Shoulder MSK Diagnostic Ultrasound. Basics for Advance Practitioners wanted to learn the diagnostic ultrasound, implement and improve musculoskeletal practice as POCUS (point of care ultrasound). Other healthcare professionals can also benefit such as sonographers, physiotherapists, osteopath, chiropractors.
3. What else:? Loss of volume, density,
fibrillary pattern.
Why hypoechoic but not anechoic as this is
a tear? (tendon sits behind the facet)
What if not sure about the full thickness?
4.
5. What else can be done:?
Consistently picking up,
Pick on different angles,
Always take two plane and two different
angle images
Look for other sign (effusion, bony/cartilage
irregularity, cartilage interface sign), try
correlation with patient history (anterior edge
tear – dead weight drop arm injury)
6.
7. Why: Full thickness appears loss of mass/volume/density –
easier to detect than partial thickness
Partial (bursal or articular) undersurface (on or under the facet),
look for signs suchas cartilage interface sign
When performed by experienced individuals, US and MR imaging
have equivalent high sensitivity
Why: operator dependence
Mention depth, width and site of tear – subscapularis example?
8. RC calcifications:
Characteristics: Fluffy or well-defined hyper-
echogenicities within the tendon, usually with posterior
acoustic shadowing depending on its calcium content.
Hydroxyapatite deposition typically occurs
approximately 10 mm from the SST insertion on the
greater tuberosity.
Tendinopathy/tendinosis - interchanged terms
Stick to same term if decided one
Characteristics = three mainly
Usual site
9.
10.
11.
12. The supraspinatus tendon appears hypoechoic and
heterogenous echotexture consistent with
tendinopathy.
There is one medium size full thickness tear in the
mid portion of supraspinatus tendon measuring 1.06
cm in width and site of tear is approximately 0.74 cm
from the BCG.
There is well formed calcified fleck in the region of
full thickness tear measuring 1.13 cm in length and
1.55 cm in width. Findings are consistent with calcific
tendonitis and related impingement.
13.
14.
15.
16. What about labrum and posterior glenohumeral
space and spinoglenoid notch – do we need to
see that
Tenosynovitis of long head of biceps tendon –
importance of fluid collection
AC joint – OA/synovial thickening – power
Doppler
Thank you
