Role of ultrasound in clinical evaluation of shoulder Dr. Muhammad Bin Zulfiqar
1. Role of Ultrasound in Clinical Evaluation
of Shoulder Pain
DR. MUHAMMAD BIN ZULFIQAR
SIMS & SERVICES HOSPITAL LAHORE
2. INTRODUCTION
• Shoulder Is one of the most sophisticated and
complicated joint of the body with great range of
movements.
• A series of complex ligaments and muscles help in
stability.
• Different pathologies especially related to rotator
cuff are encountered in patients presenting with
shoulder pain.
3. INTRODUCTION
• By assessing shoulder pain we ascertain integrity of
rotator cuff and extent of tear ,if any, in order to give
a plan to orthopedic surgeon for appropriate
treatment and further management.
• Shoulder ultrasound gives diagnostic sensitivities and
specificities in excess of 90%.
4. Learning Objectives
• Implications of the morphologic features and extent
of rotator cuff tears for glenohumeral joint
mechanics, treatment, and prognosis.
• Identify injuries to adjacent structures that may
accompany rotator cuff tears and discuss their
implications for treatment and prognosis.
• Describe the value of imaging and evaluating the
rotator cuff muscles.
5. Learning Objectives
• Distinguish between the potential contributing factors to
impingement syndrome.
• Determine if surgery is contraindicated.
• Radiologist must:
(a) identify and evaluate cuff lesions that may compromise
glenohumeral joint function, taking into account functional
anatomy.
(b) recognize imaging findings that decrease
the likelihood of favorable functional anatomic outcome after
cuff repair.
(c) identify and describe imaging findings that will assist in selecting
a repair technique.
6. Learning Objectives
• Tear dimensions, tear depth or thickness,
tendon retraction, and tear shape.
• Tear extension to adjacent structures, muscle
atrophy, size of muscle cross-sectional area,
and fatty degeneration.
• Information about the coracoacromial arch
and impingement.
21. Rotator cuff tendinopathy
Also known as -
• Rotator cuff tendinosis
• Definition – collagenous degeneration of
rotator cuff tendons, most commonly
supraspinatus (SST)
23. Rotator cuff tendinopathy
• Thickened hypoechoic
• Tears directly visible
• Less sensitive for partial thickness tears
• Advantage – allows dynamic evaluation with
pain correlation
24. Rotator cuff tendinopathy
• Supraspinatus “tendinitis”.
There is focal hypoechoic
swelling of the more
superficial fibers of
supraspinatus insertion
25. Rotator cuff tendinopathy
• Static imaging of the
supraspinatus tendon show
features of “tendinitis”
which included tenderness,
hypoechoic thickening of
the insertional fibers
(arrowheads)
26. Rotator cuff tears
• Clinical –
– Trauma (acute / chronic micro-trauma)
– Adults > 4o with impingement
– Collagen vascular diseases
– Partial more painful than complete tears !!!!
TYPES -
• Partial –
– supraspinatus most common
– Types – bursal surface
interstitial (not seen on arthroscopy)
articular surface
• Complete –
– supraspinatus most common
– Extends from bursal to articular surface
27. Dimensions of a Full-Thickness Tear
• small (1 cm),
• medium (1–3 cm),
• large (3–5 cm),
• massive (5 cm)
The dimensions of rotator cuff tears may have
implications for selection of treatment and surgical
approach, postoperative prognosis, and tear
recurrence
28. Partial tear
• Decreased echogenicity and thinning in
affected region
• Loss of convexity of tendon / bursae interface
in bursal surface tears
• Calcific foci in tendons
37. • Full thickness tear of the distal aspect of the Supraspinatus
tendon ( ) with retraction and effusion of the
subacromial bursae ( ). The humeral head cartilage is laid
bare ( ). There is also fluid in the Long Biceps sheath ().
39. Rotator interval tears
• What is rotator interval ??
– Tunnel through which long head of biceps travels
from its origin at the supraglenoid tubercle
• Rotator interval tears – tears in the capsule
between the supraspinatus and subscapularis
tendons
• Can be classified as subtype of RTC tears
50. Tendinosis
• Degeneration of long head of biceps
• Long head of biceps –
– LHBT originates at supra glenoid tubercle
– Passes through the antero-superior joint
– Enters the humeral bicipital groove
• Chronic micro-trauma
• Acute trauma (rare cause)
• Accompanies RTC disease (especially impingement)
• Common with subacromial impingement (30-60%
association)
• Biceps tenosynovitis may accompany