ultrasound of the shoulder - foundation for orthopaedic … · 2018-04-16 · ultrasound of the...
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Ultrasound of the ShoulderEric W. Lee, MDEric W. Lee, MD
Advanced Concepts in Sports Medicine Advanced Concepts in Sports Medicine November 2015November 2015
DisclosuresDisclosures
Speaker: Sonosite, Arthrex
Royalties: None
Stock Options: None Stock Options: None
I do not intend to discuss any off‐label use/ unapproved use of drugs or devices
Objectives
Uses of ultrasoundUses of ultrasoundShoulder anatomyShoulder anatomyShoulder Shoulder sonosono--Shoulder Shoulder sonosono--
anatomyanatomyUltrasound shoulder Ultrasound shoulder
examexam
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Diagnostic Uses
Soft tissue disordersSoft tissue disorders Tears
Muscle, tendon, ligament
Inflammation
Joint disordersJoint disorders Erosions on bones Loose bodies Pannus Inflammation
Tenosynovitis
Masses Hematoma, cyst, solid
tumors, calcifictendonitis
Nerve disorders Morton’s neuroma,
neuropathies, trauma
Foreign bodies Infections
Inflammation Effusion
Bone disordersBone disorders Fractures
Therapeutic Uses
InjectionsInjections Marcaine/Lidocaine
Cortisone
Hyaluronic acid
Surgical adjunct to Surgical adjunct to arthroscopyarthroscopy
BiopsyBiopsy
Removal of foreign Removal of foreign Hyaluronic acid
PRP
Stem Cells
AspirationAspiration Drain joints, cysts,
hematomas
ggbodiesbodies
Shoulder Anatomy
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Muscular Anatomy -Anterior
Muscular Anatomy -Posterior
The Labrum
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Shoulder Bony Anatomy
Shoulder Sono-Anatomy
Shoulder U/S Tissue Types
BoneBoneFatFat TendonTendonMuscleMuscle LabrumLabrumBursaBursa
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Shoulder U/S Tissue Types
BoneBoneFatFat TendonTendonMuscleMuscle LabrumLabrumBursaBursa
Other Signals
Synovial fluidSynovial fluid Synovial fluidSynovial fluid
Foreign BodyForeign Body
AirAir
Ultrasound Shoulder Exam
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Shoulder Ultrasound: Terminology
Long Axis (Longitudinal) viewLong Axis (Longitudinal) view Transducer parallel to the long axis of the Transducer parallel to the long axis of the
structure of intereststructure of interest
Short Axis (Transverse) viewShort Axis (Transverse) view Transducer perpendicular to the structure of Transducer perpendicular to the structure of
interestinterest
Shoulder Ultrasound: Approaches
AnteriorAnteriorAnterolateralAnterolateral PosteriorPosterior
Shoulder Shoulder osteology creates osteology creates challengeschallenges
Shoulder Ultrasound: Anterior exam
Biceps tendonBiceps tendon Long & Short Axis
Superior & Inferior
SubscapularisSubscapularis Long & Short Axis
Anterior LabrumAnterior Labrum
CoracoidCoracoid Subcoracoid
impingement
AC JointAC Joint
ClavicleClavicle
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Biceps Tendon – Short Axis
Arm position: Neutral
Tip: Find bicipital groove
MRI equivalent: Axial plane
Biceps Tendon – Short / Sup vs Inf
Superior: Deep bicipital groove
Inferior: Flattened bone with transition to muscle
Biceps Subluxed & SubscapTorn
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Biceps Subluxing
Biceps Tendon – Long Axis
Arm position: Neutral
Tip: Find transverse view, keep groove centered then turn probe 90o
MRI equivalent: Sagittal plane
Biceps Tenosynovitis
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Subscapularis – Long Axis
Arm position: External rotation
Tip: Find bicipital groove @ neutral then ER
MRI equivalent: Axial plane
Subscapularis – Short Axis
Arm position: External rotation
Tip: Find longitudinal view, then turn probe 90o
MRI equivalent: Sagittal plane
Partial Subscapularis Tear
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Coracoid-Subscapularis
Arm position: ER <-> IR, with Flex/Add/IR
Tip: Move medial once found Longitudinal Subscap
MRI equivalent: Axial plane
Coracoid-Subscapularis
Subscapularis Cyst
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AC Joint
Arm position: Neutral
MRI equivalent: Coronal plane
Tip: Palpate the joint for easy localization
AC Separation
Normal AC Separation, Grade II
Clavicle Fracture
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Shoulder Ultrasound: Anterolateral exam
SupraspinatousSupraspinatous Long & Short Axis
Anterior & Posterior
SubacromialSubacromial BursaBursa SubacromialSubacromial BursaBursa
Supraspinatous – Long Axis
Arm position: Extended
Tip: Probe parallel plane [Contralateral shoulder : Ipsilateral hip]
MRI equivalent: Coronal plane
Supraspinatous
BursaBursa Greater TuberosityHumeral Head
PeribursalPeribursal FatFat
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Supraspin. – Long / Ant vsPost
Anterior: Step off pronounced on tuberosity Posterior: Flatter transition of head to tuberosity
Subacromial Bursitis
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Partial-thickness RC Tears
FT RC Tears
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Calcific Tendonitis
Long Axis Short Axis
Chronic RCT w/ Cystic Changes
Shoulder Ultrasound: Posterior exam InfraspinatousInfraspinatousGlenohumeralGlenohumeral
JJoint & Posterior oint & Posterior JJoint & Posterior oint & Posterior LabrumLabrum
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Infraspinatous – Long Axis
Arm position: Neutral
Tip: Stay more lateral and find edge of humeral head
MRI equivalent: Axial plane
Infraspinatous – Short Axis
Arm position: Neutral to flexed
Tip: Find longitudinal view, then turn probe 90o
MRI equivalent: Sagittal plane
Infraspinatous - Tear
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Posterior GlenohumeralJoint
Arm position: Neutral
Tip: Find longitudinal view infraspinatous, then move medial, rotating arm
MRI equivalent: Axial plane
Posterior Instability
Posterior Labral TearUSA: Ultrasound Arthrogram
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Biceps Tendon: Biceps Split
RCT - Full Thickness?
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Biceps Tendon: Medial Subluxation
Biceps Tenosynovitis
Subcoracoid Loose Body
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Posterior Labral Tear
Severe DJD of Humeral Head
Normal Severe DJD
Bones
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5th Metatarsal
Finger Middle Phalange
Epiphyseal Plate
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Fibula: Cortical Thickening
Os Acromiale
Scanning the Cortex
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Supraspinatous
Shoulder Fracture
Courtesy of Daniel Shelton
FT RC Tears
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Ca Tendonitis
Acromioclavicular (AC) Joint
AcromionAcromionClavicleClavicle
ACROMIOCLAVICULAR LIGAMENTACROMIOCLAVICULAR LIGAMENT
Courtesy of Daniel She