Shoulder US: Anatomy, Technique, and Scanning Pitfalls

Abstract

The accuracy of shoulder ultrasonography (US) is largely dependent on the US examination technique. It is essential that the individual performing the US examination has an understanding of pertinent anatomy, such as bone surface anatomy and tendon orientation. It is also important to be familiar with imaging pitfalls related to US technique, such as anisotropy. In this article, shoulder US scanning technique, as well as related anatomy and scanning pitfalls, will be reviewed. The use of a protocol-driven shoulder US examination is important to ensure a comprehensive and efficient evaluation. An on-line video tutorial demonstrating a shoulder US also accompanies this article.

Ultrasound vs. MRI in the assessment of rotator cuff structure prior to shoulder arthroplasty

“…24,25 On the other hand, US depends considerably on the examiner's experience 26e28 and a constituted standard of examination. 29,30 For patients with limited ROM especially external rotation, US is less consistent with MRI in the diagnosis of subscapularis tears. In our opinion, US is especially advantageous for the preoperative assessment of the rotator cuff and the long biceps tendon in revision cases where MRI quality is often reduced due to metallic implants.…”

Prevalence of subacromial-subdeltoid bursitis in shoulder pain: an ultrasonographic study

“…The SASD bursa-an extra-articular synovial space-lies between the rotator cuff tendons and the undersurface of the acromion, the acromioclavicular joint and the deltoid muscle, overlying the bicipital groove [3]. It is a potential space, that appears as a hypoechoic tissue between highly reflective peribursal fat; in pathological conditions, the bursa is seen as a fluid-filled anechoic structure lined by an hyperechoic wall [4,5]. Normally, no communication exists between the bursa and the joint; a communication is realized in fullthickness tears of the rotator cuff; SASD bursa may or may not communicate with the subcoracoid bursa.…”

Imaging Algorithms for Evaluating Suspected Rotator Cuff Disease: Society of Radiologists in Ultrasound Consensus Conference Statement

“…Defined imaging techniques and protocols are important to minimize such operator dependence, especially with US. Although a review of shoulder imaging protocols is beyond the scope of this article, it is essential that a comprehensive imaging protocol be followed for both US (34) and MR imaging (35). Regardless of whether images of the rotator cuff are obtained with US or MR imaging, the goals are the same-namely to obtain high-spatial-resolution images of the rotator cuff in the short and long axis in such a way as to avoid artifacts that would limit interpretation.…”