Shoulder RMSK Flashcards
1
Q
Subscapularis inserts to
A
Lesser tuberosity
2
Q
Supraspinatus insertion
A
Greater tuberosity, superior and middle facet
3
Q
Supraspinatus footprint
A
2.25cm A-P - may insert some into lesser tuberosity
4
Q
Infraspinatus Insertion
A
Middle Facet of greater tuberosity overlapping posterior of Supraspin
5
Q
Teres Minor Insertion
A
INFERIOR FACET of GREATER tuberosity
6
Q
Intraarticular part of biceps is stabilized by
A
BICEPS Reflection Pulley
7
Q
What comprises the biceps reflection pulley?
A
SGHL and CHL
8
Q
GH joint and biceps long head tendon sheath are connected
A
are connected so joint and biceps are connected
9
Q
Other joint recess of shoulder?
A
Axillary and subscapularis recess, subcoracoid bursa
10
Q
Location of subscapularis recess?
A
medial to the rotator interval and inferior to coracoid process
11
Q
Location of subcoracoid bursa? and relationship to GH joint
A
Anterior to subscapularis and not connected to GH-Joint
12
Q
Frequently missed in shoulder checklist
A
biceps tendon dislocation, AC dynamic, teres minor, infraspinatus atrophy
13
Q
Why scan up to pectoralis tendon area
A
biceps may retract to this area
14
Q
Shape of lesser tuberosity
A
pyramid shape
15
Q
Shoulder in neutral and evaluation of supraspinatus shows what
A
only the Distal insertion but proximal pathology will be missed
16
Q
Crass position shows limited view of
A
Rotator interval
17
Q
Infraspinatus tendon appearance and location
A
middle facet striations are present
18
Q
Articular surface of humerus shape and echogenicity
A
usually round and hypoechoic articularly
19
Q
Subacromial impingement test bunching ( what plane during scan?)
A
subacromial impingement but may be asymptomatic ( coronal oblique)
20
Q
subacromial impingement test incomplete glide
A
adhesive capsulitis
21
Q
Indirect signs of supraspinatus tear
A
cortical irregularity, tendon thinning, volume loss, joint effusion, cartilage interface sign
22
Q
Bony landmark for scapular spine
A
osseous ridge of posterior scapula demarcating supra infra and teres minor
23
Q
Shoulder external rotation shows paralabral cyst look alike
A
actually DILATION of suprascapular vein but collapses on internal rotation
24
Q
Infraspinatus teres minor ratio
A
Infraspinatus 2x size of teres minor over scapular body..
25
Supraspinatus acute tears location?
proximally and may or may not have cortical irregularity
26
Chronic supraspinatus tears cause and location?
attrition, superimposed injury, occur DISTALLY, usually with cortical irregularity
27
Locations of supraspinatus tears
Bursal, articular, greater tuberosity surface
28
Tear If only at greater tuberosity what is it called
intrasubstance or concealed interstitial delamination tear -- not visible at arthroscopy or bursocopy
29
Define a full thickness tear of supraspinatus
articular to bursal extension
30
Types of full thickness tear
focal/incomplete or if involves entire tendon. complete or full width tear
31
Large supraspiatus tear appearance?
tendon retraction,
volume loss of tendon
, loss of normal superior convex shape
32
Sequelae for full thickness tears located anteriorly
retraction, atrophy, PROPAGATION overtime
RAP
33
Partial thickness tear description
well defined hypoechoic or anechoic abnormality disrupting tendon fibers
34
appearance of a tendon stump
mixer hyperechoic-hypoechoic appearance.. hypo is fluid hyper is torn tendon
35
Chronic attrition results to ?
cortical irregularity adjacent to tendon tear
36
cartilage interface sign
hyperechoic interface between the tendon tear and the hyaline cartilage
37
what is a rim rent tear?
also called a PASTA lesion. partial articular side supraspin tendon avulsion.. it is a far distal articular side partial thickness tear beside greater tuberosity surface
38
Bursal surface tear appearance
tendon thinning and volume loss usually present
39
well defined anechoic cyst in rotator cuff associated with
supraspinatus articular side tear
40
Chronic tears sequelae
remodeling of greater tuberosity and tapering of distal torn tendon without adjacent fluid but may have synovial hypertrophy
41
How to determine if supraspinatus tear includes infraspinatus
short axis over greater tuberosity, if it extends to posterior aspect of middle facet! includes infraspin already
42
Poor outcomes of rotator cuff repair
Fatty infiltration, muscle atrophy
43
Focal tendinosis apperance
heterogeneous ill defined hypoechoic area
44
Diffuse tendinosis
entire tendon hypoechoic
45
Cortical irregularity on posterior humerus at bare area
NORMAL if not extensive
46
cortical irregularity of lesser tuberosity insertion of subscap
Normal
47
Simple joint and bursal fluid echogenicity
anechoic
48
Complex fluid appearance
hyper or even isoechoic to adjacent tissue
49
SASD bursa fluid parameter
1-2mm anechoic
50
signs of posterosuperior impingement syndrome
posterosuperior labral tear,
cortical irregularity of posterior aspect of greater tuberosity
partial thickness infraspinatus
51
isolated infraspinatus atrophy can occur from what non neurologic pathology
from just a supraspin tear in can happen from altered biomechanics
52
spinoglenoid notch paralabral cyst
isolated to infraspinatus
53
paralabral cyst from labral tear affecting
supraspscapular notch
54
fatty degeneration and atrophy appearance on msk
increased echogenicity of muscle and poor differentiation bet. muscle and tendon
55
fatty degeneration and atrophy appearance on msk best seen where
at myotendinous junction at short axis
56
bony landmark for infraspin and teres minor for atrophy
posterior scapular cortex
57
Types of tendon calcification and explain
Degenerative and hydroxyappetite
58
Stages of calcification
pre-calcific (tendon metaplasia) , calcific (((Formative, resting, resorptive))) , post-calcific (fibrotic scar)
59
which stage causes pain?
calcific- resorptive
60
IS there a tear usually in calcific tendinosis?
no tears
61
Most commonly affected in calcific tendinosis ?
supraspin --> infraspin --> subscap
62
Different appearances of calcifications
amorphous, globular,
63
do all calcifications have shadowing?
NO
64
How to determine amorphous
replaces normal fibrilar tendon and can be seen with angulations
65
Can calcifications cause impingement?
yes it can cause impingement of acromion
66
Amorphous without shadow temporal relationship
ACUTE
67
well defined with shadowing
subacute or chronic
68
doppler findings indicate in calcific tendinosis
higher chance of resorptive phase
69
what consists the coracoacromial arch?
acromion, distal clavicule, AC JT, coracoid process, coracoacromial ligament
70
Other findings of subacromial impingement?
gradual distention of SASD bursa with synovial tissue or abrupt movement of a thickened bursa , superior bulging of coracoacromial ligament seen on SAX of sspn
71
Late stage of subacromial impingement?
abnormal upward migration of humeral head
72
Coracoid impingement syndrome?
subscap tendon and SASD between coracoid process and lesser tuberosity impinged, anterior aspect of SASD distention
73
Adhesive capsulitis PE?
Limited ER during subscap eval & limited supraspin sliding under aromion
74
Location of sspin tear in younger individuals?
anterior, near Rotator interval
75
How to ensure full visualization of supraspin in lax and sad
in sax reach rotator interval, in lax visualize biceps tendon near Rotator interval
76
Rotator Interval and biceps locati
intraarticular part of LHBT
77
SGHL location?
subscapularis side
78
SASD distention misinterpretation
Bursal thickness tears or full thickness tears may display thickened bursa so watch out it may mimic a tendon
check fluid if anechoic or if it has complex fluid ( synovial hypertrophy or isoechoic)..
79
Rim rent tear appearance?
well defined hypoechoic or anechoic abnormality at location of articular end adjacent to greater tuberosity
80
What do you call a tear only with greater tuberosity
intra-substance tear and cannot be seen in arthroscopy
81
characteristics of a tendon tear
anechoic, well defined, thin, homogenous, bone irregularity
82
characteristics of tendinosis
hypoechoic, ill defined, heterogeneous, increased thickness and SMOOTH cortex ( only for >40 yrs old )
83
cortical irregularity important finding in patients over 40
shows adjacent cortical irregularity and supraspinatus abnormality.
84
What is the bare area
posterior humerus beneath infraspin is devoid of cartilage... can have normal irregularities but if EXCESS consider labral injury and artial thickness infraspin tear.. if both are present ( posterosuperior impingement syndrome)
85
Synovial hypertrophy findings?
flow on color or power doppler and lack of internal movement
86
Complex fluid finding
internal movement artifacts, isoechoic, to hyperechoic
87
2mm in bicipital tendon sheath is equal to
8ml of effusion
88
differentiate gh joint effusion from biceps tenosynovitis
tendon sheath distention is focal and hyperemia,,, with pain on transducer pressure consider tenosynovitis, fluid that remains focal or loculated at level of bicipital groove with palpation also indicated tenosynovitis
89
gh joint distention at biceps features
long asymptomatic distention usually from joint recess....(gh joint or subscap)
90
PPV of biceps effusion and sasd effusion for rotator tears
60% and 95% for sasd bursal fluid
91
Watchout for refraction shadow of deltoid fascia
may appear as tendinosis
92
Location of biceps tendon pathology
usually within 3.5cm of origin... proximal to or at the bicipital groove
93
Indirect signs of biceps instability
chonrdal print sign, showing subchondral bone cortex irregularity adjacent to biceps
94
relationship between subluxation and dislocation with tears
usually associated with partial tear
95
Where can we see distention of SASD
laterally - over supraspin, anteriorly- over subscap and biceps, post over infraspin
96
echogenicity of distended bursa and interpretation
anechoic/ hypoechoic - simple fluid….
| Hyperechoic or hypoechoic - complex fluid or synovial hypertrophy
97
power doppler on SASD suggests
synovial hypertrophy
98
Causes of SASD bursal distention
impingement, tear, hemorrhage, AMYLOIDOSIS, infection, RA, calcium hydroxyapatite, synovial proliferative disorders
99
clues for gas-forming infection
hyperechoic foci with ring -down artifact
100
apperance of a normal glenoid labrum
hyperechoic, triangular attached to bony glenoid
101
degenerated labrum appearance
heterogeneous hypoechonecity
102
Glenoid tear appearance
well defined hypoechoic or anechoic cleft
103
Accuracy of posterior labrum ultrasound
88 % for abnormal - normal ? 98% differentiating posterior labral tear from normal or degeneration
104
How to assess superior labrum
LAX supraspin between clavicle and scapular spine,
105
paralabral cyst usual cause?
usually from a labral tear
106
suprascapular nerve entrapment affects which muscle
depends on location… if spinoglenoid area- infraspin only… If suprascapular fossa both IS and SS
107
greater tuberosity fracture
step off deformity, log segment cortical step off and discontinuity at the margins and point tenderness
108
Anatomic landmarks for pectoralis major
deltoid, biceps brachii tendon, coracobrachialis, sternal and clavicular head of pec major
109
Normal AC joint distention
3mm or less
110
DOA of AC joint is common at what age
40 yrs
111
axillary lymph node normal
oval, hypoechoic cortical rim, hyperechoic hilum, hilar pattern of vascularity if ever
112
malignant lymph node
peripheral vascularity… roundness, hilar thinning, absence of hilum, eccentric thickening of cortex
113
elastofibroma
tumor specific to shoulder, not true tumor,, caused by friction from chest wall and scapula.. Hyperechoic interspersed curvilinear hypoechoic strands, located at scapular tip deep to serratus anterior .
114
sternalis muscle
normal variant
115
nodule of xiphoid process
palpable mass
116
slipping rib syndrome
abnormal mobility of lower anterior rib end
