m court-payen, md, phd - dept of musculoskeletal imaging ...€¦ · van holsbeeck mt, introcaso...
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M Court-Payen, MD, PhD - Dept of Musculoskeletal Imaging GHP Gildhøj Private Hospital Copenhagen - Denmark
US of the Shoulder – Examination Technique
• High Frequency Linear Array : 12-10 MHz • Rotating Chair
• Very Systematic • Different Specific Patient Positions
• Comparison with Contralateral Side • Dynamic • Interactive ++
Longitudinal
Long Head of the Biceps
Rotator Cuff
US of the Shoulder – Examination Technique
• High Frequency Linear Array : 12-10 MHz • Rotating Chair
• Very Systematic • Different Specific Patient Positions
• Comparison with Contralateral Side • Dynamic • Interactive ++
US of the Shoulder – Examination Technique
• High Frequency Linear Array : 12-10 MHz • Rotating Chair
• Very Systematic • Different Specific Patient Positions
• Comparison with Contralateral Side • Dynamic • Interactive ++
US of the Shoulder – Examination Technique
• High Frequency Linear Array : 12-10 MHz • Rotating Chair
• Very Systematic • Different Specific Patient Positions
• Comparison with Contralateral Side • Dynamic • Interactive ++
US of the Shoulder
• Anatomy of the Shoulder
• Systematic US Examination of the Shoulder
• Dynamic Examination of the Shoulder
• (US-guided Injection)
Glenohumeral Joint
Acromioclavicular Joint Sternoclavicular Joint
Scapulothoracic Space
Subacromial Space
The Shoulder = 5 “Joints”
Long Head of the Biceps
Supraspinatus
Infraspinatus
Teres Minor Subscapularis
Lateral Scapula
Biceps Subscapularis
Supraspinatus
Infraspinatus Teres Minor
CA ligt
AC joint Acromion
Superior Shoulder
Anterior Shoulder
Coracoid Process
Lesser Tuberosity
Greater Tuberosity
Acromion AC joint
Bicipital Groove
Anterior Shoulder
Subscapularis
Biceps
Anterior Shoulder
SDSA Bursa Deltoid
Anterior Shoulder
LH Biceps
Subscap
CA Ligt
AC Joint
+ SASD Bursa
Long Head of the Biceps
Rotating Chair
Supination
Patient Sitting
Long Head of the Biceps
Rotator Cuff Interval
Biceps Muscle
Pectoralis Tendon
Transv Humeral Ligt
Transversal
Long Head of the Biceps Rotator Cuff Interval
Retropulsion
Coraco-Humeral Ligt
Anterior Sling !
Superior Glenohumeral
Ligt
Biceps Muscle
Rotator Cuf Interval
Long Head of the Biceps
Longitudinal
Subscapularis Tendon
External Rotation +
Adduction
Cor
Subscapularis Tendon
- Volume - Structure - Upper Margin
External Rotation +
Adduction
Subscapularis Tendon
Rotator Cuff
Deltoid
Coracoid Acromion
Coracoacromial Ligament
Bursa
Acromioclavicular Joint Anatomical Variations
Compaire
to Contralateral ++
SASD Bursa
No Fluid Van Holsbeeck MT, Introcaso JH, Musculoskeletal Ultrasound 2001, p 472
Hypoechoic Layer < 1.5 mm Milgrom C et al. J Bone Joint Surg [Br] 1995, 77-B, 296-298 Van Holsbeeck MT, Introcaso JH, Musculoskeletal Ultrasound 2001, p 476
Unless Steroid Injection within 48 h Major NM, Skel Radiol 1999, 28, 628-631
Lateral Shoulder
Supraspin
+ SASD Bursa
Supraspinatus Tendon
Neutral
Supraspinatus Tendon
Internal Rotation +
Retropulsion Crass JR, J Clin Ultrasound 1987, 15, 416-420
Neutral
Supraspinatus Tendon
Head Neck Great
Tuberosity
Deltoid SASD Bursa
< 1.5 mm
Cartilage
• Convexe Upper Margin
• Progressive Thining
• Echorich Fibrillar Structure
• Regular Bony Surface
• Thickness : 5 - 7 mm (neck)
Normal Supraspinatus Tendon - 5 Histologic Layers
Clark JM et al. J Bone Joint Surg Am. 1992 Jun;74(5):713-25
5 4 3
2 1
5 4 3
2 1
Modified from Guérini et al. Actualité en Echographie de l´Appareil Locomoteur, Sauramps Médical 2008:21-33
Normal Supraspinatus Tendon - 2 BioMechanical Layers
5 4 3
2 1
Modified from Guérini et al. Actualité en Echographie de l´Appareil Locomoteur, Sauramps Médical 2008:21-33
Normal Supraspinatus Tendon - 2 Layers
Homogeneous But Pitfalls ... Supraspinatus Tendon
Oblique Scan
Supraspinatus Tendon Homogeneous But Pitfalls ...
No : Muscle Layer (Young ++)
Intratendinous Lesion ?
Supraspinatus Tendon Homogeneous But Pitfalls ...
Biceps Hiatus Deltoid Septation
Homogeneous But Pitfalls ... Supraspinatus Tendon
Supraspinatus Tendon
Humeral Head
Biceps
Deltoid SASD Bursa SS 2 cm
Supraspinatus Tendon
Modified Position
Biceps
SS 2 cm
Greater Tuberosity
Humeral Head Post Recess
Spinoglenoid Notch
Posterior Shoulder
Posterior Shoulder
Infraspinatus
Teres Minor
Posterior Shoulder
Teres Minor
Infraspin
Spinoglenoid Notch
+ SASD Bursa
Muscles
Head
Neck GT
Deltoid SASD Bursa
Cartilage
Infraspinatus Tendon
Labrum
Infraspinatus Tendon
Head
Normal Irregularity Neck
TM IS
Deltoid
Infraspinatus + Teres Minor Muscles
SS
Trap
Sp
Cl
Supraspinatus Muscles
SS
Trap Ac
Supraspinatus Muscles
Spinoglenoid Notch
Spine Neck
Suprascapular Neurovascular Bundle
Infraspinatus
Neer CS, J Bone Joint Surg 1972;54-A:41-50
Painful Arc
Tendinitis Tendinosis Tendon Tear Bursitis
Subacromial Impingement
Longitudinal Movement Longitudinal US Scanning
1 2
Subacromial Impingement
Dynamic US Examination Longitudinal Views of the Supraspinatus Tendon
1- At the level of the Acromion 2- At the level of the CAL
Subacromial Impingement Bulging of Bursa and Blocking of Tendon
Calcific Tendinopathy
Thank You