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

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Transcription:

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

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

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

Biceps, transverse scan

Biceps, longitudinal scan

Anisotropic reflectors Transverse sonogram shows normal long head of biceps tendon

Effusion in the biceps tendon sheath

Effusion in the biceps tendon sheath in adhesive capsulitis

Biceps tendinitis Lesion wnl Lesion wnl longitudinal transverse

Power Doppler Biceps tenosynovitis

Subscapularis, longitudinal scan

Subscapularis partial tear

Supraspinatus, transverse scan

Supraspinatus, longitudinal scan

Normal supraspinatus tendon

Calcific tendinitis of supraspinatus longitudinal transverse

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

transverse longitudinal

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

SST, Bursal surface tear

SST, Intrasubstance tear longitudinal transverse

SST, Articular surface tear longitudinal transverse

Partial thickness tear of supraspinatus longitudinal transverse

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

Full-thickness tear of supraspinatus longitudinal transverse

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

Herniation of the deltoid muscle longitudinal transverse

Hypoechoic or anechoic cleft in the cuff transverse

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

Massive tear of supraspinatus

Probe compression

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

Infraspinatus, transverse scan Humeral head

Infraspinatus, longitudinal scan

Acromioclavicular joint

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

AC joint, arthritis

Rupture of AC joint longitudinal WNL

Subdeltoid bursa

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

Subdeltoid bursitis

Subdeltoid bursitis

Fluid collection & SASD bursitis longitudinal transverse

Subacrmomial-Subdetoid bursitis

Subacrmomial-Subdetoid bursitis

Subacrmomial-Subdetoid bursitis longitudinal transverse

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

Fracture, Greater Tuberosity

Hill-Sachs lesion

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