Shoulder ultrasound: current concepts and future perspectives

Abstract

Ultrasonography is an established and effective imaging technique that can be used to evaluate articular and periarticular structures around the shoulder. It has been shown to be useful in a wide range of rotator cuff diseases (e.g. tendon tears, rotator cuff calcific tendinopathy and bursitis) as well as non-rotator cuff abnormalities (instability, synovial joint diseases and nerve entrapment syndrome). A scanning protocol is highly recommended to reduce the rate of operators’ errors by following a standardized scheme including a list of main structures. Shoulder ultrasound has several advantages: it is a relatively cheap and widely available technique, free from ionizing radiation, that can reach excellent diagnostic accuracy even compared to magnetic resonance imaging. Moreover, it is the only imaging technique that allows dynamic evaluation of musculoskeletal structures, which is important for the evaluation of impingement. Also, due to the shoulder’s superficial anatomical position, ultrasound can also be helpful in guiding interventional percutaneous procedures, both for diagnostic (e.g. magnetic resonance arthrography) and therapeutic purposes (e.g. percutaneous treatment of calcific tendonitis). Contrast-enhanced ultrasound and speckle tracking offer complimentary evaluations of shoulder anatomy and biomechanics. Moreover, the advent of ultra-high-frequency US, with probes up to 70 MHz allowing for a resolution as low as 30 μm, is a promising tool for further evaluation of the shoulder anatomy, and diagnostic and therapeutic strategies.

Clinical application of ultra‐high frequency ultrasound: Discovering a new imaging frontier

“…Furthermore, UHFUS is able to delineate the individual nerve bundles in the median nerve useful to distinguishing the motor fascicular group on the radial side from the sensory fascicular group on the ulnar side and it may play an important role in the preoperative evaluation of carpal tunnel syndrome preventing the damage to the motor component of the median nerve. 55,56 Preliminary data highlight the promising role of UHFUS in degenerative and rheumatologic joint disorders. UHFUS could be used to identify the premature degeneration of the cartilage, characterized by its thinning and hyperechogenicity, and the alteration of the subchondral bone, characterized by the appearance of echogenic areas within it.…”

“…In normal conditions, the average thickness of the tendon retinacles is <1 mm, making these structures another optimal target of UHFUS. 55,56 Finally, UFHUS could be used in the study of breast implants and of the eye. In the first one, UHFUS could have a possible role in the detection of premature signs of breast implant ruptures.…”

“…Moreover, UHFUS could help the imaging of the digital nerves and could allow to detect small neuromas or amputation stumps in the case of cuts, wounds, and lacerations of the hand. Furthermore, UHFUS is able to delineate the individual nerve bundles in the median nerve useful to distinguishing the motor fascicular group on the radial side from the sensory fascicular group on the ulnar side and it may play an important role in the preoperative evaluation of carpal tunnel syndrome preventing the damage to the motor component of the median nerve 55,56 …”

“…In particular, UHFUS could be used to detect the lesions of the extensor tendons of the hand, with even better results obtained from a dynamic real‐time evaluation, and to evaluate the flexor tendon pulleys that with the conventional US are barely visible and are commonly subject to breakage during climbing athletes. In normal conditions, the average thickness of the tendon retinacles is <1 mm, making these structures another optimal target of UHFUS 55,56 …”

Ultrasound of Shoulder Joint Another Diagnostic Modality

“…Moreover, the advent of ultra-high-frequency US, with probes up to 70 MHz allowing for a resolution as low as 30 ìm, is a promising tool for further evaluation of the shoulder anatomy, and diagnostic and therapeutic strategies. 22…”