Beware of anisotrophy all the time
Tendons are hyperechoic and ligaments are hypoechoic
Biceps:
Transverse:
Internal rotation, elbow 90 flexion
Scroll up and down, keeping the probe perpendicular to the tendon.
Look for: change in the calibre of the tendon (hyperechoic); fluid around the tendon (may be normal in the inferior aspect); subluxation on dynamic scan; transverse ligament (hypoechoic band)
Longitudinal:
Apply little pressure at the distal end to bring the tendon in longitudinal plane
Subscapularis and subscapularis bursa:
Inserts along the medial edge of the bicepital groove
Transverse:
External rotation, elbow 90 flexion, dynamic evaluation
Long axis:
Multipinnate appearance
Supraspinatus and subacromian-subdeltoid bursa:
Anatomical transverse/ long axis view:
Best to good postions (in order): Full adduction and internal rotation - place the hand against the back or 'place your hand as if you are putting it in your back pocket' or hanging arm with palm pointing backwards
Anterior postion: for anterior free edge ( at the corner corocoid process is seen), just lateral to biceps tendon. Most medial aspect is free edge. If there is gap between two, it indicates tear
Tears are best seen in this view
Mid position: lateral to the above view. Good for midsubstance tears.
Posterior position: Supraspinatus meets infraspinatus
Anatomical coronal/ oblique long axis:
Probe rests on the angle of the shoulder flat
Tendon seen as triangle
Infraspinatus:
Hand kept on the opposite shoulder
Posteromedial long axis positioning of the probe
Coracoacromial ligament:
Lateral to the free edge of the supraspinatus in transverse plane (long axis of supraspinatus). The ligament is seen as a low echoic band superior to the supraspinatus going towards corocaoid process
Acromioclavicular joint:
Feel and keep the probe
Glenohumoral joint:
Posteromedial to the infraspinatus view
References:
1. McNally EG. Practical musculoskeletal ultrasound. Churchill Livingstone 2005
