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BELOW: Routine shoulder examination for slight pain upon abduction of the shoulder laterally.  Also this patient
demonstrated limited external rotation with pain at the posterior deep posterior shoulder.  She stated that she
injured the shoulder lifting boxes in her attic up and away from her body laterally.   
Below: normal asymptomatic shoulder images on the left; the case described above are associated on the right.  
The purpose of the below is not to show a totally pathological shoulder, but a routine set of images that are
reproduced each examination only modifying the exam when pathology presents. Again, each image is not intended
to show pathology, but the slight variations that can be seen from patient to patient.
ABOVE: Anterior Suraspinatus partial tear. The above cases are not the same patient, but similar tendonopathy.  
The Supraspinatus tendon has been partially torn as referenced here at Ultrasoundcases.info: Musculo Skeletal
Joints and Tendons I Shoulder I 6.1.7 Rotator Cuff: Partial Supraspinatus Ruptures (images here have been flipped
to better demonstrate the same tendon direction).
Routine Shoulder Examination
Biceps tendon Transverse:
Left: normal
Right: small effusion around
biceps tendon; normal variant.
Rotator Cuff Interval:
Left: normal
Right: tendons are thickened
but intact. Coracohumeral
ligament intact.
Biceps tendon long axis
distal to the rotator cuff
interval.
Subscapularis Tendon
transverse axis:
Right: Subscapularis tendon
thickened relative to the left
Lesser tuberocity at
subscapularis insertion.
Left: normal
Right: limited external rotation
tendon at level of the
coracoid process;
external rotations here.
Supraspinatus Tendon
transverse axis: note the dark
hypoechoic rim above the
cortical surface (articular
cartilage), this indicates the
probe position is over the
proximal Supraspinatus
Distal Supraspinatus at its
insertion, note the hypoechoic
rim above the cortex is absent,
image is now over the Greater
Tuberocity.  The defect in the
tendon on this image is at the
anterior margin of the tendon
at the border of the biceps
tendon.
Supraspinatus Long axis:
note the defect at the
Greater Tuberocity surface.
This image is taken at the
mid long axis. It is
important to sweep the
probe anteriorly until the
long axis bicep is seen.
Bringing the probe anteriorly
may show more pathology,
also rocking the probe heavier
on the distal
Infraspinatus long axis: note
the cortical defect on the
posterior aspect of the
humeral head.
Infraspinatus Mid Segment:
Intact with changes only to
the Infraspinatus muscle
are seen.
Proximal Infraspinatus muscle
belly. Again, the Infraspinatus
appearance.
Posterior Labrum: Changes
are seen with in the triangular
appearance of the labrum
internally and is now rounded
instead of flat over the joint.
AC Joint: cortical changes
only, capsule intact with no
effusion or internal echos
indicating loose bodies.
Other Shoulder Pathologies:
Bicep: Subluxation
Bicep: Tenosynovitis
Bicep: Tenosynovitis
Bicep: Subdeltoid Bursitis
Bicep: Rotator Interval
Injury
Bicep: Subluxation with
Tenosynovitis
Bicep: Tendon Sheath
effusion (simple fluid)
Bicep: Tenosynovitis
Bicep: Subscapularis
avulsion at interval
Supraspinatus: Bursal
Surface tear
Suprapspinatus: Full
Thickness partial tear
Supraspinatus: Complete
tear
Supraspinatus: Full
thickness partial tear
Supraspinatus:
intrasubstance and bursal
surface tearing
Supraspinatus: Partial
thickness tear, transverse
is posterior tear
Supraspinatus: Partial
thickness tear, transverse
is anterior tear
Supraspinatus: "Dip" in
Subdeltoid bursa indicates
tendon loss
Supraspinatus: Complete
Tear
Supraspinatus: Partial
Bursal surface tear
Supraspinatus: Calcific
Enthesopathy
Supraspinatus: Calcific
Enthesopathy
Supraspinatus: Partial
anterior surface tear
Supraspinatus: Bursal
Surface tear
Supraspinatus: Anterior
Surface trearing with
calcified tendon body
Shoulder Pathology
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MORE SHOULDER PATHOLOGY
10-30-2009