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Methodology of ultrasound of the shoulder joint
Last reviewed: 04.07.2025
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When performing an ultrasound examination (US) of the shoulder joint, a certain sequence should be followed and certain standard positions (sections) should be sought. The examination of the shoulder joint is best performed using a rotating chair. The patient sits in front of the doctor, placing his arms bent at an angle of 90 degrees at the elbow joint on his knees.
The study begins with an assessment of the condition of the long head of the biceps tendon, for which transverse and longitudinal sections are obtained.
The tendon of the long head of the biceps brachii muscle is well defined in both the transverse and longitudinal planes. When scanning transversely, the tendon of the long head of the biceps brachii muscle is visualized as a hyperechoic circle or ellipse, which are located in a small depression - the intertubercular groove. The tendon of the long head of the biceps brachii muscle is surrounded by a synovial membrane. Normally, a small amount of fluid may be present here.
The transducer is then rotated and the tendon is assessed in the longitudinal plane up to the level of the tendon-muscle junction. During longitudinal scanning, hyperechoic fibers of the biceps tendon are clearly visible.
The next mandatory position is the rotator cuff position, where the subscapularis tendon is examined. The patient should be asked to abduct the arm into external rotation. The bony landmarks for visualizing the subscapularis tendon are the coracoid process of the scapula and the head of the humerus. Moving the transducer outward reveals the subscapularis tendon adjacent to the lesser tuberosity of the humerus. Passive internal and external rotation improves visibility of this tendon.
The next position is the position for assessing the supraspinatus tendon. For this, the patient is asked to place the arm being examined behind the back. The sensor is placed longitudinally to the fibers of the supraspinatus tendon.
The supraspinatus tendon will look like a parrot's beak when scanned longitudinally. By rotating the sensor 90 degrees, hyperechoic fibers of the supraspinatus tendon are visualized in the transverse plane. In this case, hypoechoic hyaline cartilage will be clearly visible above the hyperechoic contour of the humeral head. The condition of the subdeltoid bursa can also be assessed on echograms in this position. It is defined as a thin hypoechoic structure located under the deltoid muscle. Normally, there is no fluid in it. The subacromial bursa is located closer to the coracoid process of the scapula.
By moving the sensor medially, it is possible to examine the anterior part (anterior glenoid labrum) of the glenohumeral joint. Normally, the glenohumeral joint looks like a hyperechoic triangle with the apex facing the joint cavity.
When scanning transversely along the anterolateral surface of the scapula, the posterior part (posterior glenoid labrum), scapulohumeral joint, teres minor muscle and infraspinatus tendon are examined.
The patient is asked to bring the arm being examined forward toward the body. In this position, the posterior labrum of the shoulder joint can be visualized as a hyperechoic triangle.
By moving the sensor upward, the infraspinatus tendon is visualized, and transverse and longitudinal sections of this tendon are obtained.
To assess the posterior glenoid labrum, the sensor is moved medially and lower to the level of the edge of the scapula.
The posterior labrum has the appearance of a hyperechoic triangle with its apex facing the joint cavity.
To examine the acromioclavicular joint, the probe is placed between two bony prominences. Sometimes it is possible to visualize the acromioclavicular ligament as a hypoechoic strip. Using panoramic scanning, it is possible to visualize all the sections of the rotator cuff of the shoulder joint of interest.
The search for the radial nerve is carried out along the posterior surface of the shoulder at the site of attachment of the distal fibers of the deltoid muscle.
Internal rotation of the forearm helps to better develop the contours of the deltoid muscle.
The nerve is fixed to the humerus by a fibrous cord. Normally, the width of the radial nerve is 4.6 mm on average, the anteroposterior size is 2.3 mm.
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