US of the Shoulder: Non–Rotator Cuff Disorders

Abstract

The most common indication for shoulder ultrasonography (US) is the diagnosis of rotator cuff disease. However, there is a spectrum of non-rotator cuff abnormalities that are amenable to US examination, including instability of the biceps tendon, glenohumeral joint, and acromioclavicular joint; arthropathies and bursites (inflammatory diseases, degenerative and infiltrative disorders, infections); nerve entrapment syndromes; and space-occupying lesions. Many of these conditions may be overlooked clinically or can even mimic rotator cuff tears, and US can help redirect the diagnosis if a complete shoulder examination rather than a simple rotator cuff assessment is performed. In addition, US can be remarkably helpful in guiding either needle aspiration procedures or local injection therapy in patients with synovial processes. Although radiography, magnetic resonance (MR) imaging, and computed tomographic and MR arthrography are effective modalities for the evaluation of non-rotator cuff disorders, US is both less costly and less invasive and will likely be used more frequently in this setting as experience increases. Once adequate radiographs have been obtained to exclude apparent bone disorders, high-resolution US should be the first-line imaging modality in the assessment of non-rotator cuff disorders of the shoulder, assuming the study is performed with high-end equipment by an experienced examiner.

Diagnostic Consistency between Sonoelastography and Conventional Sonography of Long Head of the Biceps

“…Nevertheless, it will become imaging study of choice because of it has many advantages; relatively inexpensive, may be used for patients with metallic implants; possible to exam dynamic technique; no ionizing radiation; offers better spatial resolution than MRI, and may be used for local anesthetic or corticosteroid injections into the biceps tendon sheath. [18][19][20][21] However, it can be difficult or even impossible to differentiate tissue affected by degenerative disease from healthy tissue, because damaged tissue often has the same echogenicity as the surrounding healthy tissue upon conventional ultrasound. 6) However, it is well known that inflammation and degeneration cause changes in tissue elasticity.…”

US anatomy of the shoulder: Pictorial essay

“…7) is a synovial structure situated below the clavicle, acromion and coracoacromial ligament and above the rotator cuff [3,5,6]. Under physiological conditions it does not communicate with the glenohumeral joint but it may communicate with the joint cavity after a full-thickness supraspinatus tendon tear [1,3,5,6].…”

“…For this reason, the US operator carrying out the examination of the shoulder must be thoroughly familiar with the anatomy of the structures which are normally studied by US, i.e. tendons and muscles, but also with all the other structures forming the joint such as serous bursae, ligaments, nerves and bones in order to integrate and correctly interpret clinical and instrumental findings [3].…”

“…The US operator should furthermore remember that the shoulder is made up not only of the scapulohumeral joint, but also of the acromioclavicular joint and functionally the sternoclavicular joint, where possible pathologies may cause shoulder pain [3].…”

Role of Ultrasound and Magnetic Resonance Imaging in Traumatic Shoulder Joint Injuries.

“…The main shoulder structures that can be evaluated with US in patients with instability problems are the long head of biceps, the glenohumeral joint, and the acromioclavicular joint. US can be used for documenting the presence, direction, and extent of glenohumeral translation, especially in patients with posterior shoulder dislocation (3) . MR imaging provides a global view of the shoulder and is relatively easy to learn and interpret.…”