jenelle beadle, rdms inland imaging december 15 th, 2014
TRANSCRIPT
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…)