Transcript Shoulder Ultrasound

SHOULDER ULTRASOUND
Personal protocols
Caitlin Gardiner
INTRODUCTION

The practice I did the majority of my training with in
my first year of clinical ultrasound performs little
MSK ultrasound. I have just commenced work in the
past few weeks at a general radiology practice where I
am already exposed to a significant degree more MSK
ultrasound that ever before. At this stage, I’m
scanning MSK with another sonographer and the
plan is to slowly add various scans to my list as I gain
competency. Shoulder ultrasound is challenging due
to the large number of tendons very proximal to one
another and unique scanning plane. Using my images
I submitted for homework, this is a summary of what
I know so far with the feedback I have been given by
my tutor.
BICEPS
Patient
Position/Manoeuvre

Ipsilateral hand of the
shoulder placed on the
knee with palm
upwards.
Assessment of Structure
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Observe in Trans
-?surrounding fluid
Observe it Long

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Ensure visualization from
upper biceps muscle to very
superior segment
Assess groove
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
?regular fibers
Any hypoechoic/thickening
<3mm= shallow
Transverse bicep central/medial
edge(subluxed)/out of the
groove (dislocated)
Assess pop-eye sign, to aid
biceps rupture
BICEPS- SUBMITTED IMAGES AND
FEEDBACK
Lovely
SUBSCAPULARIS
Patient
Position/Manoeuvre
Place probe in
transverse, fully
rotate the arm
externally
 Assess subscupularis
like this and then
visualize in mild
extension and partial
external rotation
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Assessment of Structure
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Assess all fibres,
including those adjacent
to the bicep tendon
(utilise manoeuvres)
Ensure observation of
subscapularis sliding
under coracoid
(?entrapment)
Visualise fibrillar
pattern and any bursal
thickening
Mild bony irregularly is
acceptable
SUBMITTED IMAGES AND FEEDBACK
Image with internal rotation does not have
subscapularis in it
CA LIGAMENT
Patient
Position/Manoeuvre

Maintain external
rotation of the arm.
Slide the probe medial
to visualize the
clavicle and angle the
lateral end of probe
superior to around 45°
to see acromium.
Assessment of Structure
SUBMITTED IMAGES AND FEEDBACK
Lovely
AC JOINT
Patient
Position/Manoeuvre

‘Plonk’ probe on top,
in line with the
clavicle
Assessment of Structure
Is there any focal
tenderness?
 Any separation of the
two bones (can get
patient to pull from
underneath of bed to
apply pressure)
 Any cysts or bony
spurs
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SUBMITTED IMAGES AND FEEDBACK
Lovely.
SUPRASPINATUS
Patient
Position/Manoeuvre
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Place the ipsilateral hand
on the ipsilateral hip with
elbow posterior. Visualize
the bicep in transverse in
the most medial side of the
screen. Slide the probe
backwards to visual is
transverse. Rotate 90°to
view tendon in
longitudinal.
Consider various positions
(eg, hand behind
back/neutral) throughout
to maximize assessment
Assessment of Structure

In true transverse, assess
from anterior to posterior
ensuring visualisation
adjacent to biceps tendon


Regular contour
(?thinning, flattening)
In longitudinal, image
from medial to lateral
fibrillar pattern
Bony irregularity
(?enthesopathy)
 Bursal thickening
 Note any calcifications
and associated
hypervascularity
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SUBMITTED IMAGES AND FEEDBACK
None of trans images have biceps in them, therefore most anterior
portion is not imaged. Mid and post long images are a little oblique.
INFRASPINATUS
Patient
Position/Manoeuvre

Place hand on
contralateral
shoulder. Position
probe on posterior of
shoulder (not too far
back).
Assessment of Structure
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Mild bony irregularity is
acceptable
Significant bony
irregularity/Hill-Sachs
deformities indicate
dislocation
If need to differentiate
from supraspinatus,
refer to previous
position where the
infraspinatus fibres run
oblique
SUBMITTED IMAGES AND FEEDBACK
Lovely.
POSTERIOR JOINT
Patient
Position/Manoeuvre
Drop field of depth
from infraspinatus
and slide probe
slightly medial
 Ask patient to slowly
tap ipsilateral
shoulder and observe
any joint fluid.

Assessment of Structure
Appears as an
echogenic triangle
 ?fluid
 ?cysts
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SUBMITTED IMAGES AND FEEDBACK
No feedback.
SPINOGLENOID/SUPRASCAPULAR NOTCHES
Patient
Position/Manoeuvre
Spinoglenoid notchmove probe more
medially
 Suprascapular notchposition probe
between the superior
scapula and the
posterior border of the
lateral clavicle
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Assessment of Structure
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Exclude ganglion and
cysts
SUBMITTED IMAGES AND FEEDBACK
?Mislabelled
ABDUCTION
Patient
Position/Manoeuvre
Patients arm is bent
beside their torso with
their palm up. Abduct
slowly.
 Observe anterior and
mid supraspinatus
under CA Ligament
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Assessment of Structure
? Bunching of the
supraspinatus
 ?bunching of the
bursa

SUBMITTED IMAGES AND FEEDBACK
Good.
REFERENCES

Ideas extracted from
McNally E, 2005. Practical Musculoskeletal
Sonography. Elevisier Churchill Livingstone,
Philadelphia
 Coombs P, 2005. Shoulder Ultrasound: a discussion
paper. Soundeffects; 3:18-25
