Ultrasound of the shoulder 2012
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23/03/2013 1 Ultrasound Scanning of the Shoulder – Lennard Funk [email protected] UBUNTU • Ubuntu speaks of the very essence of being human. [We] say [...] "Hey, soFandFso has ubuntu." Then you are generous, you are hospitable, you are friendly and caring and compassionate. • You share what you have. It is to say, "My humanity is caught up, is inextricably bound up, in yours." We belong in a bundle of life. • We say, "A person is a person through other persons." What is Ultrasound
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Transcript of Ultrasound of the shoulder 2012
23/03/2013
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Ultrasound+Scanning+of+the+Shoulder+
UBUNTU+
• �Ubuntu speaks+of+the+very+essence+of+being+human.+[We]+say+[...]+"Hey,+soFandFso+has+ubuntu."+Then+you+are+generous,+you+are+hospitable,+you+are+friendly+and+caring+and+compassionate.++
• You share what you have.+It+is+to+say,+"My+humanity+is+caught+up,+is+inextricably+bound+up,+in+yours."+We+belong+in+a+bundle+of+life.++
• We+say,+"A person is a person through other persons."+
What+is+Ultrasound+
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Medical+Ultrasound+
" Compound+waterFbath+scanner+" Gun+turret+of+B29+Bomber+
Howry & Bliss, 1949
Ultrasound+of+the+Shoulder+
" 1979+F+Seltzer+(Harvard)+Rhesus+monkeys+
" 1983+F+Bunker+F+first+USS+shoulder+(Exeter)+
" 1984+F+Craig+F+J+Clin+Ultrasound+" 1985+F+Bunker+presented+to+BOA+" 1987+F+Thesis+&+publica_on+(Bunker)+++++++++++F+100+shoulders+
Bunker T. Journal Bone Joint Surg 1985; 68B Bunker T. Seminars in Orthopaedics 1987;2(4): 267-276
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Bunker,+1985+
Modern+portable+Ultrasound+
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What+can+you+see+
Rotator Cuff
AC Joint
Greater Tuberosity
Biceps
Subacromial Bursa
What+you+cannot+see+
Intra-articular LHB
Labrum
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Benefits+" Cheap+" Convenient+" Quick+" No+radia_on+" Dynamic+" Interac_ve+" OfficeFBased+
Limita_ons+
" Operator+Dependent+
Diagnos_c+F+When+to+use+it+
" Rotator+Cuff+" Impingement+" Tears+" Calcific+Tendoni_s+
" Biceps+(ExtraFar_cular)+
" HillFSachs+Lesions+
" Frozen Shoulder " AC Joint " Arthritis " Osteolysis " Instability
" Fractures
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Impingement+Bursi_s+
Rotator+Cuff+Tear+
Calcific+Tendoni_s+
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Biceps+Tendoni_s+
Dislocated+LHB+
Fracture+Greater+Tuberosity+
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Fracture+Greater+Tuberosity+
HillFSachs+Lesion+
PostFop+Cuff+Repair+
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�Ultrasound is a highly accurate imaging study for evaluating the integrity of the rotator cuff in shoulders that have undergone an operation. Its accuracy for operatively treated shoulders appears to be comparable with that previously reported for shoulders that had not been operated on.�
Pectoralis+Major+
Interven_onal+
Guided Injections
1. Subacromial Impingement 2. AC Joint 3. Biceps
Hydrodilatation / Distension
Frozen Shoulder - Primary - Post Trauma / Surgery
Barbotage Calcific Tendonitis
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Subacromial Injection
Biceps Injection
Barbotage for Calcific Deposit
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When+not+to+use+it+
" Shoulder+Instability+
" Labral+Tears+" Young+Athle_c++
OfficeFBased+Ultrasound+
Changing+world+
" Consumer+society+" Faster+diagnosis+" Quicker+_me+to+treatment+&+recovery+" Difficult+/+slow+access+to+Imaging+
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Suspected+Rotator+Cuff+Tear+
" Does+he+have+a+rotator+cuff+tear?+
" How+big+is+it?+
" What+do+the+tendon+edges+look+like+
" What+is+the+state+of+the+Long+Head+of+Biceps?+
Suspected+Rotator+Cuff+Tear+• First Visit
• Referral+for+Ultrasound+
2 months / 1 week
Report
Ultrasound Scan
Ultrasound+Report+• There is a full thickness tear of the supraspinatus tendon.
• The infraspinatus tendon is a bit thinned, but is probably intact.
• Long head of biceps is not well seen.
How big is the tear? What is the quality of the cuff edges?
Is LHB subluxed / torn / partially torn / absent?
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Suspected+Rotator+Cuff+Tear+• First Visit
• Referral+for+Ultrasound+
Ultrasound Scan
2 months / 1 week
1 week
Report Read Report 1 week
OPD Review
2 months / 1 week
Surgery
6 months / 3 weeks
6 months / 3 weeks
There is a full thickness tear of the supraspinatus tendon.
The infraspinatus tendon is a bit thinned, but is probably intact.
Long head of biceps is not well seen.
Problems+
" Time+
" Inconvenience+
" Loss+of+earnings+
" Con_nued+disability+
• Exact Tear not known
• Surgical Plan less clear
• Tears get bigger
• Muscle degenerates
• Bigger tears = worse results
Revolu_on+–+Office+Ultrasound+✤ Performed+by+Clinician+✤ Quick+✤ CostFEffec_ve+✤ One+Stop+Clinic+
✤ Immediate+Diagnosis+✤ Management+Plan+✤ Shorter+Wai_ng+Time+for+Surgery+
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Surgeon+with+scanner:+
Learning+Curve+
" 4+surgeons;+159+shoulders+" Correlated+with+Arthroscopy+" Surgeons+>+100+scans:+" 94%+Sensi_vity+" 88%+Specificity+
BESS+Guidelines+
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BESS+Guidelines+
BESS+Guidelines+
Shoulderscan.com+
