Intro to Musculoskeletal Ultrasound of the Shoulder

Slides:

Advertisements

Similar presentations

When things go wrong! Common Sport Injuries.

Advertisements

The shoulder complex.

Anatomy of Shoulder Part 2

Shoulder Injuries.

Chapter 5:Part 1 The Upper Extremity: The Shoulder Region

SHOULDER ANATOMY. BONY ANATOMY Humerus proximal end articulates with scapula to from shoulder distal end articulates with bones of the forearm to form.

Abbie Bintliff Amanda Phillip Erin Wojno Kyle Barile.

Anatomy Case Correlate

Read assigned readings of text

Shoulder Anatomy. This is an axial T1 MRI image at the top of the shoulder. All structures look dark because of fat suppression. We use fat suppression.

1 Injuries to the Shoulder Region 2 Movements of the Shoulder – Flexion – Extension – Abduction – Adduction – Internal Rotation – External Rotation –

Shoulder Joint Complex

Ultrasound Guided Injections in a Sports Medicine Practice Edward W. Kelly, MD October 7, 2013 Annual Orthopedic Care Team Conference.

Radiology Workshop Extremities Andrew Haims. Case #1 This is a 35 year old male who fell off a roof and is now complaining of knee pain How would you.

Shoulder Anatomy and Physiology REVIEW

Quiz #2 available today at 3pm until Monday at 11pm Quiz #2 covers material from THIS week: Chapters 6,7,8 & 9 Take 1 index card each for class today.

Method of Study for This Section Read assigned readings of text Use Thompson Manual and the Dynamic Human CD- ROM to help review structure of bones, joints,

Shoulder Pain and the Shoulder Exam

Shoulder Orthopedic Tests

In the name of GOD Sheikhlotfolah mosque Isfahan.

The Shoulder Joint Anatomy and Physiology of Human Movement 420:050.

Objectives:Understand: The anatomy of the shoulder complex and upper arm The anatomy of the shoulder complex and upper arm The principles of rehabilitation.

CYMATHERAPY ® Orthopedic Solutions ~ Sound Advice in Sports Medicine ~ The Shoulder.

Shoulder Evaluation.

-Welcome Guide for Patients-

ASCM Clinical Skills Shoulder. LOOK Inspection Swelling, bony prominence Swelling, bony prominence Bruising / lacerations Bruising / lacerations Position.

FUNCTIONAL ANATOMY OF THE SHOULDER AND UPPER ARM

Dr Jamila EL Medany. OBJECTIVESOBJECTIVES At the end of the lecture, students should: the name  List the name of muscles of the shoulder region. attachments.

Ultrasound Case: Biceps Tendonitis and Sub-Deltoid Bursitis Diagnosis: Biceps Tendonitis and Sub-Deltoid Bursitis. History: Patient complaining of anterior.

Part 2: Muscle Testing for the Shoulder, Elbow, Wrist, and Hand

Anatomy & Biomechanics of the Shoulder

Shoulder Injury Evaluation Justin Landers LAT. Basic Anatomy & Kinesiology 3 Bone Structures Clavicle Scapula Humerus.

SHOULDER COMPLEX.

Starting with movements.  Flexion 180/Extension  Abduction  Adduction  IR 70-80/ ER 80-90(at 0 and 90 degrees)

The shoulder. The shoulder  Passive elements  Active elements.

Ch. 21 Shoulder.

Shoulder Girdle Tanya Nolan. Shoulder Girdle Formed by 2 bones Scapula Clavicle Function Connect upper limb to trunk.

ANATOMY OF THE SHOULDER REGION

COMMONLY ENCOUNTERED SHOULDER PATHOLOGIES IN ULTRASOUND Teena Anderson Student ID

Physical Evaluation of the shoulder By Beverly Nelson.

The Shoulder Anatomy. Bones 4 Articulations – AC, GH, SC, and Sub Ac Glenoid Labrum – fibrocartilagenous rim of glenoid fossa 50% of socket provided by.

Dr. Sama ul Haque Dr. Sama ul Haque Dr. Rania Jabr Dr. Rania Jabr.

Chapter 10 Shoulder Injuries Care and Prevention.

In the name of GOD Sheikhlotfolah mosque Isfahan.

Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Magnetic Resonance Imaging of the Shoulder*† by RICHARD J. HERZOG J Bone.

S HOULDER U LTRASOUND Personal protocols Caitlin Gardiner.

Jenelle Beadle, RDMS Inland Imaging December 15 th, 2014.

Shoulder region Bones Joints Muscles Vessels & Nerves.

Upper Extremity Anatomy (Shoulder,elbow,and wrist)

Deltoid Abducts the shoulder Posterior deltoid extends the shoulder Anterior deltoid flexes the shoulder.

Shoulder Osteology X-ray Muscles CT/MRI.

ANATOMY OF THE SHOULDER REGION

Upper Limb Regions Shoulder Arm & Forearm Hand.

Chapter- 3.  Student must recall structural features / landmarks in different images of Shoulder joint & Upper Limb.  Student must Distinguish between.

The Shoulder. Label the Shoulder  The shoulder is made up of three bones Humerus Scapula Clavicle  Humerus – upper arm bone  Scapula – shoulder blade.

Lecture 19---Shoulder joint. At the end of this lecture the students should be able to: Enlist bones forming shoulder joint. Explain the shoulder joint.

Shoulder Jeopardy. You can type your own categories and points values in this game board. Type your questions and answers in the slides we’ve provided.

Musculoskeletal Ultrasound Krishna Khanal, MD SIU Sports Medicine Fellow.

SHOULDER INJURIES DR MARK RIDGEWELL 27/7/2010.

Prevention of Shoulder Injuries

Orthopaedics in Primary Care The Shoulder Andrew Pearse Worcestershire Acute Hospitals.

Chapter 22: The Shoulder Complex. The shoulder is an extremely complicated region of the body Joint which has a high degree of mobility but not without.

movement impairment syndrome of the humerus

ANATOMY OF THE SHOULDER REGION

Shoulder Osteology X-ray Muscles CT/MRI.

Ultrasound of the Shoulder: Sonoanatomy

Dr Rania Gabr Dr Samaulhaq.

Transverse sonogram of a right anterior shoulder in a patient with a chronic subacromial (subdeltoid) bursitis. A large, complex hypoechoic collection.

Shoulder Evaluation.

Presentation transcript:

Intro to Musculoskeletal Ultrasound of the Shoulder John Hill, DO Tim Mazzola, MD University of Colorado Office Based Sports Medicine Saturday, May 17, 2014

Disclosure Statement Newton Shoes: Physician Advisory Board MuscleSound: Physician advisor for software development to determine muscle glycogen content.

Objectives Discuss the normal ultrasound appearance of the shoulder and the individual structures Describe the AIUM standard shoulder exam Discuss the uses of dynamic imaging

The Standard Examination Shoulder The Standard Examination

Sonography of Shoulder Complex structure containing Muscles Tendons Bursa Bone Labrum Fixed and Dynamic evaluations

Sonography of Shoulder Physician Practice Guideline is established by AIUM & ACR for the Shoulder U/S Biceps tendon Subscapularis tendon Supraspinatus tendon Infraspinatus tendon Teres minor Dynamic evaluation

Sonography of Shoulder Examination of: Joint effusions Bursa effusions Comparison of contralateral side Evaluate for: Bursal thickening Loose bodies Tendon calcification Muscle & bone abnormalities

Biceps Tendon- Short Axis Transverse Normal transverse Normal Notch view

Biceps Tendon- Short Axis Transverse Chronic Tendinopathy Acute Tendinopathy

Biceps Tendon - Long Axis Normal Biceps LA Normal Long Axis

Biceps Tendon - Long Axis Chronic Tendinopathy Fluid in tendon sheath Long Axis Acute Tendinopathy

Long Head of Biceps Tendon Normal internal/external motion Normal long axis appearance

Is there subluxation of the Long Head of Biceps Tendon?

Subscapularis Tendon Instruct patient to place their arm in full EXTERNAL rotation Sagittal view (Short axis) Short Axis view of Subscap Short Axis Subscap

Subscapularis Tendon Instruct patient to place their arm in full EXTERNAL rotation Transverse view (Long axis) Long Axis view of Subscap Long Axis Subscap

Subscapularis Tendon Instruct patient to place their arm in full EXTERNAL rotation Transverse view (Long axis) Sagittal view (Short axis) Short Axis view of Subscap Long Axis Subscap

Supraspinatus Tendon Instruct patient to place their arm in INTERNAL rotation Place hand in back pocket (Long axis)45 degrees Coronal/ Sagittal SST WNL SST Normal Long Axis view

Supraspinatus Tendon Instruct patient to place their arm in INTERNAL rotation Place hand in back pocket (Short axis) 90 degrees Rotation of long axis SST, internal shoulder rotation SA view SST Short Axis WNL

Supraspinatus Tendon Instruct patient to place their arm in INTERNAL rotation Place hand in back pocket (Long axis)45 degrees Coronal/ Sagittal (Short axis) 90 degrees Rotation of long axis SST WNL SST with Tendinopathy

Supraspinatus Tendon-Long Axis Subacromial Bursa GT Supraspinatous, birds beak view (insertion)

Supraspinatus Tendon-Short Axis WNL SAB

Dynamic Motion Good Humeral Head Depression Rotten Humeral Head Depression Poor Posture, Weak Scapula Stability

Infraspinatus Tendon Instruct patient to place their arm in full INTERNAL rotation Place hand in back pocket Similar to Supraspinatus, but moved posteriorly (Long axis)45 degrees Coronal/ Sagittal (Short axis) 90 degrees Rotation of long axis

Infraspinatus Tendon Instruct patient to place their arm in full INTERNAL rotation Place hand in back pocket Similar to Supraspinatus, but moved posteriorly (Long axis)45 degrees Coronal/ Sagittal Long Axis appearance of IST Normal appearance of IST

Teres Minor Tendon Instruct patient to place their arm in full INTERNAL rotation Place hand in back pocket Similar to Infraspinatus, but moved Inferiorly (Long axis)45 degrees Coronal/ Sagittal (Short axis) 90 degrees Rotation of long axis

Teres Minor Tendon Instruct patient to place their arm in full INTERNAL rotation Place hand in back pocket Similar to Infraspinatus, but moved Inferiorly (Long axis)45 degrees Coronal/ Sagittal Normal Long Axis of Teres minor

Teres Minor Tendon Instruct patient to place their arm in full INTERNAL rotation Place hand in back pocket Similar to Infraspinatus, but moved Inferiorly (Short axis) 90 degrees Rotation of long axis Normal Short Axis of Teres minor

Contralateral Comparison Long Axis Views Left SST is WNL Right SST Thickened chronic Tendinopathy

AC Joint AC Joint

AC Joint AC Joint If the person is very thin, you might need standoff/interface disc

AC Joint Arthritic Changes but no effusion Less evidence of DJD, but effusion present

Summary Many structures in the shoulder are superficial and can be examine accurately with MSK ultrasound Diagnostic Ultrasound should incorporated static and dynamic image If you examine many normal shoulders, then you will soon be able to pick-up even subtle changes