Ultrasound of the shoulder 2012

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Ultrasound of the shoulder 2012

  1. 1. 23/03/2013 Ultrasound+Scanning+ of+the+Shoulder+ –  Lennard+Funk+ lenfunk@shoulderdoc.co.uk+ UBUNTU+•  Ubuntu speaks+of+the+very+essence+of+being+human.+[We]+ say+[...]+"Hey,+soFandFso+has+ubuntu."+Then+you+are+generous,+ you+are+hospitable,+you+are+friendly+and+caring+and+ compassionate.++•  You share what you have.+It+is+to+say,+"My+humanity+is+ caught+up,+is+inextricably+bound+up,+in+yours."+We+belong+in+a+ bundle+of+life.++•  We+say,+"A person is a person through other persons."+ What+is+Ultrasound+ 1
  2. 2. 23/03/2013 Medical+Ultrasound+ Howry & Bliss, 1949"   Compound+waterFbath+scanner+"   Gun+turret+of+B29+Bomber+ Ultrasound+of+the+Shoulder+ Bunker T. Journal Bone Joint Surg 1985; 68B Bunker T. Seminars in Orthopaedics 1987;2(4): 267-276"   1979+F+Seltzer+(Harvard)+Rhesus+ monkeys+"   1983+F+Bunker+F+first+USS+shoulder+ (Exeter)+"   1984+F+Craig+F+J+Clin+Ultrasound+"   1985+F+Bunker+presented+to+BOA+"   1987+F+Thesis+&+publica_on+ (Bunker)++ +++++++++F+100+shoulders+ 2
  3. 3. 23/03/2013 Bunker,+1985+Modern+portable+Ultrasound+ 3
  4. 4. 23/03/2013 What+can+you+see+ Subacromial AC Joint Rotator Bursa CuffGreaterTuberosity Biceps What+you+cannot+see+ Intra-articular LHBLabrum 4
  5. 5. 23/03/2013 Benefits+ "  Cheap+ "  Convenient+ "  Quick+ "  No+radia_on+ "  Dynamic+ "  Interac_ve+ "  OfficeFBased+ Limita_ons+"  Operator+ Dependent+ Diagnos_c+F+When+to+use+it+ "  Rotator+Cuff+ "  Frozen Shoulder "  Impingement+ "  AC Joint "  Tears+ "  Calcific+Tendoni_s+ "  Arthritis "  Biceps+(ExtraF " Osteolysis ar_cular)+ "  Instability "  HillFSachs+Lesions+ "  Fractures 5
  6. 6. 23/03/2013Impingement+Bursi_s+ Rotator+Cuff+Tear+ Calcific+Tendoni_s+ 6
  7. 7. 23/03/2013 Biceps+Tendoni_s+ Dislocated+LHB+Fracture+Greater+Tuberosity+ 7
  8. 8. 23/03/2013Fracture+Greater+Tuberosity+ HillFSachs+Lesion+ PostFop+Cuff+Repair+ 8
  9. 9. 23/03/2013 Ultrasound is a highly accurate imaging study forevaluating the integrity of the rotator cuff in shouldersthat have undergone an operation. Its accuracy for operatively treated shoulders appears tobe comparable with that previously reported forshoulders that had not been operated on. Pectoralis+Major+ Interven_onal+ 1. Subacromial Impingement Guided 2. AC Joint Injections 3. Biceps Frozen Shoulder Hydrodilatation / - Primary Distension - Post Trauma / Surgery Barbotage Calcific Tendonitis 9
  10. 10. 23/03/2013Subacromial InjectionBiceps InjectionBarbotage for CalcificDeposit 10
  11. 11. 23/03/2013 When+not+to+use+it+ "  Shoulder+ Instability+ "  Labral+Tears+ "  Young+Athle_c++ OfficeFBased+Ultrasound+ Changing+world+"  Consumer+society+"  Faster+diagnosis+"  Quicker+_me+to+treatment+&+recovery+"  Difficult+/+slow+access+to+Imaging+ 11
  12. 12. 23/03/2013 Suspected+Rotator+Cuff+Tear+"   Does+he+have+a+rotator+cuff+tear?+"   How+big+is+it?+"   What+do+the+tendon+edges+look+like+"   What+is+the+state+of+the+Long+Head+of+Biceps?+ Suspected+Rotator+Cuff+Tear+ •  First Visit •  Referral+for+Ultrasound+ 2 months / 1 week Ultrasound Scan Report Ultrasound+Report+ •  There is a full thickness tear of the supraspinatus tendon. •  The infraspinatus tendon is a bit thinned, but is probably intact. •  Long head of biceps is not well seen. How big is the tear? What is the quality of the cuff edges? Is LHB subluxed / torn / partially torn / absent? 12
  13. 13. 23/03/2013 Suspected+Rotator+Cuff+Tear+ •  First Visit •  Referral+for+Ultrasound+ Surgery 6 months / 3 weeks 6 months 2 months / 1 week / 3 weeks Ultrasound Scan OPD Review 1 week 2 months / 1 week Report Read Report 1 week There is a full thickness tear of the supraspinatus tendon. The infraspinatus tendon is a bit thinned, but is probably intact. Long head of biceps is not well seen. Problems+ "   Time+ •  Exact Tear not known "   Inconvenience+ •  Surgical Plan less clear "   Loss+of+earnings+ •  Tears get bigger "   Con_nued+disability+ •  Muscle degenerates •  Bigger tears = worse results Revolu_on+–+Office+Ultrasound+✤  Performed+by+Clinician+✤  Quick+✤  CostFEffec_ve+✤  One+Stop+Clinic+ ✤  Immediate+Diagnosis+ ✤  Management+Plan+ ✤  Shorter+Wai_ng+Time+for+Surgery+ 13
  14. 14. 23/03/2013 Surgeon+with+ scanner:+ Learning+ Curve+"  4+surgeons;+159+shoulders+"  Correlated+with+Arthroscopy+"  Surgeons+>+100+scans:+ "  94%+Sensi_vity+ "  88%+Specificity+ BESS+Guidelines+ 14
  15. 15. 23/03/2013BESS+Guidelines+BESS+Guidelines+ Shoulderscan.com+ 15

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