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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…)