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Ultrasound Scanning of the ShoulderLennard Funklenfunk@shoulderdoc.co.uk
@theshoulderdoc
@theshoulderdocTim Bunker
Ultrasound of the Shoulder
1979 - Seltzer (Harvard) Rhesus monkeys
1983 - Bunker - first USS shoulder (Exeter)
1984 - Craig - J Clin Ultrasound
1985 - Bunker presented to BOA
1987 - Thesis & publication (Bunker) - 100 shoulders
Bunker T. Journal Bone Joint Surg 1985; 68B Bunker T. Seminars in Orthopaedics 1987;2(4): 267-276
Bunker, 1985
Modern portable Ultrasound
What can you see
Rotator Cuff
AC Joint
Greater Tuberosity
Biceps
Subacromial Bursa
What you cannot see
Intra-articular LHB
Labrum
Diagnostic - When to use it
Rotator Cuff
Impingement
Tears
Calcific Tendonitis
Biceps (Extra-articular)
Frozen Shoulder
AC Joint
Arthritis
Osteolysis
Instability
Fractures
Hill-Sachs Lesions
Benefits
Cheap
Convenient
Quick
Simple
No radiation
Dynamic
Interactive
Office-Based
@theshoulderdocLiving Anatomy
Interventional
Guided Injections
1. Subacromial Impingement 2. AC Joint 3. Biceps
Hydrodilatation / Distension
Frozen Shoulder - Primary - Post Trauma / Surgery
Barbotage Calcific Tendonitis
When not to use itShoulder Instability Labral Tears Young Athletic
@theshoulderdocChanging world
Consumer society
Faster diagnosis
Quicker time to treatment & recovery
Difficult / slow access to Imaging
@theshoulderdocSuspected 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?
@theshoulderdocSuspected Rotator Cuff Tear
2 months / 1 week
Report
First Visit
Referral for Ultrasound
Ultrasound Scan
@theshoulderdocUltrasound 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?
@theshoulderdocSuspected Rotator Cuff Tear
First Visit
Ultrasound Scan
2 months / 1 week
1 week
Report Read Report1 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.
@theshoulderdocSo What?
Time
Inconvenience
Loss of earnings
Continued disability
• Exact Tear not known
• Surgical Plan less clear
• Tears get bigger
• Muscle degenerates
• Bigger tears = worse
results
@theshoulderdocRevolution – Office Ultrasound
Performed by Clinician
Quick
Cost-Effective
One Stop Clinic
Immediate Diagnosis
@theshoulderdocSurgeon with a Scanner !?
ROTATOR CUFF TEARS Sensitivity Specificity
Positive predictive
value
Negative predictive
value
Complete tears 94% 99% 95% 94%
Partial tears 87% 88% 83% 88%
@theshoulderdocSurgeon with scanner:
“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
@theshoulderdocOffice Ultrasound
Quick
One-stop-shop
Technology improving
Prices dropping
@theshoulderdocShoulder Ultrasound
Who should be doing it?
Europe vs. UK
Experience
Knowledge
In the patient’s interest
@theshoulderdocRoyal College of Radiologists
“ethically and legally vulnerable if they have not been adequately trained. “
@theshoulderdocLearning Curve
4 surgeons; 159 shoulders
Correlated with Arthroscopy
Surgeons > 100 scans:
94% Sensitivity
88% Specificity
@theshoulderdocBESS Guidelines
@theshoulderdocBESS Guidelines
@theshoulderdocBESS Guidelines
@theshoulderdocOffice Ultrasound
Quick
One-stop-shop
Technology improving
Prices dropping
Shoulderscan.com
@theshoulderdoc
I can see it now !
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