shoulder protocol

Question 1

Long head biceps- patient postition?

Answer 1

• patient rests hand pal ip on thigh

Question 2

how thick should a tendon be?

Answer 2

<5mm thick

Question 3

long head biceps protocol?

Answer 3

TRV:

• visulaize bicipital groove
• biceps tendon in groove

SAG:

• tendon should be uniform and fibrillar
• <5mm thick
• examine in TRV during internal/external rotation to ensure it doesn’t sublux medially

Question 4

subscapularis protocol?

Answer 4

TRV

• at bicipital groove
• externally rotate patients arm
• Subscapularis tendon visible inserting medial to groove
• It will be seen as an elongated slightly convex tendon

Question 5

supraspinatus (SSP) patient position?

Answer 5

• patient palm up with their elbow flexed and pulled back passed their side so their hand is near their hip

Question 6

supraspinatus (SSP) protocol?

Answer 6

• Identify the SSP tendon supero-lateral to the bicipital groove
• In a coronal plane, the tendon emerges from beneath the acromion to insert on the greater tuberosity of the humerus
• It should be uniform, fibrillar & ‘beak shaped’ (convex superiorly)

Question 7

infraspinatus patient position?

Answer 7

• patient places their affected hand across their chest towards the contralateral shoulder

Question 8

Infraspinatus protocol?

Answer 8

• The ISP can be seen by placing the probe immediately inferior to the spine of the scapula and following the tendon to it’s insertion postero-laterally on the humeral head
• It will have a similar appearance to subscapularis.

Question 9

Dynamic assessment of the biceps?

Answer 9

• assess stability within the bicipital groove during external rotation

Question 10

Dynamic assessment subscapularis?

Answer 10

• assess for any overlying subdeltoid bursal bunching against coracoid during internal rotation

Question 11

Dynamic assessment supraspinatus?

Answer 11

• assess for bunching of the tendon and overlying subacromial bursa against the acromion or coraco-acromial igament during abduction
• ensure patient does not hunch their shoulder or lean towards the contralateral side during abduction

Question 12

Dynamic assessment posterior joint recess?

Answer 12

• during internal/external rotation, assess for glenohumeral joint effusion
• most evident during external rotation

Question 13

Dynamic assessment acromio-clavicular joint?

Answer 13

• during forward flexion with internal rotation look for boney contact or ganglia of the ACJ