (or tendinopathy)

1) corresonding to tendon degeneration without inflammation.

2) a heterogeneous, somewhat ill defined, hypoechoic area in the tendon without a tendon defect.


Supraspinatus tendinosis


Biceps tendinitis

• 위팔두갈래힘줄염(Biceps tendinitis) 임상 증상

• 어깨의 앞쪽에 발생하는 통증이 특징적임(가끔 어깨 전체도 나타남)

• 위팔두갈래근 힘줄윤활막염(tenosynovitis of biceps tendon)과 잘 동반됨

• Speed test and Yergason’s test

KCR textbook of Rheumatology 2nd

Biceps tendinitis

Popeye sign (biceps tendon tear)

N ENGL J MED 2017; 377:1976

https://radiopaedia.org/cases/long-head-of-biceps-tendon-tear-1

Tendon calcification

•임상 증상• Rotator cuff tear 혹은 impingement syndrome과 유사함

• 외상이 없이 점진적으로 나타나기도 함

• 야간에 통증이 증가, 아픈 쪽으로 누워 자기 힘듬

• 머리위로 손을 올리는 동작을 하는 경우 통증이 동반됨

• 일부에는 3~6개월 뒤에 저절로 호전됨

• 약 30%정도의 환자는 만성적인 경과를 보임


• Calcific deposits within the rotator cuff may take one of two forms

1. Degenerative calcification2. Calcium hydroxyapatite deposition

• Calcific tendinitis: the presence of inflammatory markers

-> active and passive range of motion may be limited

(may be warm and tender)

• Calcific tendinosis: a reported prevalence of 24% of asymptomatic females

• Supraspinatus is most commonly involved



• The calcific deposits in calcific tendinosis most commonly are hyperechoic with posterior acoustic shadowing

• Cortical erosions and osseous involvement may also be present

• In approximately 7% of cases, tendon calcification shadowing is absent, and radiographs may be normal (if calcifications are in the form of a thick fluid or slurry)


Calcific tendinitis- supraspinatus tendon

https://radiopaedia.org/articles/calcific-tendinitis?lang=us

Diagnostic Ultrasound: Musculoskeletal

Calcific tendinitis- supraspinatus tendon


Impingement syndrome

• 임상 증상

• Rotator cuff tendinopathy와 증상이 유사함

• 머리 위로 손을 올리게 되면 통증이 동반됨

• Deltoid area와 lateral arm에 통증이 있음

• 야간 및 통증이 있는 부위로 눕기 힘듬

• 이학적 검사

• Painful arc

• Neer’s test

• Hawkin’s sign

Shoulder impingement syndrome

https://www.rehabmypatient.com/shoulder/shoulder-impingement-syndrome




The Egyptian Journal of Radiology and Nuclear Medicine (2014)45, 1171–1182


Supraspinatustendon

Supraspinatustendon

AcromionAcromionAcromion

Greatertubercle

Greatertubercle

SASD bursitis

Glenohumeral joint effusion


www.med.umich.edu

Infraspinatus

Humerous

부종, 열감, 경직감, 통증

Shoulder Injection

https://musculoskeletalkey.com/ultrasound-guided-interventional-procedures-about-the-shoulder/

https://www.youtube.com/watch?v=OAeOEc-X0kU

https://musculoskeletalkey.com/ultrasound-guided-interventional-

Take home message

•정확한 진단을 위해서는 병력 청취가 중요합니다

•정상 구조물에 대한 숙지가 중요합니다

•정상 구조물을 바탕으로 pathologic finding을 감별 할 수 있어야 합니다

감사합니다

어깨초음파스캔 정상소견및증례imedimp4.castcity.net/kacu/20190609/hara1/02.pdf ·...

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