Sonographic Routines: Shoulder
#1. European Guidelines for Shoulder Scanning
Reference
Beggs, I. (n.d.). Musculoskeletal Ultrasound Technical Guidelines: I Shoulder. European Society of MusculoSkeletal Radiology. Retrieved from http://www.essr.org/html/img/pool/shoulder.pdf
Beggs, I. (n.d.). Musculoskeletal Ultrasound Technical Guidelines: I Shoulder. European Society of MusculoSkeletal Radiology. Retrieved from http://www.essr.org/html/img/pool/shoulder.pdf
#2. Mohawk-McMaster Institute of Applied Health Sciences Shoulder Scanning Routine
1. BICEPS TENDON
· Patient position
o Patient is seated facing sonographer
o Rest their forearm on their thigh, bending the elbow at 90 degrees with the back of the hand resting on the thigh
· Trans interrogation
o Start at bicipital groove
Long Axis Image
· Annotation: LONG RT BICEPS
Short Axis Image:
· Transverse at the transverse humeral ligament
· Annotation: TR RT BICEPS
Dynamic Assessment:
· In the short axis of the biceps tendon
· Have patient externally rotate their arm and assess for subluxation
· Patient position
o Patient is seated facing sonographer
o Rest their forearm on their thigh, bending the elbow at 90 degrees with the back of the hand resting on the thigh
· Trans interrogation
o Start at bicipital groove
Long Axis Image
· Annotation: LONG RT BICEPS
Short Axis Image:
· Transverse at the transverse humeral ligament
· Annotation: TR RT BICEPS
Dynamic Assessment:
· In the short axis of the biceps tendon
· Have patient externally rotate their arm and assess for subluxation
2. SUBSCAPULARIS TENDON
· Patient Position
o Patient seated facing sonographer
o Resting their forearm and back of their hand on the top of their thigh with the elbow bent at 90 degrees
· Long interrogation (long axis)
o With transducer in the transverse position starting at the biceps tendon, slide the transducer medially
o Have patient slowly externally rotate the arm
o External rotation will make the long axis of the subscapularis come into view
o Demonstrate the muscle insertion
· Trans interrogation
o Rotate transducer 90 degrees clockwise to assess the short axis
o Remember to externally rotate their arm and sweep from the insertion (laterally) to the musculotendinous junction (medially)
Long Axis Images
· Image the long axis at the insertion onto the lesser tuberosity
· Annotation: RT SUBSCAP LA
Short Axis Images
· Demonstrate the bundle appearance of the fibres
· Annotation: RT SUBSCAP SA
· Patient Position
o Patient seated facing sonographer
o Resting their forearm and back of their hand on the top of their thigh with the elbow bent at 90 degrees
· Long interrogation (long axis)
o With transducer in the transverse position starting at the biceps tendon, slide the transducer medially
o Have patient slowly externally rotate the arm
o External rotation will make the long axis of the subscapularis come into view
o Demonstrate the muscle insertion
· Trans interrogation
o Rotate transducer 90 degrees clockwise to assess the short axis
o Remember to externally rotate their arm and sweep from the insertion (laterally) to the musculotendinous junction (medially)
Long Axis Images
· Image the long axis at the insertion onto the lesser tuberosity
· Annotation: RT SUBSCAP LA
Short Axis Images
· Demonstrate the bundle appearance of the fibres
· Annotation: RT SUBSCAP SA
3. CORACOACROMIAL LIGAMENT
· From long axis of subscap, with the coracoid process in view, rotate transducer clockwise until you see the acromion
· The CAL ligament is the hypoechoic band inbetween the acromion and the coracoid
· Image
o Annotation: RT CA LIG
· From long axis of subscap, with the coracoid process in view, rotate transducer clockwise until you see the acromion
· The CAL ligament is the hypoechoic band inbetween the acromion and the coracoid
· Image
o Annotation: RT CA LIG
4. SUPRASPINATUS (SST)
· Patient Position
o Tell patient to put their hand in their back pocket
· Trans/Short Axis
o Identify coracoid process
o Look for the rotator cuff interval
o Begin the sweep anteriorly and sweep laterally though
· Long Axis
o From mid SST rotate clockwise to get long axis
o Follow SST from insertion (birds beak) to the musculotendinous insertion
Long Axis Image:
· Image the SST at the insertion (birds beak)
· Annotation: RT SUPRA LA
Short Axis Images:
· 1. Short axis demonstrating the rotator cuff interval
· Annotation: RT SUPRA SA ANT
· 2. Short axis demonstrating the mid portion of the tendon
· Annotation: RT SUPRA SA MID
· Patient Position
o Tell patient to put their hand in their back pocket
· Trans/Short Axis
o Identify coracoid process
o Look for the rotator cuff interval
o Begin the sweep anteriorly and sweep laterally though
· Long Axis
o From mid SST rotate clockwise to get long axis
o Follow SST from insertion (birds beak) to the musculotendinous insertion
Long Axis Image:
· Image the SST at the insertion (birds beak)
· Annotation: RT SUPRA LA
Short Axis Images:
· 1. Short axis demonstrating the rotator cuff interval
· Annotation: RT SUPRA SA ANT
· 2. Short axis demonstrating the mid portion of the tendon
· Annotation: RT SUPRA SA MID
5. INFRASPINATUS
· Patient Position:
o Patient places their hand on opposite shoulder with their arm resting against their chest
· Infraspinatus lies parallel to the spine of the scapula
· Start at scapular spine, move down, then over until you see the beak (where it inserts on the greater tuberosity)
· Image:
o Annotation: RT INFRA LA
o Long axis of the infraspinatus where is attaches to the greater tuberosity
· Patient Position:
o Patient places their hand on opposite shoulder with their arm resting against their chest
· Infraspinatus lies parallel to the spine of the scapula
· Start at scapular spine, move down, then over until you see the beak (where it inserts on the greater tuberosity)
· Image:
o Annotation: RT INFRA LA
o Long axis of the infraspinatus where is attaches to the greater tuberosity
6. TERES MINOR
· Inferior to the infraspinatous
· Muscle is thinner and more trapezoid in shape
· Begin at muscle and scan lateral to insertion on greater tuberosity
· Image:
o Annotation: RT TERES MINOR
o Long axis of the teres minor at the insertion
· Inferior to the infraspinatous
· Muscle is thinner and more trapezoid in shape
· Begin at muscle and scan lateral to insertion on greater tuberosity
· Image:
o Annotation: RT TERES MINOR
o Long axis of the teres minor at the insertion
7. POSTERIOR LABRUM
· Patient position
o Hand still on opposite shoulder
· Landmarks
o Posterior labrum is in the transverse plane at the level of the humeral head and superior to the glenoid fossa
o Transducer should be slightly rotated with the lateral aspect running obliquely to the shoulder
o Infraspinatous tendon can be identified overlying the fossa
· Image
o Posterior labrum demonstrating the echogenic, triangular shaped labral cartilage within the space
o Annotation: RT POST LABRUM
· Dynamic Assessment
o Externally rotate the arm and check for fluid bubbles coming into the posterior labrum
· Patient position
o Hand still on opposite shoulder
· Landmarks
o Posterior labrum is in the transverse plane at the level of the humeral head and superior to the glenoid fossa
o Transducer should be slightly rotated with the lateral aspect running obliquely to the shoulder
o Infraspinatous tendon can be identified overlying the fossa
· Image
o Posterior labrum demonstrating the echogenic, triangular shaped labral cartilage within the space
o Annotation: RT POST LABRUM
· Dynamic Assessment
o Externally rotate the arm and check for fluid bubbles coming into the posterior labrum
8. SPINOGLENOID NOTCH
· Patients hand is still on the opposite shoulder
· Slide transducer medially when you are still in the transverse plane looking at the posterior labrum
· Image
o Image the posterior labrum in the transverse plane
o Annotation: RT NOTCH
· Patients hand is still on the opposite shoulder
· Slide transducer medially when you are still in the transverse plane looking at the posterior labrum
· Image
o Image the posterior labrum in the transverse plane
o Annotation: RT NOTCH
9. AC JOINT
· Patient Position
o Forearm on their lap with the hand supinated
· Dynamic assessment
o Have the patient outstretch their arm anteriorly (stretching out the elbow)
· Landmarks
o Move medially to indluce a length of the clavicle
o Remain stationary over the joint space as the patient repeats the manoeuver
· Image
o Split screen – one with the arm normal and one with the arm extended forwards
o Annotation: RT AC JT & RT JT EXT
· Patient Position
o Forearm on their lap with the hand supinated
· Dynamic assessment
o Have the patient outstretch their arm anteriorly (stretching out the elbow)
· Landmarks
o Move medially to indluce a length of the clavicle
o Remain stationary over the joint space as the patient repeats the manoeuver
· Image
o Split screen – one with the arm normal and one with the arm extended forwards
o Annotation: RT AC JT & RT JT EXT
Reference
Bernacci, C. & Kras, S. Thomas, L. (2013). 3R03 Lab Manual. [Class handout]. Department of Medical Radiation Science. University of McMaster, Hamilton, Canada.
Bernacci, C. & Kras, S. Thomas, L. (2013). 3R03 Lab Manual. [Class handout]. Department of Medical Radiation Science. University of McMaster, Hamilton, Canada.