Musculoskeletal ultrasound

-shoulder

OSR2 박철
 Anisotrophy
commonest artifact in musculoskeletal US
different US echogenicity of normal tissue when the angle
of insonation is not 90°
A common site of occurrence : SS tendon

To separate anisotropy from pathology,

the transducer is held in the same position but it is angled
perpendicular to the tissue

When this position is achieved,

if normal : homogeneous echogenecity
If pathologic : remains hypoechoic
Anisotrophy
 Long head of biceps tendon

neutral position with arm in supination res

ting on the ipsilateral thigh
(the bicipital groove anteriorly)

dynamic exam performed with IR & ER

assess integrity of THL and biceps tendon subl
uxation
Long head of biceps tendon
Long head of biceps tendon
Long head of biceps tendon
Long head of biceps tendon
 Long head of biceps tendon

Evaluate the bicipital sheath

to its inferior-most extent;

this is a common location for intraarticular

bodies to gravitate!!
 subscapularis
with the arm both in neutral and in ER positions

dynamic assessment Maintaining the elbow by t

he side and abducting and adducting the forearm
help discriminate anisotropy, focal tendi
nosis, and partial tears
subscapularis
subscapularis
 suprasupinatus
Crass position
full IR and hyperextension with forearm behind the back, palm
facing posteriorly, overlapping the scapular tip while maintai
ning elbow by the side

modified Crass/Middleton position

With upper arm extended and shoulder in neutral position, el
bow flexed and pointing directly posteriorly and palm of ha
nd placed forward against ipsilateral back pocket

allows for visualization of SS tendon immediately adjacent t

o bicipital interval, area often obscured by acromion in Cras
s position
suprasupinatus
suprasupinatus
suprasupinatus
suprasupinatus
suprasupinatus
 InfraS & teres minor
With forearm placed across chest and palm of han
d placed against contralateral shoulder
InfraS & teres minor
 Post. Labrum &
spinoglenoid notch
Ant. labrum
AC joint
Coracohumeral lig. & coracoacromial l
ig.
SS dynamic impingement test