Jenelle Beadle, RDMS Inland Imaging December 15 th, 2014

Biceps Tendon Palm up and resting on the patient’s leg Transducer placed on the anterior shoulder find the best sonographic window with slight external/internal rotation dynamically evaluate (external/internal rotation) for subluxation or dislocation angle transducer as appropriate to avoid anisotropy Long Biceps Tendon Trans Biceps Tendon

Biceps Tendon - Trans

Biceps Tendon - Long

Transverse Humeral Ligament over Synovial Tendon Sheath

Biceps Tendon - Long

Subscapularis Tendon Palm up and arm externally rotated Transducer placed on the anterior shoulder find the best sonographic window with slight external/internal rotation dynamically evaluate (external/internal rotation) for tears and impingement angle transducer as appropriate to avoid anisotropy Long SubscapularisTrans Subscapularis

Subscapularis Tendon - Long Musculotendonis junction coming from under the coracoid process

Subscapularis Tendon - Long Cartilage on the head of the humerus up to the point of insertion

Subscapularis Tendon - Long Tendon extends medially to the insertion on the lesser tuberosity

Subscapularis Tendon - Long Anisotropy where tendon fibers turn to insert

Subscapularis Tendon - Long

Tendon insert along this flattened area of the lesser tuberosity

Subscapularis Tendon - Long

Bicipital Groove

Subscapularis Tendon - Trans

Supraspinatus Tendon hand placed in back pocket with palm facing in transducer placed on the anterior shoulder scan anterior to posterior from biceps interval to infraspinatus tendon dynamically evaluate (external/internal rotation) for tears dynamically evaluate (abduction/adduction) for impingement angle transducer as appropriate to avoid anisotropy Long Supraspinatus

Supraspinatus Tendon - Long Long Supraspinatus Neutral Position Long Supraspinatus Stressed Position Acromion

Supraspinatus Tendon - Long

Musculotendonis junction coming from under the acromion

Supraspinatus Tendon - Long

Supraspinatus Tendon - Trans Biceps Interval: biceps tendon should be seen adjacent to the supraspinatus tendon any separation here indicates an anterior full thickness supraspinatus tear BT Supra

Supraspinatus Tendon - Trans Biceps Interval: biceps tendon should be seen adjacent to the supraspinatus tendon any separation here indicates an anterior full thickness supraspinatus tear

Supraspinatus Tendon - Trans

Infraspinatus Tendon atiene’s hand placed on contralateral shoulder transducer placed on the posterolateral shoulder scan anterior to posterior from the supraspinatus tendon to teres minor tendon dynamically evaluate (extreme external rotation and abduction) for impingement angle transducer as appropriate to avoid anisotropy Long Supraspinatus

Infraspinatus Tendon - Long

Supraspinatus vs Infraspinatus Tendons - Long

Infraspinatus Tendon - Trans

Acromioclavicular Joint Assessed for stability and fluid

Acromioclavicular Joint

Posterior Glenohumeral (GH) Joint & Spinoglenoid Notch / Scapular Fossa

Posterior Glenohumeral (GH) Joint

Labrum Humeral Head Glenoid Rim Infraspinatus Musculotendinous Junction

Posterior Glenohumeral (GH) Joint

Spinoglenoid (SG) Notch / Scapular Fossa

“Skeletal Muscle Ultrasound” European Journal Translational Myology 2010; 1 (4): “Ultrasonographic Findings of Musculoskeletal Tissues” J Korean Orthop Assoc Oct;48(5): “Sonography of Common Tendon Injuries” American Journal of Roentgenology. 2009;193: “Tendon and Ligament Imaging” Br J Radiol. Aug 2012; 85(1016): 1157–1172 “Imaging of the Bursae” J Clin Imaging Sci 2011; 1:22 “Ultrasonography of tendon abnormalities” OA Musculoskeletal Medicine 2013 Jun 01;1(2):12 “Sonography of Lower Limb Muscle Injury” American Journal of Roentgenology. 2004;182: “Full Thickness and Partial Thickness Supraspinatus Tendon Tears” Radiology 2004; 230:234–242 “Long Head of Biceps Brachii Tendon Evaluation...” AJR 2011; 197:942–948 “Ultrasound of the Shoulder” JBR–BTR, 2007, 90: Gaitini D. “Shoulder Ultrasonography: Performance and Common Findings” J Clin Imaging Sci 2012; 2: Read J, Perko M. “Ultrasound Diagnosis of Subacromial Impingement for Lesions of the Rotator Cuff” AJUM May 2010; 13 (2): References

injection-of-joints.html injection-of-joints.html shoulder shoulder References (continued…)