Common Shoulder Pathologies - BMUS · Alam, A & Shrestha, M (2011) A Comparative Evaluation of...

Common Shoulder Pathologies

Normal tendons

Tears

Tendinopathy aka Tendinosis

Bursitis

Bicipital Tenosynovitis

Subacromial Impingement

Other…

https://media1.britannica.com/eb-media/88/182388-004-41CAA735.jpg

http://journal.frontiersin.org/article/10.3389/fbioe.2014.00077/full

http://www.ultrasoundcases.info/Test-Yourself-Case.aspx?test=6500&cat=322&group=68&page=52&show=1

http://www.ultrasoundcases.info/Test-Yourself-Case.aspx?test=6500&cat=322&group=68&page=52&show=1

Median Nerve

Warning! Beware of the subscapularis

https://essr.org/content-essr/uploads/2016/10/shoulder.pdf

Classification:

Partial thickness – involving some of the tendon

Full thickness – basically a hole in part of the tendon; spanning the full depth of the tendon, but does not involve the entire width of the tendon

Complete – involving the entire tendon

Humerus

LS Supraspinatus Tendon Bursal

https://www.google.co.uk/search?q=longitudinal+supraspinatus+tendon&tbm=isch&imgil=__A9l_cpoDqUdM%253A%253B7zYwxZMjap4nTM%253Bhttp%25253A%25252F%25252Fwww.med.umich.edu%25252Fradiology%25252Fmskus%25252Fimages%25252F190%25252F190_sst.html&source=iu&pf=m&fir=__A9l_cpoDqUdM%253A%252C7zYwxZMjap4nTM%252C_&usg=__wvwCYP_X59dhylsQ_X7ZhNkFOF8%3D&biw=1280&bih=623&ved=0ahUKEwim5YnLloPTAhVjFMAKHRvvDM0QyjcIKA&ei=_ZHfWObyHuOogAab3rPoD

A#tbm=isch&q=longitudinal+supraspinatus+tendon+partial+thickness+tear&*&imgrc=MLoVp0grU8c_8M:&spf=558

Humerus

LS Supraspinatus Tendon Articular

http://ultrasoundcases.info/Slide-View.aspx?cat=581&case=6443

Cartilage

Tear

Humerus

LS Supraspinatus Tendon Intratendinous

http://ultrasoundcases.info/Slide-View.aspx?cat=582&case=5120

Humerus

LS Supraspinatus Tendon

http://ultrasoundcases.info/Slide-View.aspx?cat=338&case=7771

Full Thickness

Humerus

LS Supraspinatus Tendon

http://ultrasoundcases.info/Slide-View.aspx?cat=339&case=5406

Complete

http://www.ultrasoundcases.info/Slide-View.aspx?cat=323&case=5012

http://www.med.umich.edu/radiology/mskus/images/190/190_sst.html

Normal

Abnormal

http://321gomd.com/wp-content/uploads/2012/05/biceps-SLAP-Tear.png

Internal tendon degeneration;

An imbalance between tendon break down and repair

In some cases calcium deposits form in damaged tendons, leading to; calcific tendinopathy

http://ultrasoundcases.info/Slide-View.aspx?cat=335&case=6746

22yr old volley ball player

http://ultrasoundcases.info/Slide-View.aspx?cat=336&case=127

Normal

http://ultrasoundcases.info/Slide-View.aspx?cat=327&

http://www.med.umich.edu/radiology/mskus/images/190/190_sst.html

http://www.ultrasoundcases.info/Test-Yourself-Case.aspx?test=7521&cat=322&group=68&page=44&show=1

http://mskultrasoundprocedures.com/Procedures/ShoulderArthrogram.html

http://www.clinicalimagingscience.org/article.asp?issn=2156-7514;year=2012;volume=2;issue=1;spage=38;epage=38;aulast=Gaitini

Normal

Abnormal

http://emedicine.medscape.com/article/401595-overview

When the subacromial structures are compressed between the acromion and humerus during elevation of the arm;

Structural

Functional (Strijcher, D (?) [ONLINE])

http://www.southamptonshoulderclinic.co.uk/shoulder-problems/subacromial-impingement/

https://www.youtube.com/watch?v=w47flKxXD3o

https://essr.org/content-essr/uploads/2016/10/shoulder.pdf

https://www.studyblue.com/notes/note/n/kevin-notes/deck/16293985

http://www.slredultrasound.com/ImageBank/Skeletal.html https://books.google.co.uk/books?id=HnOKCwAAQBAJ&pg=RA4-

PA49&lpg=RA4-PA49&dq=ultrasound+pathological+fracture+humerus&source=bl&ots=CRPHhGhpEN&sig=zlAy9k6IUhNXli6i7fPhP6ehwhc&hl=en&sa=X&ved=0ahUKEwjfqfSCh9bTAhVGORoKHb4LDx0Q6AEIVTAM#v=onepage&q=ultraso

und%20pathological%20fracture%20humerus&f=false

http://ultrasoundcases.info/Slide-View.aspx?cat=451&case=5119

The prevalence of non-symptomatic rotator cuff pathology in the general population varies

Incidence increases with age (Girsh et al, 2011)

Buchbinder et al (2011): 32.24% of 2553 cadavers had a full thickness

rotator cuff tear

It is therefore imperative that ultrasound findings are correlated with the clinical findings and patient history to avoid the over exaggeration of ‘normal for age findings’ which do not require treatment (Girsh

et al, 2011)

Option of comparing with the non

symptomatic side…..

Any Questions?

Alam, A & Shrestha, M (2011) A Comparative Evaluation of Rotator Cuff Injuries of the Shoulder joint Using High Resolution Ultrasound and Magnetic Resonance Imaging. Medical Journal of Shree Birendra Hospital,10(1). June 2011. Pgs 9-14

Al-Ani, Z et al. (2016) Scientific Poster: “The Forgotten Rotator cuff Tendon” – Subscapularis Under the Spotlight. ESSR: www.essr.org. Available: http://webcache.googleusercontent.com/search?q=cache:6G3-Qm9za_UJ:pdf.posterng.netkey.at/download/index.php%3Fmodule%3Dget_pdf_by_id%26poster_id%3D135485+&cd=2&hl=en&ct=clnk&gl=uk

Beggs, I (2011) Shoulder Ultrasound. Seminars in Ultrasound, CT and MRI, 32(2). April 2011. Pgs 101-113

Buchbinder, L et al (2011) Magnetic Resonance Imaging Versus Ultrasonography for Assessing Rotator Cuff Tears in Patients with Shoulder Pain for Whom Surgery is Being Considered (Protocol). The Cochrane Library, 3. Pgs 1-13

Buchbinder, L et al (2011) Magnetic Resonance Imaging Versus Ultrasonography for Assessing Rotator Cuff Tears in Patients with Shoulder Pain for Whom Surgery is Being

Considered (Protocol). The Cochrane Library, 3. Pgs 1-13 Fotiadou, A et al (2008) Ultrasonography of Symptomatic Rotator Cuff Tears

Compared with MR Imaging and Surgery. European Journal of Radiology, 68. Pgs 174-179

Girsh et al,(2011) Ultrasound of the Shoulder: Asymptomatic Findings in Men. American Journal of Roentgenology, 197(4). May 2011. Pgs 713-718

Jacobson, J (2007) Fundamentals of Musculoskeltal Ultrasound. Elsvier Saunder: Philadelphia

Ottenheijm, R et al, (2010) Accuracy of Diagnostic Ultrasound in Patients with Suspected Subacromial Disorders: A Systematic Review and Meta-Analysis. Archives of Physical Medicine and Rehabilitation, 91(10). October 2010. Pgs 1616-1625

Replicel™ (2013) Tendons & Tendinosis [online] Available: http://www.replicel.com/tendon-repair/tendons-tendinosis/

Strijcher, D (?) Subacromial Impingement [ONLINE] Available : http://www.physio-pedia.com/Subacromial_Impingement