(C) N. Rawool. 2007
Shoulder Bony Landmarks
Shoulder Ultrasound
Anatomy and Technique
Nandkumar Rawool, MD, RDMS
Associate Professor, Department of Radiologic Sciences
Program Director, Diagnostic Medical Sonography and CVT
Thomas Jefferson University, Philadelphia
Shoulder Joint
Hip Joint
US of Shoulder - Technique
•
•
•
•
High frequency linear array transducer
10 to 14 MHz
Patient sitting on a stool
Both shoulder should be examined
– At least initially when you are new to scanning
– Compare the symptomatic to Asymptomatic side
• Images are orientated as if one were facing the
patient
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(C) N. Rawool. 2007
US of Shoulder - Technique
US of Shoulder - Technique
• Images are orientated
as if one were facing
the patient
US of Shoulder - Technique
US of the Shoulder
US of the Shoulder
• Rotator cuff consists of tendons of
–
–
–
–
• Other important structures
Subscapularis tendon
Supraspinatus tendon
Infraspinatus tendon
Teres minor
– Biceps tendon
– Deltoid muscle
– Subdeltoid bursa
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(C) N. Rawool. 2007
Muscles of Shoulder
Muscle - Origin
Tendon - Insertion
Biceps Tendon
Biceps
Biceps Tendon
• Origin:
• Flexes shoulder and stabilizes the shoulder
joint
– Long head –
supraglenoid tubercle
– Short head – Coracoid
process
• Insertion
– Long head and short
head – radial tuberosity
and antebrachial fascia
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(C) N. Rawool. 2007
Biceps Tendon
Biceps Tendon
Biceps Tendon – Transverse
Biceps Tendon – Transverse
Biceps Tendon - Transverse
• Bicipital groove – appears as a concavity in the
body surface of the humerus
• Hyperechoic oval structure within the bicipital
groove
– Musculotendinous junction, midtendon and rotator cuff
interval
• Small amount of intra-articular fluid surrounding
the biceps tendon can be visualized
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(C) N. Rawool. 2007
Biceps Tendon
Biceps Sagittal
Biceps Sagittal
Subscapularis Tendon
Subscapularis
Subscapularis
• Origin: Subscapularis fossa
• Insertion: lesser tubercle of humerus
• Action: medial rotation of the arm and
stabilizes the joint
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(C) N. Rawool. 2007
Subscapularis Tendon
Subscapularis Tendon
Subscapularis Tendon
Subscapularis Tendon
Subscapularis Tendon
Subscapularis – Short Axis
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(C) N. Rawool. 2007
Subscapularis Tendon
Subscapularis – Short Axis
Supraspinatus Anatomy
Supraspinatus Tendon
Supraspinatus - Anatomy
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(C) N. Rawool. 2007
Supraspinatus - Action
Elevates the arm the first 15 degrees and stabilizes the joint
Supraspinatus Tendon – Sag
Supraspinatus
• Beak shaped soft-tissue structure extending from
under the acromion to its attachment along the
greater tuberosity
• Passive abduction and adduction with the patients
palm parallel to the trunk helpful in assessing the
integrity of the tendon
• Scan lateral to the greater tuberosity – small
effusion in the subdeltoid bursa can be visualized
Supraspinatus
Supraspinatus Tendon – Sag
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(C) N. Rawool. 2007
Supraspinatus Tendon – Trans
Supraspinatus Anatomy
• Band of medium level echoes deep to the
subdeltoid bursa and superficial to the
bright echoes originating from the bony
surface of the greater tuberosity
• Articular cartilage of the humeral head may
be visualized as a hypoechoic band just
superficial to the bony margin
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(C) N. Rawool. 2007
Articular Cartilage
Subdeltoid Bursa
• Separates the deltoid
muscle from the head
of the humerus and the
insertion of the rotator
cuff muscles
Infraspinatus Tendon
Infraspinatus Tendon
• Origin: Infraspinatus fossa of the scapula
• Insertion: Greater tuberosity of the humerus
Infraspinatus Tendon
Infraspinatus
Laterally rotates the arm and stabilizes the shoulder joint
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(C) N. Rawool. 2007
Infraspinatus Tendon
Infraspinatus Tendon
• Beak-shaped soft-tissue
structure that
progressively thins as it
approaches its attachment
to the posterior aspect of
the greater tuberosity
• Passive internal and
external rotation helpful in
confirming the integrity of
the tendon
Infraspinatus Tendon - Scanning
Other Posterior Structures
• * spinoglenoid notch
• Curved arrow – bony
glenoid
• Arrowheads –
posterior labrum
• Remember Infraspinatus tendon is deeper
– You need to change the depth (increase)
– You need to lower the frequency (to get better
penetration)
Infraspinatus Tendon
• Additional structures
visualized
– Articular cartilage of
the humeral head –
thin, hypoechoic layer
superficial to the highlevel echoes
originating from the
bony surface
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(C) N. Rawool. 2007
Infraspinatus Tendon
Infraspinatus Tendon
Teres Minor
Teres Minor
• Origin: inferior angle of scapula
• Insertion: greater tuberosity of the humerus
• Action: laterally rotates arm and stabilizes
the joint
Acromioclavicular Joint
• The clavicle articulates with with the
acromion process of the scapula
• The acromioclavicular ligament bridges the
joint and provides anterior-posterior
stability
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(C) N. Rawool. 2007
Acromioclavicular Joint
• Place transducer in
coronal plane over the
shoulder
Thank You
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