Jenelle Beadle, RDMS Inland Imaging December 15 th, 2014.

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 - Long


Transverse Humeral Ligament over Synovial Tendon Sheath

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


Long Subscapularis Trans Subscapularis

Subscapularis Tendon - Long

Musculotendonis junction coming from under the coracoid process


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


Tendon extends medially to the insertion on the lesser tuberosity


Anisotropy where tendon fibers turn to insert


Tendon insert along this flattened area of the lesser tuberosity


Bicipital Groove

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


Long Supraspinatus

Supraspinatus Tendon - Long

Long SupraspinatusNeutral Position

Long SupraspinatusStressed Position

Acromion


Musculotendonis junction coming from under the acromion

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


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

• any separation here indicates an anterior full thickness supraspinatus tear

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


Long Supraspinatus

Infraspinatus Tendon - Long

Supraspinatus vs Infraspinatus Tendons - Long

Infraspinatus Tendon - Trans

Acromioclavicular Joint• Assessed for stability and fluid

Acromioclavicular Joint

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

Posterior Glenohumeral (GH) Joint


Labrum

Humeral HeadGlenoidRim

Infraspinatus Musculotendinous Junction

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…)

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



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

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

Jenelle Beadle, RDMS Inland Imaging December 15 th, 2014.

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Transcript of Jenelle Beadle, RDMS Inland Imaging December 15 th, 2014.