A Stepwise Guide to Performing Shoulder Ultrasound: The Acromio-Clavicular Joint, Biceps, Subscapularis, Impingement, Supraspinatus Protocol

Abstract

Shoulder pain is a common and painful patient condition. Unfortunately, diagnostic imaging of shoulder pain in the emergency department (ED) is often limited to radiography. While diagnostic for fractures and dislocations, drawbacks of radiography include time delays and non-diagnostic imaging in the case of rotator cuff pathology. While bedside ultrasound has been incorporated into many procedural and diagnostic applications in the ED, its use for musculoskeletal complaints and specifically shoulder pain is infrequent among ED clinicians. The incorporation of shoulder ultrasound in the ED may improve diagnostic certainty while decreasing time to diagnosis and treatment, yielding patient and health system benefits. Herein, we present the ABSIS (Acromio-clavicular joint, Biceps, Subscapularis, Impingement, Supraspinatus) Protocol for performing bedside ultrasound of the shoulder including the rotator cuff and bony anatomy.

Point-of-Care Ultrasound Unveiling Rotator Cuff Injuries in the Emergency Department: A Case Series

“…Shoulder POCUS was performed according to the stepwise shoulder ultrasound protocol [11]. This protocol introduces the acromioclavicular (AC) joint, biceps tendon, subscapularis, impingement, and supraspinatus (ABSIS) ultrasound protocol, which provides a stepwise approach to performing and interpreting shoulder ultrasound.…”

“…All ultrasound examinations were performed with the probe-oriented cephalad or toward the patient's right. If shoulder dislocation is not on the clinical differential, the protocol begins with the linear probe and examines the AC joint and clavicle, biceps tendon, subscapularis tendon, supraspinatus tendon and subacromial space, humeral head, and glenohumeral joint from the posterior aspect (typically performed using the curvilinear probe) [11]. If shoulder dislocation is on the differential, it is recommended to start initially with the view of the glenohumeral joint; however, these cases are not presented in this case series.…”