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Advancing high-resolution musculoskeletal ultrasound: A histology- and anatomy-driven approach for enhanced shoulder imaging. Part I: Posterior and coronal shoulder

Giorgio Tamborrini

Giorgio Tamborrini

  • Ultrasound, UZR – Swiss Ultrasound Center, Institute of RheumatologyBasel, Switzerland
  • Clinic for Rheumatology, University Hospital of BaselBasel, Switzerland
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Tamborrini, Giorgio
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Raphael Micheroli

Raphael Micheroli

  • Ultrasound, UZR – Swiss Ultrasound Center, Institute of RheumatologyBasel, Switzerland
  • Department of Rheumatology, University Hospital ZürichZürich, Switzerland
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Micheroli, Raphael
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Vincenzo Ricci

Vincenzo Ricci

Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-SaccoMilano, Italy
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Ricci, Vincenzo
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Marco Becciolini

Marco Becciolini

  • Ultrasound, Misericordia di PistoiaPistoia, Italy
  • Ultrasound, Scuola Siumb di Ecografia MuscoloscheletricaPistoia, Italy
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Becciolini, Marco
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Mario Garcia-Pompermayer

Mario Garcia-Pompermayer

Rheumatology, Hospital San Jose, TecSalud, Tecnologico de MonterreyMonterrey, Mexico
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Garcia-Pompermayer, Mario
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Andres Serrano Belmar Gonzalo

Andres Serrano Belmar Gonzalo

Department of Radiology, Clínica AlemanaSantiago, Chile
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Gonzalo, Andres Serrano Belmar
, 
Magdalena Müller-Gerbl

Magdalena Müller-Gerbl

Institute of Anatomy, Department of Biomedicine, Musculoskeletal Research, University of BaselBasel, Switzerland
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Müller-Gerbl, Magdalena
 und 
Felix Margenfeld

Felix Margenfeld

Institute of Anatomy, Department of Biomedicine, Musculoskeletal Research, University of BaselBasel, Switzerland
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Margenfeld, Felix
  
30. Nov. 2024
Advancing high-resolution musculoskeletal ultrasound: A histology- and anatomy-driven approach for enhanced shoulder imaging. Part I: Posterior and coronal shoulder's Cover Image
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COVER HERUNTERLADEN
Artikel-Kategorie: Pictorial essay
Online veröffentlicht: 30. Nov. 2024
Seitenbereich: 1 - 9
Eingereicht: 11. Feb. 2024
Akzeptiert: 21. Mai 2024
DOI: https://doi.org/10.15557/jou.2024.0026
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© 2024 Giorgio Tamborrini et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1.

Illustration of the rotator cuff of the shoulder. acr – acromion; cal – cora-coacromial ligament; cp – coracoid process; it – infraspinatus tendon; lhbt – long head biceps tendon; tmt – teres minor tendon, sscmt – sub-scapularis tendon, sumt – supraspinatus tendon, bu – bursa
Illustration of the rotator cuff of the shoulder. acr – acromion; cal – cora-coacromial ligament; cp – coracoid process; it – infraspinatus tendon; lhbt – long head biceps tendon; tmt – teres minor tendon, sscmt – sub-scapularis tendon, sumt – supraspinatus tendon, bu – bursa

Fig. 2.

Illustration of a selection of probe positions, posterior/dorsal shoulder. a – posterior; b – anterior, c – lateral in the coronal plane
Illustration of a selection of probe positions, posterior/dorsal shoulder. a – posterior; b – anterior, c – lateral in the coronal plane

Fig. 3.

Probe positions, posterior/dorsal shoulder on the model
Probe positions, posterior/dorsal shoulder on the model

Fig. 4.

Posterior transverse overview. A. Gray-scale ultrasonography posterior transverse panoramic image. B. Anatomical image. C. Histological image. bu – bursa; cu – cutis; dm – deltoid muscle; fa – fascia; gl – glenoid; hc – hyaline cartilage; hh – humeral head; im – infraspinatus muscle; it – infraspinatus tendon; jc – joint capsule/ligament; la – labrum; sc – scapula; sgn – spinoglenoid notch; su – subcutis
Posterior transverse overview. A. Gray-scale ultrasonography posterior transverse panoramic image. B. Anatomical image. C. Histological image. bu – bursa; cu – cutis; dm – deltoid muscle; fa – fascia; gl – glenoid; hc – hyaline cartilage; hh – humeral head; im – infraspinatus muscle; it – infraspinatus tendon; jc – joint capsule/ligament; la – labrum; sc – scapula; sgn – spinoglenoid notch; su – subcutis

Fig. 5.

Posterior transverse. A. Gray-scale ultrasonography posterior transverse image in external rotation. B. Grayscale ultrasonography posterior transverse image in internal rotation. C. Anatomical image. D. Histological image. bu – bursa; cu – cutis; dm – deltoid muscle; e – enthesis; fa – fascia; gl – glenoid; hc – hyaline cartilage; hu – humeral head; im – infraspinatus muscle; it – infraspinatus tendon; jc – joint capsule/ligament; la – labrum; sc – scapula; sgn – spinoglenoid notch; su – subcutis
Posterior transverse. A. Gray-scale ultrasonography posterior transverse image in external rotation. B. Grayscale ultrasonography posterior transverse image in internal rotation. C. Anatomical image. D. Histological image. bu – bursa; cu – cutis; dm – deltoid muscle; e – enthesis; fa – fascia; gl – glenoid; hc – hyaline cartilage; hu – humeral head; im – infraspinatus muscle; it – infraspinatus tendon; jc – joint capsule/ligament; la – labrum; sc – scapula; sgn – spinoglenoid notch; su – subcutis

Fig. 6.

Posterior transverse. A, B. Gray-scale ultrasonography posterior transverse image in internal rotation. C. Anatomical image. D. Histological image. arrow – enlarged view of the cutout (box); bu – bursa; cu – cutis; dm – deltoid muscle; e1 – enthesis of the joint capsule/glenohumeral ligament; e2 – enthesis of the infraspinatus tendon; fa – fascia; gl – glenoid; hc – hyaline cartilage; hu – humeral head; im – infraspinatus muscle; it – infraspinatus tendon; jc – joint capsule/ligament; la – labrum; su – subcutis
Posterior transverse. A, B. Gray-scale ultrasonography posterior transverse image in internal rotation. C. Anatomical image. D. Histological image. arrow – enlarged view of the cutout (box); bu – bursa; cu – cutis; dm – deltoid muscle; e1 – enthesis of the joint capsule/glenohumeral ligament; e2 – enthesis of the infraspinatus tendon; fa – fascia; gl – glenoid; hc – hyaline cartilage; hu – humeral head; im – infraspinatus muscle; it – infraspinatus tendon; jc – joint capsule/ligament; la – labrum; su – subcutis

Fig. 7.

Posterior longitudinal. A. Gray-scale ultrasonography posterior longitudinal image. B. Gray-scale ultrasonography posterior longitudinal in internal rotation. C. Gray-scale ultrasonography posterior transverse (left) and longitudinal (right). D. Gray-scale and Power-Doppler ultrasonography posterior longitudinal. E. Anatomical image. axn – axillary nerve; ca –glenohumeral joint cavity; cu – cutis; dm – deltoid muscle; fa – fascia; gl – glenoid; gt – posterior facet of the greater tubercle; im – infraspinatus muscle; it – infraspinatus tendon; la – labrum; pca – posterior circumflex artery; su – subcutis; spi – scapular spine; tma – teres major muscle; tmm – teres minor muscle; tmt – teres minor tendon; trm – triceps muscle; trt –triceps tendon; qs – quadrilateral space
Posterior longitudinal. A. Gray-scale ultrasonography posterior longitudinal image. B. Gray-scale ultrasonography posterior longitudinal in internal rotation. C. Gray-scale ultrasonography posterior transverse (left) and longitudinal (right). D. Gray-scale and Power-Doppler ultrasonography posterior longitudinal. E. Anatomical image. axn – axillary nerve; ca –glenohumeral joint cavity; cu – cutis; dm – deltoid muscle; fa – fascia; gl – glenoid; gt – posterior facet of the greater tubercle; im – infraspinatus muscle; it – infraspinatus tendon; la – labrum; pca – posterior circumflex artery; su – subcutis; spi – scapular spine; tma – teres major muscle; tmm – teres minor muscle; tmt – teres minor tendon; trm – triceps muscle; trt –triceps tendon; qs – quadrilateral space

Fig. 8.

Posterior longitudinal overview. A, B. Gray-scale ultrasonography posterior longitudinal panoramic image. C, D. Anatomical image. bu – bursa; cl – clavicle; cu – cutis; dm – deltoid muscle; fa – fascia; gl – glenoid; im – infraspinatus muscle; it – infraspinatus tendon; sc – scapula; sgn –spinoglenoid notch; spi – scapular spine; su – subcutis; sum – supraspinatus muscle; tmm –teres minor muscle; tmt – teres minor tendon; tr – trapezius muscle; trm – triceps muscle; trt – triceps tendon; qs – quadrilateral space
Posterior longitudinal overview. A, B. Gray-scale ultrasonography posterior longitudinal panoramic image. C, D. Anatomical image. bu – bursa; cl – clavicle; cu – cutis; dm – deltoid muscle; fa – fascia; gl – glenoid; im – infraspinatus muscle; it – infraspinatus tendon; sc – scapula; sgn –spinoglenoid notch; spi – scapular spine; su – subcutis; sum – supraspinatus muscle; tmm –teres minor muscle; tmt – teres minor tendon; tr – trapezius muscle; trm – triceps muscle; trt – triceps tendon; qs – quadrilateral space

Fig. 9.

Probe positions, frontal/coronal
Probe positions, frontal/coronal

Fig. 10.

Coronal region. A, B. Gray-scale ultrasonography coronal transverse image. C. Gray-scale ultrasonography coronal longitudinal image. D. Anatomical image of the AC joint. E. Histological image of the superior part of the labrum and the glenohumeral joint. acj – acromioclavicular joint cavity; acr – acromion; cl – clavicle; cu – cutis; dm – deltoid muscle; hc – hyaline cartilage; hu – humeral head; iacl – inferior acromioclavicular ligament; jc – joint capsule; la – labrum; sacl – superficial acromioclavicular ligament; su – subcutis; sum – supraspinatus muscle; sumt – supraspinatus tendon; sun – suprascapular notch
Coronal region. A, B. Gray-scale ultrasonography coronal transverse image. C. Gray-scale ultrasonography coronal longitudinal image. D. Anatomical image of the AC joint. E. Histological image of the superior part of the labrum and the glenohumeral joint. acj – acromioclavicular joint cavity; acr – acromion; cl – clavicle; cu – cutis; dm – deltoid muscle; hc – hyaline cartilage; hu – humeral head; iacl – inferior acromioclavicular ligament; jc – joint capsule; la – labrum; sacl – superficial acromioclavicular ligament; su – subcutis; sum – supraspinatus muscle; sumt – supraspinatus tendon; sun – suprascapular notch

Fig. 11.

Coronal views. A. Gray-scale ultrasonography coronal transverse panoramic image. B. Gray-scale ultrasonography coronal longitudinal image. C. Grayscale ultrasonography coronal transverse image. D. Power-Doppler ultrasonography coronal transverse image. E. Anatomical image. acr – acromion; a – artery; cl – clavicle; cu – cutis; dm – deltoid muscle; fa – fascia; hu – humeral head; sc – scapula; spi – scapular spine; ssn – suprascapular nerve; su – subcutis; sum – supraspinatus muscle; sumt – supraspinatus tendon; sun – suprascapular notch; v – vein
Coronal views. A. Gray-scale ultrasonography coronal transverse panoramic image. B. Gray-scale ultrasonography coronal longitudinal image. C. Grayscale ultrasonography coronal transverse image. D. Power-Doppler ultrasonography coronal transverse image. E. Anatomical image. acr – acromion; a – artery; cl – clavicle; cu – cutis; dm – deltoid muscle; fa – fascia; hu – humeral head; sc – scapula; spi – scapular spine; ssn – suprascapular nerve; su – subcutis; sum – supraspinatus muscle; sumt – supraspinatus tendon; sun – suprascapular notch; v – vein

Anatomical structures of the posterior shoulder

Posterior aspect of the humeral head and humeral neck

Glenoid, lateral angle of the scapula

Scapular neck and spine

Acromion (lateral)

Glenohumeral joint recess (in between glenoid and humeral head, posterior glenoid fossa)

Posterior glenoid labrum

Spinoglenoid notch (suprascapular vessels and suprascapular nerve)

Posterior joint capsule, glenohumeral ligament

Deltoid muscle, dorsal part

Infraspinatus muscle and tendon (from spine of the scapula / infraspinatus fossa to posterior facet of the greater tuberosity)

Teres minor muscle and tendon (from infraspinatus fossa, follows intramuscular myotendinous connection; insertion: posterior/inferior facet of the greater tuberosity)

Subdeltoid bursa, posterior part

Quadrilateral space (posterior humeral circumflex vessels and axillary nerve)

Triceps muscle

Standard scans of the posterior shoulder

Position: neutral position, elbow 90° flexion, hand in supination

Dynamic active and passive internal and external rotation

Longitudinal and transverse view, arm in neutral position

Longitudinal and transverse view, arm in external position

Longitudinal and transverse view, arm in internal and body cross position

Dynamic ABER position (abduction + external rotation)

Standard scans of the frontal shoulder

Position: neutral position, elbow 90° flexion, hand in supination

Dynamic active and passive adduction, abduction, internal and external rotation

Multiplanar, longitudinal and transverse frontal scans

Standard scans of the shoulder

Posterior shoulder: longitudinal and transverse view, arm in neutral position

Posterior shoulder: longitudinal and transverse view, arm in external rotation

Posterior shoulder: longitudinal and transverse view, arm in internal rotation

Frontal (coronal) view: longitudinal and transverse view, in neutral position

Anterior shoulder: longitudinal and transverse view, in neutral position

Anterior shoulder: longitudinal and transverse view, arm in external rotation

Anterior shoulder: longitudinal and transverse view, arm in internal rotation

Anterior shoulder: longitudinal and transverse view, arm in oblique position

Lateral shoulder: longitudinal and transverse view, arm in neutral position

Lateral shoulder: longitudinal and transverse view, arm in external and internal rotation

Anatomical structures of the frontal shoulder

Joint capsule of the acromioclavicular (AC) joint

Glenohumeral joint, cranial part, lateral to the suprascapular notch

Superior and inferior AC ligament

Acromion

Clavicle

Greater tuberosity, lateral part

Labrum, joint capsule and glenohumeral ligament, cranial part

Suprascapular notch with suprascapular vessels and suprascapular nerve (medial to the superior part of the glenoid, labrum)

Superior transverse scapular ligament

Deltoid muscle, lateral part

Supraspinatus muscle in the supraspinatus fossa

Tendon of the supraspinatus muscle with its insertion at the greater tuberosity

Subdeltoid-subacromial bursa, subacromial part
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