Methods of ultrasound of the shoulder joint
Last reviewed: 23.04.2024
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When performing ultrasound (ultrasound) of the shoulder joint, you should follow a certain sequence and try to get certain standard positions (slices). Study of the shoulder joint is best done using a rotating chair. The patient sits in front of the doctor, placing his hands bent at an angle of 90 degrees at the elbow joint to his knees.
The study begins with an evaluation of the condition of the tendon of the long bicep head, for which its transverse and longitudinal sections are obtained.
The tendon of the long head of the biceps arm muscle is well defined both in the transverse and longitudinal planes. With a transverse scan, the tendon of the long head of the biceps arm muscle is visualized in the form of a hyperechoic circle or ellipse, which are located in a small depression - the mezhbugorkovaya furrow. The tendon of the long head of the biceps muscle of the shoulder is surrounded by the synovial membrane. Normally, a small amount of liquid may be present here.
The sensor is then rotated and the tendon is evaluated in the longitudinal plane to the level of the tendon-muscle junction. With longitudinal scanning, the hyperechoic fibers of the biceps tendon are clearly differentiated.
The next mandatory position is the position for assessing the rotator cuff in which the tendon of the subscapular muscle begins. In this case, the patient should be asked to take his hand to the position of external rotation. Bony guidelines for visualization of the tendon of the scapula are the beak-shaped process of the scapula and the head of the humerus. When moving the sensor outward, the tendon of the subscapular muscle is determined, which is adjacent to the small tuberosity of the humerus. Passive internal and external rotations improve the visibility of this tendon.
The next position is the position for assessing the tendon of the supraspinatus. To do this, ask the patient to bring the test arm behind his back. The sensor is installed longitudinally along the tendon fibers of the supraspinatus.
The tendon of the supraspinatus with longitudinal scanning will look like a beak of a parrot. Rotating the sensor 90 degrees visualizes the hyperechoic fibers of the tendon of the supraspinatus in the transverse plane. At the same time, a hypoechoic hyaline cartilage will be clearly visible over the hyperechoic contour of the head of the humerus. On the echograms in this position, it is also possible to evaluate the state of the sub-dildot bag. It is defined as a thin hypoechoic structure located under the deltoid muscle. Normally there is no liquid in it. Closer to the beak-like process of the scapula is the subacromial sac.
By biasing the sensor medially, one can examine the anterior section (anterior joint lip) of the shoulder-scapular articulation. Normally, the shoulder-scapular articulation looks like a hyperechoic triangle with a vertex facing the joint cavity.
In transverse scanning on the anterior-lateral surface of the scapula, the posterior section (posterior articular lip), the scapula-humeral articulation, the round small muscle and the tendon of the subacute muscle are examined.
In this case, the patient is asked to bring the test arm to the body anteriorly. In this position, the posterior articular lip of the shoulder joint can be visualized as a hyperechoic triangle.
Moving the sensor upward, the tendon of the subacute muscle is visualized, the transverse and longitudinal sections of the tendon are obtained.
To assess the posterior articular lip, the sensor is displaced medially and lower - to the level of the shoulder edge.
The posterior articular lip has the appearance of a hyperechoic triangle, which is turned into the joint cavity by the apex.
To investigate clavicular-acromial articulation, the sensor is placed between two bony protuberances. Sometimes it is possible to visualize the clavicular-acromial ligament in the form of a hypoechoic strip. Using panoramic scanning, you can visualize all the interesting sections of the rotator cuff of the shoulder joint.
Search for the radial nerve is carried out on the posterior surface of the shoulder at the site of attachment of distal fibers of the deltoid muscle.
The inner rotation of the forearm helps to better work out the contours of the deltoid muscle.
The nerve is fixed to the humerus with fibrous strand. Normally, the width of the radial nerve is on average 4.6 mm, the anterior-posterior dimension 2.3 mm.
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