The sonographic representation of the shoulder region in horses with special consideration of clinically relevant structures

Abstract

ZusammenfassungEs werden die Möglichkeiten der sonographischen Darstellbarkeit verschiedener Strukturen der Schulterregion des Pferdes erarbeitet, Standarduntersuchungsebenen vorgeschlagen und den Ultraschallbildern angepasste anatomische Vergleichsschnitte erstellt. Außerdem wird ein neuer Punkt zur Arthrozentese vorgestellt und eine umstrittene Verbindung zwischen Bursa intertubercularis und Schultergelenk über-prüft. Die Untersuchungen erfolgten an 23 Gliedmaßen unter Einsatz eines 6,0 / 8,0 MHz Linear-und eines 5,0 / 7,5 MHz Mehrfachwinkelsektorschallkopfes.Schlüsselwörter: Ultraschall, Schultergelenk, Bizepssehne, Bursa intertubercularis, PferdThe sonographic representation of the shoulder region in horses with special consideration of clinically relevant structuresThe possibilities of sonographic representation of various structures in the shoulder region of the horse are elaborated, standardized diagnostical planes suggested and comparative anatomical preparations adapted to the ultrasound pictures made. Furthermore, a new aspect of arthrocentesis is presented and the controversial connection between the bicipital bursa and the shoulder joint is examined. In vivo ultrasound was performed on 23 limbs using a linear probe (6,0 or 8,0 MHz) and a multiple angle sector probe (5,0 or 7,5 MHz). For the sonographical examinations, the shoulder region was divided into 4 diagnostic areas with on overall of 16 diagnostic planes. These diagnostical planes and the structures associated with them were selected for their clinical relevance and their relation to easily palpable anatomical spots in order to ensure an easy reproducibility. The tendon of the biceps brachii muscle was evaluated in its full extension from its origin at the supraglenoid tubercle, along the shoulder joint and the intertubercular groove, up to its transition into the muscle, as well as, the underlying bursa. Furthermore, the 2 terminal tendons of the supraspinatus muscle were examined. The visible shoulder joint portions of the lateral shoulder region (joint capsule, synovial space, scapula, and head of the humerus) were evaluated and the terminal tendon of the infraspinatus muscle as well as the underlying bursa were represented. In the scapula region the scapular spine and the area around the turning point of the suprascapular nerve were examined. All mentioned structures with the exception of the scapular spine were measured by means of a scanner-integrated measuring device. Postmortal arthrocentesis and colouring of the joint was performed on one shoulder of each of the 18 euthanized horses. Hereby, a position just caudally to the infraspinatus tendon, ca. 1 cm caudally to the centre of the caudal eminence of the greater tubercle, was chosen. A methyl blue coloration was used to test the existence of a controversially discussed connection between the shoulder joint and the intertubercular bursa. In one of the 18 examined cases the bursa was also coloured. A connection between these two synovial structures can therefore not be ruled out. Sono...

Comparison of ultrasound‐guided vs. ‘blind’ techniques for intra‐synovial injections of the shoulder area in horses: Scapulohumeral joint, bicipital and infraspinatus bursae

“…This can increase accuracy of needle placement and can reduce complications associated with inaccurate deposition of solutions or inadvertent damage to surrounding structures such as cartilage, nerve and vessels. Ultrasonographic evaluation of the normal shoulder joint, including the biceps tendon, BB and tendons of attachment of the infraspinatus and supraspinatus muscles and infraspinatus bursa (IB) has previously been described in detail [25–29]. A complete ultrasonographic examination can be performed using standard ultrasound equipment readily available to the ambulatory equine practitioner.…”