US finding of the shoulder (with live demonstration) 인제의대상계백병원 안재기

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1 US finding of the shoulder (with live demonstration) 인제의대상계백병원 안재기

2 Shoulder US Biceps tendon & Rotator Cuff Long Head of Biceps Tendon Subscapularis tendon Supraspinatus tendon Infraspinatus tendon Teres minor tendon Acromioclavicular joint Glenoid labrum SASD Bursa

3

4 Surface anatomy Greater tuberosity Lesser tuberosity Acromion Clavicle AC joint Scapular spine Bicipital groove Coracoid Surpaspinatus tendon Infraspinatus tendon Subscapularis tendon

5 Biceps, transverse scan

6 Biceps, longitudinal scan

7 Anisotropic reflectors Transverse sonogram shows normal long head of biceps tendon

8 Effusion in the biceps tendon sheath

9 Effusion in the biceps tendon sheath in adhesive capsulitis

10 Biceps tendinitis Lesion wnl Lesion wnl longitudinal transverse

11 Power Doppler Biceps tenosynovitis

12

13 Subscapularis, longitudinal scan

14 Subscapularis partial tear

15 Supraspinatus, transverse scan

16 Supraspinatus, longitudinal scan

17 Normal supraspinatus tendon

18 Calcific tendinitis of supraspinatus longitudinal transverse

19 Acoustic shadowing longitudinal transverse Longitudinal and transverse US scans of a calcium (Ca) deposit in a rotator cuff (supraspinatus tendon)

20 transverse longitudinal

21 Rotator cuff tear Partial thickness tear Bursal surface tears Intrasubstance tears Articular surface tears (~90% of partial tear) Full-thickness tear (communication between the GH joint and the SASD bursa) small (1cm), medium (2-3cm), large (3-5cm), massive (>5cm) In larger tears, chronically retracted muscles undergo fatty degeneration over time that may be irreversible

22 SST, Bursal surface tear

23 SST, Intrasubstance tear longitudinal transverse

24 SST, Articular surface tear longitudinal transverse

25 Partial thickness tear of supraspinatus longitudinal transverse

26 Secondary signs Full-thickness tears Cortical irregularity of the greater tuberosity Subacromial-subdeltoid bursitis Cartilage sign Effusion in the biceps tendon sheath Glenohumeral joint effusion

27 Full-thickness tear of supraspinatus longitudinal transverse

28 Secondary signs of full-thickness rotator cuff tear Cortical irregularity of tuberosity Volume loss, subacromial-subdeltoid bursa contour deformity, flattening,

29 Herniation of the deltoid muscle longitudinal transverse

30 Hypoechoic or anechoic cleft in the cuff transverse

31 Chronic massive tear of supraspinatus longitudinal transverse Absence of rotator cuff Atrophy of greater tuberosity

32 Massive tear of supraspinatus

33 Probe compression

34 Massive tear of supraspinatus Deltoid cartilage interface (cartilage sign) Probe compression

35 Infraspinatus, transverse scan Humeral head

36 Infraspinatus, longitudinal scan

37 Acromioclavicular joint

38 Acromioclavicular joint 1. Lax capsule, AC ligament(superior, inferior, anterior, posterior) 2. Intraarticular disc, fibrocartilage disc 3. Concave acromion, convex distal clavicle

39 AC joint, arthritis

40 Rupture of AC joint longitudinal WNL

41 Subdeltoid bursa

42 Bursae around the shoulder joint Subacromial-subdeltoid bursa Subscapularis bursa Subcoracoid bursa Coracoclavicular bursa Supraacromial bursa

43 Subdeltoid bursitis

44 Subdeltoid bursitis

45 Fluid collection & SASD bursitis longitudinal transverse

46 Subacrmomial-Subdetoid bursitis

47 Subacrmomial-Subdetoid bursitis

48 Subacrmomial-Subdetoid bursitis longitudinal transverse

49 Fracture, greater tuberosity after trauma longitudinal transverse cortical disruption of greater tuberosity(arrows) at supraspinatus insertion

50 Fracture, Greater Tuberosity

51 Hill-Sachs lesion

52 Thanks for your attention!!

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