Comprehensive Shoulder US Examination: A Standardized Approach with Multimodality Correlation for Common Shoulder Disease

Abstract

1Shoulder pain is one of the most common musculoskeletal conditions encountered in primary care and specialty orthopedic clinic settings. Although magnetic resonance (MR) imaging is typically the modality of choice for evaluating the soft-tissue structures of the shoulder, ultrasonography (US) is becoming an important complementary imaging tool in the evaluation of superficial softtissue structures such as the rotator cuff, subacromial-subdeltoid bursa, and biceps tendon. The advantages of US driving its recent increased use include low cost, accessibility, and capability for realtime high-resolution imaging that enables dynamic assessment and needle guidance. As more radiologists are considering incorporating shoulder US into their practices, the development of a standardized approach to performing shoulder US should be a priority to facilitate the delivery of high-quality patient care. Familiarity with and comfort in performing a standardized shoulder US examination, as well as knowledge of the types of anomalies that can be evaluated well with US, will enhance the expertise of those working in musculoskeletal radiology practices and add value in the form of increased patient and health care provider satisfaction. This review describes the utility and benefits of shoulder US as a tool that complements MR imaging in the assessment of shoulder pain. A standardized approach to the shoulder US examination is also described, with a review of the basic technique of this examination, normal anatomy of the shoulder, common indications for shoulder US, and characteristic US findings of common shoulder diseases-with select MR imaging and arthroscopic correlation. Abbreviations: AC = acromioclavicular, IST = infraspinatus tendon, LHBT = long head of the biceps tendon, RC = rotator cuff, SASD = subacromial-subdeltoid, SST = supraspinatus tendon, SubST = subscapularis tendon

Role of dynamic ultrasound versus MRI in diagnosis and assessment of shoulder impingement syndrome

“…Although the exact pathogenesis of calcific tendinitis condition remains unknown, it is probably multifactorial-likely being related to degeneration, reactive change, predisposing medical conditions, and genetics [10]. This is agreed with (Chiou et al), who reported the high accuracy of the ultrasonography in detection of calcific tendinitis.…”

The Hyperechoic Appearance of the Deltoid Muscle on Shoulder Ultrasound Imaging as a Predictor of Diabetes and Prediabetes

“…Musculoskeletal ultrasound (US) use has substantially increased over the past decades, especially with shoulder US for the evaluation of pain and rotator cuff disorders . The ability to perform a dynamic US examination while interacting directly with the patient, the ease of accessibility, and the lower cost compared to magnetic resonance imaging have all contributed to its increased use …”

The Repaired Rotator Cuff: MRI and Ultrasound Evaluation

“…Oblique coronal IR (a) and oblique coronal PD (b) images demonstrate a screw (arrow) displaced into the substance of the proximal deltoid muscle, inciting surrounding soft tissue edema, and subacromial-subdeltoid bursitis subscapularis tendon) are examined first, followed by superior structures (acromioclavicular joint, supraspinatus tendon, and subacromial-subdeltoid bursa), and the posterior structures (infraspinatus and teres minor tendons and posterior glenohumeral joint). While sonographic evaluation of the rotator cuff tendons is dependent on patient cooperation, such as the ability to maneuver into the Crass and modified Crass positions for evaluation of the supraspinatus tendon footprint [41], complete supraspinatus tears at the footprint can still be identified with the patient imaged in the neutral position. Unlike an MRI, which is a static exam, the ability to perform dynamic maneuvers is an advantage of US.…”