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Shoulder RMSK > Shoulder RMSK > Flashcards

Shoulder RMSK Flashcards

1
Q

Subscapularis inserts to

A

Lesser tuberosity

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2
Q

Supraspinatus insertion

A

Greater tuberosity, superior and middle facet

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3
Q

Supraspinatus footprint

A

2.25cm A-P - may insert some into lesser tuberosity

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4
Q

Infraspinatus Insertion

A

Middle Facet of greater tuberosity overlapping posterior of Supraspin

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5
Q

Teres Minor Insertion

A

INFERIOR FACET of GREATER tuberosity

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6
Q

Intraarticular part of biceps is stabilized by

A

BICEPS Reflection Pulley

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7
Q

What comprises the biceps reflection pulley?

A

SGHL and CHL

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8
Q

GH joint and biceps long head tendon sheath are connected

A

are connected so joint and biceps are connected

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9
Q

Other joint recess of shoulder?

A

Axillary and subscapularis recess, subcoracoid bursa

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10
Q

Location of subscapularis recess?

A

medial to the rotator interval and inferior to coracoid process

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11
Q

Location of subcoracoid bursa? and relationship to GH joint

A

Anterior to subscapularis and not connected to GH-Joint

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12
Q

Frequently missed in shoulder checklist

A

biceps tendon dislocation, AC dynamic, teres minor, infraspinatus atrophy

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13
Q

Why scan up to pectoralis tendon area

A

biceps may retract to this area

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14
Q

Shape of lesser tuberosity

A

pyramid shape

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15
Q

Shoulder in neutral and evaluation of supraspinatus shows what

A

only the Distal insertion but proximal pathology will be missed

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16
Q

Crass position shows limited view of

A

Rotator interval

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17
Q

Infraspinatus tendon appearance and location

A

middle facet striations are present

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18
Q

Articular surface of humerus shape and echogenicity

A

usually round and hypoechoic articularly

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19
Q

Subacromial impingement test bunching ( what plane during scan?)

A

subacromial impingement but may be asymptomatic ( coronal oblique)

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20
Q

subacromial impingement test incomplete glide

A

adhesive capsulitis

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21
Q

Indirect signs of supraspinatus tear

A 
cortical irregularity, 
tendon thinning, 
volume loss,
 joint effusion, 
cartilage interface sign
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22
Q

Bony landmark for scapular spine

A

osseous ridge of posterior scapula demarcating supra infra and teres minor

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23
Q

Shoulder external rotation shows paralabral cyst look alike

A

actually DILATION of suprascapular vein but collapses on internal rotation

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24
Q

Infraspinatus teres minor ratio

A

Infraspinatus 2x size of teres minor over scapular body..

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25
Q

Supraspinatus acute tears location?

A

proximally and may or may not have cortical irregularity

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26
Q

Chronic supraspinatus tears cause and location?

A

attrition, superimposed injury, occur DISTALLY, usually with cortical irregularity

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27
Q

Locations of supraspinatus tears

A

Bursal, articular, greater tuberosity surface

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28
Q

Tear If only at greater tuberosity what is it called

A

intrasubstance or concealed interstitial delamination tear – not visible at arthroscopy or bursocopy

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29
Q

Define a full thickness tear of supraspinatus

A

articular to bursal extension

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30
Q

Types of full thickness tear

A

focal/incomplete or if involves entire tendon. complete or full width tear

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31
Q

Large supraspiatus tear appearance?

A

tendon retraction,
volume loss of tendon
, loss of normal superior convex shape

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32
Q

Sequelae for full thickness tears located anteriorly

A

retraction, atrophy, PROPAGATION overtime

RAP

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33
Q

Partial thickness tear description

A

well defined hypoechoic or anechoic abnormality disrupting tendon fibers

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34
Q

appearance of a tendon stump

A

mixer hyperechoic-hypoechoic appearance.. hypo is fluid hyper is torn tendon

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35
Q

Chronic attrition results to ?

A

cortical irregularity adjacent to tendon tear

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36
Q

cartilage interface sign

A

hyperechoic interface between the tendon tear and the hyaline cartilage

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37
Q

what is a rim rent tear?

A

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

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38
Q

Bursal surface tear appearance

A

tendon thinning and volume loss usually present

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39
Q

well defined anechoic cyst in rotator cuff associated with

A

supraspinatus articular side tear

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40
Q

Chronic tears sequelae

A

remodeling of greater tuberosity and tapering of distal torn tendon without adjacent fluid but may have synovial hypertrophy

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41
Q

How to determine if supraspinatus tear includes infraspinatus

A

short axis over greater tuberosity, if it extends to posterior aspect of middle facet! includes infraspin already

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42
Q

Poor outcomes of rotator cuff repair

A

Fatty infiltration, muscle atrophy

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43
Q

Focal tendinosis apperance

A

heterogeneous ill defined hypoechoic area

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44
Q

Diffuse tendinosis

A

entire tendon hypoechoic

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45
Q

Cortical irregularity on posterior humerus at bare area

A

NORMAL if not extensive

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46
Q

cortical irregularity of lesser tuberosity insertion of subscap

A

Normal

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47
Q

Simple joint and bursal fluid echogenicity

A

anechoic

48
Q

Complex fluid appearance

A

hyper or even isoechoic to adjacent tissue

49
Q

SASD bursa fluid parameter

A

1-2mm anechoic

50
Q

signs of posterosuperior impingement syndrome

A

posterosuperior labral tear,
cortical irregularity of posterior aspect of greater tuberosity
partial thickness infraspinatus

51
Q

isolated infraspinatus atrophy can occur from what non neurologic pathology

A

from just a supraspin tear in can happen from altered biomechanics

52
Q

spinoglenoid notch paralabral cyst

A

isolated to infraspinatus

53
Q

paralabral cyst from labral tear affecting

A

supraspscapular notch

54
Q

fatty degeneration and atrophy appearance on msk

A

increased echogenicity of muscle and poor differentiation bet. muscle and tendon

55
Q

fatty degeneration and atrophy appearance on msk best seen where

A

at myotendinous junction at short axis

56
Q

bony landmark for infraspin and teres minor for atrophy

A

posterior scapular cortex

57
Q

Types of tendon calcification and explain

A

Degenerative and hydroxyappetite

58
Q

Stages of calcification

A

pre-calcific (tendon metaplasia) , calcific (((Formative, resting, resorptive))) , post-calcific (fibrotic scar)

59
Q

which stage causes pain?

A

calcific- resorptive

60
Q

IS there a tear usually in calcific tendinosis?

A

no tears

61
Q

Most commonly affected in calcific tendinosis ?

A

supraspin –> infraspin –> subscap

62
Q

Different appearances of calcifications

A

amorphous, globular,

63
Q

do all calcifications have shadowing?

A

NO

64
Q

How to determine amorphous

A

replaces normal fibrilar tendon and can be seen with angulations

65
Q

Can calcifications cause impingement?

A

yes it can cause impingement of acromion

66
Q

Amorphous without shadow temporal relationship

A

ACUTE

67
Q

well defined with shadowing

A

subacute or chronic

68
Q

doppler findings indicate in calcific tendinosis

A

higher chance of resorptive phase

69
Q

what consists the coracoacromial arch?

A

acromion, distal clavicule, AC JT, coracoid process, coracoacromial ligament

70
Q

Other findings of subacromial impingement?

A

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
Q

Late stage of subacromial impingement?

A

abnormal upward migration of humeral head

72
Q

Coracoid impingement syndrome?

A

subscap tendon and SASD between coracoid process and lesser tuberosity impinged, anterior aspect of SASD distention

73
Q

Adhesive capsulitis PE?

A

Limited ER during subscap eval & limited supraspin sliding under aromion

74
Q

Location of sspin tear in younger individuals?

A

anterior, near Rotator interval

75
Q

How to ensure full visualization of supraspin in lax and sad

A

in sax reach rotator interval, in lax visualize biceps tendon near Rotator interval

76
Q

Rotator Interval and biceps locati

A

intraarticular part of LHBT

77
Q

SGHL location?

A

subscapularis side

78
Q

SASD distention misinterpretation

A

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
Q

Rim rent tear appearance?

A

well defined hypoechoic or anechoic abnormality at location of articular end adjacent to greater tuberosity

80
Q

What do you call a tear only with greater tuberosity

A

intra-substance tear and cannot be seen in arthroscopy

81
Q

characteristics of a tendon tear

A

anechoic, well defined, thin, homogenous, bone irregularity

82
Q

characteristics of tendinosis

A

hypoechoic, ill defined, heterogeneous, increased thickness and SMOOTH cortex ( only for >40 yrs old )

83
Q

cortical irregularity important finding in patients over 40

A

shows adjacent cortical irregularity and supraspinatus abnormality.

84
Q

What is the bare area

A

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
Q

Synovial hypertrophy findings?

A

flow on color or power doppler and lack of internal movement

86
Q

Complex fluid finding

A

internal movement artifacts, isoechoic, to hyperechoic

87
Q

2mm in bicipital tendon sheath is equal to

A

8ml of effusion

88
Q

differentiate gh joint effusion from biceps tenosynovitis

A

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
Q

gh joint distention at biceps features

A

long asymptomatic distention usually from joint recess….(gh joint or subscap)

90
Q

PPV of biceps effusion and sasd effusion for rotator tears

A

60% and 95% for sasd bursal fluid

91
Q

Watchout for refraction shadow of deltoid fascia

A

may appear as tendinosis

92
Q

Location of biceps tendon pathology

A

usually within 3.5cm of origin… proximal to or at the bicipital groove

93
Q

Indirect signs of biceps instability

A

chonrdal print sign, showing subchondral bone cortex irregularity adjacent to biceps

94
Q

relationship between subluxation and dislocation with tears

A

usually associated with partial tear

95
Q

Where can we see distention of SASD

A

laterally - over supraspin, anteriorly- over subscap and biceps, post over infraspin

96
Q

echogenicity of distended bursa and interpretation

A

anechoic/ hypoechoic - simple fluid….

Hyperechoic or hypoechoic - complex fluid or synovial hypertrophy

97
Q

power doppler on SASD suggests

A

synovial hypertrophy

98
Q

Causes of SASD bursal distention

A

impingement, tear, hemorrhage, AMYLOIDOSIS, infection, RA, calcium hydroxyapatite, synovial proliferative disorders

99
Q

clues for gas-forming infection

A

hyperechoic foci with ring -down artifact

100
Q

apperance of a normal glenoid labrum

A

hyperechoic, triangular attached to bony glenoid

101
Q

degenerated labrum appearance

A

heterogeneous hypoechonecity

102
Q

Glenoid tear appearance

A

well defined hypoechoic or anechoic cleft

103
Q

Accuracy of posterior labrum ultrasound

A

88 % for abnormal - normal ? 98% differentiating posterior labral tear from normal or degeneration

104
Q

How to assess superior labrum

A

LAX supraspin between clavicle and scapular spine,

105
Q

paralabral cyst usual cause?

A

usually from a labral tear

106
Q

suprascapular nerve entrapment affects which muscle

A

depends on location… if spinoglenoid area- infraspin only… If suprascapular fossa both IS and SS

107
Q

greater tuberosity fracture

A

step off deformity, log segment cortical step off and discontinuity at the margins and point tenderness

108
Q

Anatomic landmarks for pectoralis major

A

deltoid, biceps brachii tendon, coracobrachialis, sternal and clavicular head of pec major

109
Q

Normal AC joint distention

A

3mm or less

110
Q

DOA of AC joint is common at what age

A

40 yrs

111
Q

axillary lymph node normal

A

oval, hypoechoic cortical rim, hyperechoic hilum, hilar pattern of vascularity if ever

112
Q

malignant lymph node

A

peripheral vascularity… roundness, hilar thinning, absence of hilum, eccentric thickening of cortex

113
Q

elastofibroma

A

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
Q

sternalis muscle

A

normal variant

115
Q

nodule of xiphoid process

A

palpable mass

116
Q

slipping rib syndrome

A

abnormal mobility of lower anterior rib end

Shoulder RMSK (2 decks)

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