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Intro to Musculoskeletal Ultrasound of the Shoulder Intro to Musculoskeletal Ultrasound of the Shoulder John Hill, DO Tim Mazzola, MD University of Colorado.

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Presentation on theme: "Intro to Musculoskeletal Ultrasound of the Shoulder Intro to Musculoskeletal Ultrasound of the Shoulder John Hill, DO Tim Mazzola, MD University of Colorado."— Presentation transcript:

1 Intro to Musculoskeletal Ultrasound of the Shoulder Intro to Musculoskeletal Ultrasound of the Shoulder John Hill, DO Tim Mazzola, MD University of Colorado Office Based Sports Medicine Saturday, May 17, 2014

2 Disclosure Statement Newton Shoes: Physician Advisory Board MuscleSound: Physician advisor for software development to determine muscle glycogen content.

3 Objectives Discuss the normal ultrasound appearance of the shoulder and the individual structures Discuss the normal ultrasound appearance of the shoulder and the individual structures Describe the AIUM standard shoulder exam Describe the AIUM standard shoulder exam Discuss the uses of dynamic imaging Discuss the uses of dynamic imaging

4 Shoulder The Standard Examination

5 Sonography of Shoulder Complex structure containing Muscles Tendons Bursa Bone Labrum Fixed and Dynamic evaluations

6 Sonography of Shoulder Physician Practice Guideline is established by AIUM & ACR for the Shoulder U/S Biceps tendon Biceps tendon Subscapularis tendon Subscapularis tendon Supraspinatus tendon Supraspinatus tendon Infraspinatus tendon Infraspinatus tendon Teres minor Teres minor Dynamic evaluation Dynamic evaluation

7 Sonography of Shoulder Examination of: Joint effusions Bursa effusions Comparison of contralateral side Evaluate for: Bursal thickening Loose bodies Tendon calcification Muscle & bone abnormalities

8 Biceps Tendon- Short Axis Transverse Normal Notch view Normal transverse

9 Biceps Tendon- Short Axis Transverse Acute Tendinopathy Chronic Tendinopathy

10 Biceps Tendon - Long Axis Long Axis Normal Long Axis Normal Biceps LA

11 Biceps Tendon - Long Axis Long Axis Chronic Tendinopathy Acute Tendinopathy Fluid in tendon sheath

12 Long Head of Biceps Tendon Normal internal/external motion Normal long axis appearance

13 Is there subluxation of the Long Head of Biceps Tendon?

14 Subscapularis Tendon Instruct patient to place their arm in full EXTERNAL rotation Sagittal view (Short axis) Short Axis Subscap Short Axis view of Subscap

15 Subscapularis Tendon Instruct patient to place their arm in full EXTERNAL rotation Transverse view (Long axis) Long Axis Subscap Long Axis view of Subscap

16 Subscapularis Tendon Instruct patient to place their arm in full EXTERNAL rotation Transverse view (Long axis) Sagittal view (Short axis) Long Axis Subscap Short Axis view of Subscap

17 Supraspinatus Tendon Instruct patient to place their arm in INTERNAL rotation Place hand in back pocket (Long axis)45 degrees Coronal/ Sagittal SST WNL SST Normal Long Axis view

18 Supraspinatus Tendon Instruct patient to place their arm in INTERNAL rotation Place hand in back pocket (Short axis) 90 degrees Rotation of long axis SST Short Axis WNL SST, internal shoulder rotation SA view

19 Supraspinatus Tendon Instruct patient to place their arm in INTERNAL rotation Place hand in back pocket (Long axis)45 degrees Coronal/ Sagittal (Short axis) 90 degrees Rotation of long axis SST WNL SST with Tendinopathy

20 Supraspinatus Tendon-Long Axis Subacromial Bursa Supraspinatous, birds beak view (insertion) GT

21 Supraspinatus Tendon-Short Axis WNL SAB

22 Dynamic Motion Good Humeral Head Depression Rotten Humeral Head Depression Poor Posture, Weak Scapula Stability

23 Infraspinatus Tendon Instruct patient to place their arm in full INTERNAL rotation Place hand in back pocket Similar to Supraspinatus, but moved posteriorly (Long axis)45 degrees Coronal/ Sagittal (Short axis) 90 degrees Rotation of long axis

24 Infraspinatus Tendon Instruct patient to place their arm in full INTERNAL rotation Place hand in back pocket Similar to Supraspinatus, but moved posteriorly (Long axis)45 degrees Coronal/ Sagittal Long Axis appearance of ISTNormal appearance of IST

25 Teres Minor Tendon Instruct patient to place their arm in full INTERNAL rotation Place hand in back pocket Similar to Infraspinatus, but moved Inferiorly (Long axis)45 degrees Coronal/ Sagittal (Short axis) 90 degrees Rotation of long axis

26 Teres Minor Tendon Instruct patient to place their arm in full INTERNAL rotation Place hand in back pocket Similar to Infraspinatus, but moved Inferiorly (Long axis)45 degrees Coronal/ Sagittal Normal Long Axis of Teres minor

27 Teres Minor Tendon Instruct patient to place their arm in full INTERNAL rotation Place hand in back pocket Similar to Infraspinatus, but moved Inferiorly (Short axis) 90 degrees Rotation of long axis Normal Short Axis of Teres minor

28 Contralateral Comparison Long Axis Views Left SST is WNL Right SST Thickened chronic Tendinopathy

29 AC Joint

30 If the person is very thin, you might need standoff/interface disc

31 AC Joint Arthritic Changes but no effusion Less evidence of DJD, but effusion present

32 Summary Many structures in the shoulder are superficial and can be examine accurately with MSK ultrasound Many structures in the shoulder are superficial and can be examine accurately with MSK ultrasound Diagnostic Ultrasound should incorporated static and dynamic image Diagnostic Ultrasound should incorporated static and dynamic image If you examine many normal shoulders, then you will soon be able to pick-up even subtle changes If you examine many normal shoulders, then you will soon be able to pick-up even subtle changes


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