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Ultrasound of

Shoulder Anatomy

J. Antonio Bouffard, MDDept. of Orthopaedic Surgery & Sports Medicine

Detroit Medical Center

39th Annual Conference

May 14 - 16, 2019

Topography U/S Anatomy

Shoulder Ultrasound

Linear-Array (7.5 MHz) Curved Linear-Array (5 MHz)

Linear Array – 7.5 MHz Curved Linear – 5 MHz

Transducers

• Anterior

• Superior

• Lateral (Anterior)

• Posterior

Four Shoulder Regions

• Anterior

• Superior

• AnteroLateral

• Posterior

Shoulder Regions

• Anterior

• Superior

• AnteroLateral

• Posterior

Shoulder Regions

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• Anterior

• Superior

• AnteroLateral

• Posterior

Shoulder Regions

• Anterior

• Superior

• AnteroLateral

• Posterior

Shoulder Regions

• Anterior

• Superior

• AnteroLateral

• Posterior

Shoulder Anatomy Shoulder Osteology

Dzung Vu, MD

NSWU, 2002

Anterior Shoulder Long Bicipital & Subscapularis

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Anterior Structures Superior Shoulder

AnteroLateral Shoulder

The Skeleton of the

Posterior Shoulder

Posterior Osteology

Glenoid Labrum

Posterior Shoulder

Suprascapular

Nerve

Posterior Shoulder

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Suprascapular

Artery

Posterior Shoulder

Teres Minor

Posterior Shoulder

Supraspinatus

Posterior Shoulder

Infraspinatus

Posterior Shoulder

Deltoid

Posterior Shoulder

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Shoulder Technique Long Axis & Short Axis

Long Axis

Short Axis

Short Axis

Long Axis Short Axis

Orthogonal Planes

Short Axis Long Axis

• Anterior

• Superior

• AnteroLateral

• Posterior

Normal Shoulder Ultrasound Long Bicipital Tendon

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Outlet Portion Distal Portion

Outlet Portion: Long Axis Musculotendinous Junction

Pectoralis Major Tendon Long Bicipital Tendon: Short-Axis

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Anisotropy Artifact

Toggle

Maneuver

“Heel - Toe” Maneuver

Subscapularis

PROBE

Rest Ext Rotation

Subscapularis: Dynamic Maneuver

Subscapularis:short axis view

Acromioclavicular Joint

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• Anterior

• Superior

• AnteroLateral

• Posterior

Normal Shoulder Ultrasound Supraspinatus

Hyperextension

Internal Rotation

Supraspinatus

Supraspinatus – Short Axis

Acromial Level

Tuberosity Level

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“Jeffrey Crass MD” “William Middleton MD”

Rotator Cuff Interval

• Anterior

• Superior

• AnteroLateral

• Posterior

Normal Shoulder Ultrasound

• Anterior

• Superior

• AnteroLateral

• Posterior

Normal Posterior Shoulder

Ball & Socket Maneuver

External & Internal Rotation Glenohumeral Joint

Internal-External Rotation

Spinoglenoid GrooveLong Axis

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Subacromial Impingement

• Topographical Spots

• Bony Acoustic Landmarks

• Shoulder Anatomy

• Routine Protocol: Dynamic

Conclusions