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MSK ultrasound > Shoulder Anatomy and Pathology > Flashcards

Shoulder Anatomy and Pathology Flashcards

1
Q

What is the most common joint evaluated on sonography?

A

Shoulder

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2
Q

What is the most common cause of rotator cuff injuries in people under age 40?

A

Trauma

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3
Q

What are the two joints called on either end of the clavicle?

A

SC joint - sternoclavicular

AC joint - acromioclavicular

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4
Q

What is the posterior projection that gives rise to the acromion process, which articulates with the clavicle at the AC joint?

A

Scapular spine

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5
Q

The coracoid process is the attachment site for what two muscles?

A

Biceps short head and pectorlalis

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6
Q

What type of cartilage covers the humeral head?

A

Articular

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7
Q

The humeral head contains the greater and lesser tuberosities. Where do these tuberosities lie on the humerus? (ex. medial, lateral, anterior, posterior)

A

Greater - lies lateral
Lesser - lies anterior

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8
Q

What rotator cuff tendon inserts on the lesser tuberosity?

A

Subscapularis - on the anterior portion of the scapula

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9
Q

What is the most frequently injured tendon of the shoulder? Why?

A

Supraspinatus, because it runs underneath the AC joint and over the humeral head

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10
Q

What facets of the greater tuberosity does the supraspinatus insert into?

A

The superior facet and anterior portion of middle facet

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11
Q

What facet of the greater tuberosity does the infraspinatus insert into?

A

Middle facet

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12
Q

What facet of the greater tuberosity does the Teres minor insert into?

A

Inferior facet

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13
Q

Which biceps head tendon are we imaging and which runs through the bicipital groove?

A

The long head - is more lateral

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14
Q

Where does the long head biceps brachii tendon originate and where does the short head originate?

A

Long head - superior glenoid labrum

Short head - coracoid process

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15
Q

The biceps tendon is held in the bicipital groove by which two ligaments?

A
  1. Coracohumeral ligament
  2. Transverse ligament
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16
Q

In SAX of the biceps tendon, how do we avoid anisotropy? (hint: what transducer movement do we use)

A

Angle cranially/cephalad

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17
Q

In LAX of the biceps tendon, how do we avoid anisotropy? (hint: what transducer movement do we use)

A

Heel the probe

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18
Q

The AC joint is evaluated for fluid in the case of a tear in what tendon?

A

Supraspinatus

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19
Q

What type of tissue makes up the glenoid labrum?

A

Fibrocartilage

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20
Q

What are the two main bursae in the shoulder?

A
  1. Subcoracoid bursa - anterior to the subscapularis
  2. SASD bursa - main bursae of the shoulder and largest in the body
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21
Q

How thick is the bursae typically?

A

1.5mm

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22
Q

Where are degenerative tears most common in patients older than 40?

A

Posterior aspect of supraspinatus

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23
Q

What is the most common cause of shoulder pain?

A

Tendinosis

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24
Q

What are the 3 types of partial thickness tears?

A
  1. Bursal sided - “flat tire appearance” in SS
  2. Interstitial or intra-substance
  3. Articular sided - the most common
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25
Q

What are 2 indirect signs of a tear?

A
  1. cortical irregularity of the supraspinatus (superior/middle facet)
  2. Volume loss
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26
Q

What is the “critical zone” where tears often begin in the Supraspinatus?

A

In the ANTEROLATERAL supra tendon, 1cm from insertion on greater tuberosity

27
Q

How can you confirm if a tear is anterior or posterior in the supraspinatus?

A

Follow SS to the insertion point and view the apex and facets. The anterior SS inserts on the superior facet (double bump) while the posterior SS inserts on the middle facet (more flattened)

28
Q

What are two secondary indicators to confirm a tear?

A
  1. Diffuse thickening
  2. Bone irregularities
29
Q

Supraspinatus partial-thickness tears usually involve which side? (bursal, interstitial, or articular).

A

Articular

30
Q

Articular surface tears typically have what presentation?

A

Fluid in bicep tendon

31
Q

How do you measure partial thickness tears?

A

Length and width. Determine if the thickness is greater than 50% of the tendon from articular and bursal.

32
Q

What is the most common location for anisotropy and therefore error in diagnosis tears? (hint: what tendon and what side: bursal, articular, interstitial).

A

Supraspinatus - articular surface

33
Q

What pathology describes the “flattened tire” appearance? (hint: what tendon and what side: bursal, articular, interstitial).

A

Supraspinatus - bursal side

34
Q

How do you know if the supraspinatus is gone (full width tear)?

A

Measure from the IS to the biceps tendon, if it is about 2cm, the SS is gone

35
Q

In order, what are the most common tears?

A
  1. Supraspinatus
  2. Infraspinatus
  3. Subscapularis
  4. Teres minor
36
Q

What is the appearance of a muscle when that tendon has a full thickness tear?

A

Fatty infiltration (echogenic) and atrophy

37
Q

What is the “naked tuberosity” sign of supraspinatus? - slide 25

A

When the deltoid muscle is in direct contact with the humeral head

38
Q

What is the “double effusion” sign of supraspinatus?

A

Fluid in the SASD bursae and biceps tendon sheath

39
Q

When comparing the teres minor and infraspinatus muscle, what should we look for? (hint: muscle size and appearance)

A
  • Infra should be 2x size of TM (normal)
  • Hyperechoic and atrophy (abnormal)
40
Q

What is the bony landmark in the “sunglasses” view of the IS and TM?

A

Scapular ridge

41
Q

When is cortical irregularity important vs. not important?

A

When there is irregularity of the GREATER tuberosity = significant

Irregularity of the lesser tuberosity is NOT significant

42
Q

What is the most common tendon abnormality?

A

Tendinosis

43
Q

What are the main SF of tendinosis?

A

Hypoechoic, ill-defined, thickened, slightly vascular (neovascularity), heterogenous, possible calcifications

44
Q

Calcifications can appear in what three forms and Sonographic appearances?

A
  1. Liquid - hyperechoic with no shadow
  2. Pastes - vague shadow
  3. Solid - distinct posterior shadowing
45
Q

Describe appearances of degenerative, formative, and resorptive calcifications. Note: formative and resorptive are due to calcific tendinosis

A
  1. Degenerative - linear thin echo
  2. Formative - has a distinct shadow
  3. Resorptive - Globular, variable shadow and is PAINFUL
46
Q

What are the two phases of calcific tendinosis?

A

Formative - defined calcification with a distinct shadow

Resorptive - globular with a variable shadow (IS PAINFUL)

47
Q

Differences between a tear vs. tendinosis?

A

Tear - anechoic to hypoechoic, homogenous, thinned tendon, well-defined, bone-irregularity

Tendinosis - hypoechoic, heterogenous, thickened, swollen, ill-defined, smooth bone contour, neovascularity

48
Q

What are the 4 secondary findings of rotator cuff tears?

A
  1. Cortical irregularity of greater tuberosity
  2. Cartilage interface sign
  3. Volume loss of tendon
  4. Effusion - fluid in SASD bursae and biceps tendon
49
Q

What is sub-acromial impingement syndrome and how do we check for it with ultrasound? (slide 39)

A

When the rotator cuff and/or SASD bursae is compressed by the coraco-acromial arch. To check, place the transducer coronally at end of acromion, ask patient to ABDUCT arm 80-100 degrees, and if humerus does not move inferiorly as it’s supposed to and it moves superiorly, its impinged.

50
Q

Subscap tears are usually due to a massive tear and very rarely isolated. What part of the subscap is most commonly affected?

A) Anteroinferior
B) Anterosuperior
C) Posteroinferior
D) Posterosuperior

A

B) Anterosuperior

51
Q

Glenohumeral joint effusions are located around what tendon? hint: think of the anatomy of where each tendon inserts

A

Biceps tendon

51
Q

If effusion around a tendon is suspected, what measurement is abnormal of the pocket surrounding tendon?

A

> 1mm

51
Q

Where in the biceps tendon do tears and tendinosis typically occur?

A

Proximally, where the tendon traverses over the humerus

51
Q

What SF do we look for when a pseudo-biceps tendon is suspected?

A
  1. Retracted tendon distally
  2. Bicep muscle atrophy (long head) and fatty infiltration
52
Q

What is the most common dislocation of the biceps tendon?

A

Medially and deep to subscap, out of the bicipital groove

53
Q

SF of bursitis?

A

Anterior to the biceps tendon, teardrop shaped, blind-ending, not connected to biceps tendon

54
Q

What is the term for ‘Frozen Shoulder’ ?

A

Adhesive capsulitis

55
Q

What 3 causes are associated with Frozen shoulder?

A
  1. Diabetes
  2. Trauma
  3. Immobilization
56
Q

What is geyser or “volcano” sign?

A

When there is fluid tracking through AC joint, due to a full-thickness rotator cuff tear

57
Q

What are the degrees of which sub-acromial impingement syndrome occurs?

A

80-100 degrees - presents with lateral shoulder pain

58
Q

What does the “Popeye” sign indicate in the bicep?

A

Full rupture of the biceps tendon - the biceps muscle will appear bulged/enlarged

59
Q

What type of tear typically present w/ fluid in the biceps tendon sheath?

A

Articular surface partial thickness

60
Q

A large amount of fluid in the SASD bursae is associated with what pathology?

A

FULL THICKNESS tear

61
Q

Atrophy of which muscle is most important in predicting cuff failure AFTER surgical repair?

A

Infraspinatus

MSK ultrasound (9 decks)

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