Podcast
Questions and Answers
What is one of the main indications for a shoulder ultrasound?
What is one of the main indications for a shoulder ultrasound?
Which of the following is a normal ultrasound finding in a rotator cuff tendon?
Which of the following is a normal ultrasound finding in a rotator cuff tendon?
What type of transducer is commonly used for shoulder ultrasound?
What type of transducer is commonly used for shoulder ultrasound?
What is a limitation of shoulder ultrasound?
What is a limitation of shoulder ultrasound?
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What is a pathological ultrasound finding in a rotator cuff tendon?
What is a pathological ultrasound finding in a rotator cuff tendon?
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What is an advantage of shoulder ultrasound compared to MRI?
What is an advantage of shoulder ultrasound compared to MRI?
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The subscapularis tendon is located on the posterior aspect of the humeral head.
The subscapularis tendon is located on the posterior aspect of the humeral head.
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A full-thickness tear of the rotator cuff tendon appears as a hypoechoic defect on ultrasound.
A full-thickness tear of the rotator cuff tendon appears as a hypoechoic defect on ultrasound.
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The acromioclavicular joint is located between the humeral head and the scapula.
The acromioclavicular joint is located between the humeral head and the scapula.
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The linear transducer used for shoulder ultrasound has a frequency range of 3.5-5 MHz.
The linear transducer used for shoulder ultrasound has a frequency range of 3.5-5 MHz.
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Subacromial bursitis is diagnosed on ultrasound by the presence of an anechoic defect in the bursa.
Subacromial bursitis is diagnosed on ultrasound by the presence of an anechoic defect in the bursa.
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The infraspinatus tendon is located on the anterior aspect of the humeral head.
The infraspinatus tendon is located on the anterior aspect of the humeral head.
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Shoulder ultrasound is limited by a large field of view that can capture the entire rotator cuff.
Shoulder ultrasound is limited by a large field of view that can capture the entire rotator cuff.
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Anisotropy can cause tendons to appear artificially hyperechoic on ultrasound.
Anisotropy can cause tendons to appear artificially hyperechoic on ultrasound.
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Study Notes
Shoulder Ultrasound
Indications
- Evaluation of rotator cuff tendons and muscles
- Assessment of joint fluid and bursae
- Guidance for injections and aspirations
- Diagnosis of shoulder impingement and tendinopathy
Anatomy
- Rotator cuff: supraspinatus, infraspinatus, teres minor, and subscapularis tendons
- Bursae: subacromial-subdeltoid bursa and subscapular bursa
- Joints: glenohumeral joint and acromioclavicular joint
Scanning Techniques
- Transducer: high-frequency linear transducer (7-12 MHz)
- Scanning positions: patient seated or standing with arm relaxed or abducted
- Scanning planes: longitudinal and transverse planes
Normal Ultrasound Findings
- Rotator cuff tendons: homogeneous, fibrillar pattern with clear margins
- Bursae: anechoic or hypoechoic fluid-filled spaces
- Joints: smooth, congruent articular surfaces
Pathological Ultrasound Findings
- Rotator cuff tendons: tendinosis (hypoechoic, heterogeneous), tears (discontinuity, retraction), or calcifications
- Bursae: fluid accumulation or thickening
- Joints: joint effusion, synovitis, or osteophytes
Diagnostic Accuracy
- High sensitivity and specificity for rotator cuff tears and tendinopathy
- Equivalent or superior to MRI for certain shoulder pathologies
Limitations
- Operator dependency
- Limited assessment of deeper structures (e.g., glenohumeral joint)
- Artifacts from bone or air interfaces
Shoulder Ultrasound
Indications
- Evaluation of rotator cuff tendons and muscles is a primary indication for shoulder ultrasound
- Assessment of joint fluid and bursae is another key indication
- Guidance for injections and aspirations can be provided with ultrasound
- Diagnosis of shoulder impingement and tendinopathy is an important indication
Anatomy
- Rotator cuff consists of supraspinatus, infraspinatus, teres minor, and subscapularis tendons
- Subacromial-subdeltoid bursa and subscapular bursa are the two main bursae in the shoulder region
- Glenohumeral joint and acromioclavicular joint are the two joints assessed in shoulder ultrasound
Scanning Techniques
- High-frequency linear transducer (7-12 MHz) is used for shoulder ultrasound
- Patient can be seated or standing with arm relaxed or abducted during the scan
- Longitudinal and transverse planes are used for scanning
Normal Ultrasound Findings
- Rotator cuff tendons demonstrate homogeneous, fibrillar pattern with clear margins
- Bursae are anechoic or hypoechoic fluid-filled spaces
- Joints show smooth, congruent articular surfaces
Pathological Ultrasound Findings
- Tendinosis appears as hypoechoic, heterogeneous areas in rotator cuff tendons
- Tears in rotator cuff tendons manifest as discontinuity or retraction
- Calcifications may be seen in rotator cuff tendons
- Bursae may show fluid accumulation or thickening
- Joints may exhibit joint effusion, synovitis, or osteophytes
Diagnostic Accuracy
- Shoulder ultrasound has high sensitivity and specificity for rotator cuff tears and tendinopathy
- Equivalent or superior to MRI for certain shoulder pathologies
Limitations
- Operator dependency is a significant limitation of shoulder ultrasound
- Deeper structures like glenohumeral joint may not be fully assessed
- Artifacts from bone or air interfaces can affect image quality
Shoulder Ultrasound
Indications
- Evaluation of rotator cuff tendons and muscles is an indication for shoulder ultrasound
- Diagnosis of rotator cuff tears, tendinopathy, and calcific tendinitis can be made using shoulder ultrasound
- Shoulder ultrasound is used to assess shoulder impingement and subacromial bursitis
- Guided injections and aspirations are also an indication for shoulder ultrasound
Scanning Technique
- Patient should be seated or standing with arm relaxed by their side during the scan
- A linear transducer with a frequency of 7.5-12 MHz is used for high-resolution imaging
- Scanning is performed in multiple planes, including longitudinal, transverse, and oblique
Anatomy
- Supraspinatus tendon is located on the posterior aspect of the humeral head
- Infraspinatus tendon is located on the posterior aspect of the humeral head, inferior to the supraspinatus tendon
- Teres minor tendon is located on the posterior aspect of the humeral head, inferior to the infraspinatus tendon
- Subscapularis tendon is located on the anterior aspect of the humeral head
- Subacromial-subdeltoid bursa is located between the acromion and humeral head
- Acromioclavicular joint is located between the acromion and clavicle
Pathology
- Full-thickness rotator cuff tears appear as anechoic defects in the tendon
- Partial-thickness rotator cuff tears appear as hypoechoic defects in the tendon
- Rotator cuff tendinopathy appears as thickening and hypoechogenicity of the tendon
- Calcific tendinitis appears as echogenic foci with posterior acoustic shadowing
- Subacromial bursitis appears as fluid and/or echogenic material within the bursa
Pitfalls and Limitations
- Operator dependence is a pitfall, as technique and image quality depend on operator experience
- Anisotropy can make tendons appear artifactually hypoechoic
- Limited field of view can prevent capture of the entire rotator cuff
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Description
This quiz covers the indications and anatomy of shoulder ultrasound, including the evaluation of rotator cuff tendons and muscles, and assessment of joint fluid and bursae.
