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Shoulder ultrasound: current concepts and future perspectives

Francesca Serpi
Francesca Serpi
, 
Domenico Albano
Domenico Albano
, 
Santi Rapisarda
Santi Rapisarda
, 
Vito Chianca
Vito Chianca
, 
Luca Maria Sconfienza
Luca Maria Sconfienza
 y 
Carmelo Messina
Carmelo Messina
   | 18 jun 2021
Journal of Ultrasonography's Cover Image
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Article Category: review-article
Publicado en línea: 18 jun 2021
Páginas: 154 - 161
Recibido: 28 feb 2021
Aceptado: 19 abr 2021
DOI: https://doi.org/10.15557/jou.2021.0025
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© 2021 Polish Ultrasound Society. Published by Medical Communications Sp. z o.o.
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Fig. 1.

The rotator cuff is composed of four muscles with relative tendons attaching onto the humerus: the subscapularis, the supraspinatus, the infraspinatus, and the teres minor. The long head of the biceps tendon (LHBT) is located in the humeral groove, stabilized by the subscapularis tendon. The subacromial-subdeltoid (SASD) bursa is a large synovial space that lies between the coracoacromial arch and the supraspinatus tendon
The rotator cuff is composed of four muscles with relative tendons attaching onto the humerus: the subscapularis, the supraspinatus, the infraspinatus, and the teres minor. The long head of the biceps tendon (LHBT) is located in the humeral groove, stabilized by the subscapularis tendon. The subacromial-subdeltoid (SASD) bursa is a large synovial space that lies between the coracoacromial arch and the supraspinatus tendon

Fig. 2.

Full-thickness rupture of the LHBT. Transverse short axis ( A ) over the bicipital groove shows anechoic effusion and hemorrhage in the synovial sheath (arrow). Sagittal long axis ( B ) shows large effusion with a thicker sheath wall (arrow). No tendon fibers are recognized at these points, with the muscle belly and the distal stump being retracted inferiorly
Full-thickness rupture of the LHBT. Transverse short axis ( A ) over the bicipital groove shows anechoic effusion and hemorrhage in the synovial sheath (arrow). Sagittal long axis ( B ) shows large effusion with a thicker sheath wall (arrow). No tendon fibers are recognized at these points, with the muscle belly and the distal stump being retracted inferiorly

Fig. 3.

Partial-thickness supraspinatus tear of the articular surface (white arrows) on the short ( A ) and long ( B ) axis, and of the bursal surface (yellow arrows) on the short ( C ) and long ( D ) axis. The tear is displayed as a hypoechoic area with loss of normal fibrillar pattern, involving only one side of the tendon. Star: humeral head. Asterisk: greater tuberculum at the supraspinatus footprint
Partial-thickness supraspinatus tear of the articular surface (white arrows) on the short ( A ) and long ( B ) axis, and of the bursal surface (yellow arrows) on the short ( C ) and long ( D ) axis. The tear is displayed as a hypoechoic area with loss of normal fibrillar pattern, involving only one side of the tendon. Star: humeral head. Asterisk: greater tuberculum at the supraspinatus footprint

Fig. 4.

Full-thickness tear of supraspinatus insertional fibers (arrow) with fiber retraction (dashed arrow). Star: humeral head. Asterisk: greater tuberculum at the supraspinatus footprint
Full-thickness tear of supraspinatus insertional fibers (arrow) with fiber retraction (dashed arrow). Star: humeral head. Asterisk: greater tuberculum at the supraspinatus footprint

Fig. 5.

Cartilage interface sign. This represents a curvilinear hyperechoic line that courses parallel to the hypoechoic hyaline cartilage of the humeral head (yellow arrow), located at the interface between the hyaline cartilage and the abnormal hypoechoic tendon. It is a result of increased US transmission due to changes in acoustic impedance in cases of articular surface–sided tendon disease, being more pronounced in cases of full-thickness RC tears. White arrow: full-thickness supraspinatus tear. Star: humeral head. Asterisk: greater tuberculum at the supraspinatus footprint
Cartilage interface sign. This represents a curvilinear hyperechoic line that courses parallel to the hypoechoic hyaline cartilage of the humeral head (yellow arrow), located at the interface between the hyaline cartilage and the abnormal hypoechoic tendon. It is a result of increased US transmission due to changes in acoustic impedance in cases of articular surface–sided tendon disease, being more pronounced in cases of full-thickness RC tears. White arrow: full-thickness supraspinatus tear. Star: humeral head. Asterisk: greater tuberculum at the supraspinatus footprint

Fig. 6.

Small pre-insertional intratendinous calcification of the supraspinatus, with acoustic shadowing. Asterisk: footprint of the supraspinatus at the greater tuberosity
Small pre-insertional intratendinous calcification of the supraspinatus, with acoustic shadowing. Asterisk: footprint of the supraspinatus at the greater tuberosity

Fig. 7.

Long-standing full-thickness supraspinatus tear with a degenerative change of the shoulder and inferior acromioclavicular (AC) joint capsule disruption. Fluid erupts superiorly from the SASD bursa and the glenohumeral joint through the AC interval (white arrow), forming a supraclavicular collection known as the geyser sign (yellow arrows). Star: AC joint
Long-standing full-thickness supraspinatus tear with a degenerative change of the shoulder and inferior acromioclavicular (AC) joint capsule disruption. Fluid erupts superiorly from the SASD bursa and the glenohumeral joint through the AC interval (white arrow), forming a supraclavicular collection known as the geyser sign (yellow arrows). Star: AC joint

Fig. 8.

Partial dislocation of the AC joint after trauma. US shows widening of the articular space (asterisk) with capsule distension and effusion (arrow). The contralateral normal joint is displayed in the right inferior corner
Partial dislocation of the AC joint after trauma. US shows widening of the articular space (asterisk) with capsule distension and effusion (arrow). The contralateral normal joint is displayed in the right inferior corner

Fig. 9.

Subcoracoid impingement. A synovial hypertrophic nodule (white arrow) and the coracoid (asterisk) determine impaired sliding of the subscapularis (yellow arrow) during dynamic internal rotation on US scan. A. initial internal rotation. The belly of the suprascapularis is compressed passing under the coracoid. B. with rotation progression, the belly snaps and passes under the coracoid. Star: lesser tuberosity of the humeral head
Subcoracoid impingement. A synovial hypertrophic nodule (white arrow) and the coracoid (asterisk) determine impaired sliding of the subscapularis (yellow arrow) during dynamic internal rotation on US scan. A. initial internal rotation. The belly of the suprascapularis is compressed passing under the coracoid. B. with rotation progression, the belly snaps and passes under the coracoid. Star: lesser tuberosity of the humeral head

Fig. 10.

US paralabral cyst (arrows) at the SGN ( A ), confirmed with MRI arthrography ( B ). The cyst is located in close proximity to the suprascapular nerve, which may lead to progressive infraspinatus neurogenic muscle atrophy (not affected in this case)
US paralabral cyst (arrows) at the SGN ( A ), confirmed with MRI arthrography ( B ). The cyst is located in close proximity to the suprascapular nerve, which may lead to progressive infraspinatus neurogenic muscle atrophy (not affected in this case)
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