Ultrasound of the Shoulder

Dr Tom Marshall Norfolk and Norwich University Hospital
Radiology Norwich UK

Shoulder U/S
Objectives:
• • • • Appreciate normal sonographic appearances Appreciate normal sonographic anatomy Dynamic evaluation of the shoulder Differentiate tendinopathy and full thickness tendon tear • Perform guided aspiration/steroid injections
Radiology Norwich UK

Anterior shoulder

Radiology Norwich UK

Shoulder U/S
Deltoid Coracoid process Subacromial bursa
Articular Cartilage
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Supraspinatus Biceps

Shoulder U/S

Biceps Tendon TS Radiology Norwich UK

Shoulder U/S
Deltoid muscle

Biceps Humeral shaft Biceps Tendon LS
Radiology Norwich UK

Biceps sheath fluid
• Fluid is dependent • High association with cuff tears

Radiology Norwich UK

Shoulder U/S
Subscapularis tendon Transverse ligament

Bicipital Groove

Biceps Tendon TS
Radiology Norwich UK

Shoulder U/S

Pectoralis major tendon

Pectoralis major tendon ts
Radiology Norwich UK

Shoulder U/S
Deltoid Subacromial bursa Supraspinatus Articular cartilage
Radiology Norwich UK

Shoulder U/S
Deltoid Acromion Subacromial bursa
Supraspinatus

Articular Cartilage
Radiology Norwich UK

Posterior shoulder

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Shoulder U/S

Infraspinatus Posterior glenoid Posterior humeral head Infraspinatus LS
Radiology Norwich UK

Shoulder U/S

Infraspinatus
Posterior gleno-humeral joint

Humeral head

Glenoid labrum
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Anatomy
• Compare sides • Beware of variants • Consult the books

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Pitfalls - Reflective “artefact”
• seen at 90 degree beam angle • moves with the probe • small for curved or sector probes • wide for linear array

Known as “Anisotropy”

Radiology Norwich UK

Shoulder U/S

Acromion

Clavicle

Acromio-clavicular joint

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Shoulder U/S
Coraco-acromial ligament

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Shoulder U/S

Coraco-clavicular ligament
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Arthrography & ultrasound

• Ultrasound directly views the cuff
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Rotator cuff tear ultrasound

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Rotator cuff tear

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Ultrasound - Rotator Cuff Tear

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MRI - Rotator Cuff Tear

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Shoulder U/S Para- labral Cyst

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Evaluation and treatment of subacromial impingement
• Rule out rotator cuff tears or calcific deposits • Dynamic evaluation for impingement • U/S guided treatment – bursal distension, steroid injection, dry needling and calcific deposit aspiration
Radiology Norwich UK

Evaluation and treatment of sub-acromial impingement Calcific tendonitis

Radiology Norwich UK

Sonographically guided glenohumeral joint injection. Zwar RB, Read JW, Noakes JB. Department of Radiology, Austin Health, 145-163 Studley Rd., Heidelberg, Victoria 3084, Australia. AJR Am J Roentgenol. 2004 Jul;183(1):48-50.

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Shoulder capsulitis hydrodistension
Before After

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Conclusion
• • • • Appreciate normal sonographic appearances Appreciate normal sonographic anatomy Dynamic evaluation of the shoulder Differentiate tendinopathy and full thickness tendon tear • Perform guided aspiration/steroid injections
Radiology Norwich UK