: Giorgio Tamborrini, Andreas Müller, Gregor Szöllösy, Stefano Bianchi, David Haeni, Markus Wurm, Anna
: Shoulder Ultrasound Sonoanatomy and Sonopathology Atlas of the Shoulder Including Anatomy, Radiography and Arthroscopy
: Books on Demand
: 9783756283736
: 1
: CHF 88.60
:
: Medizin
: English
: 236
: Wasserzeichen
: PC/MAC/eReader/Tablet
: ePUB
In the diagnosis and evaluation of musculoskeletal (msk) diseases such inflammatory and non-inflammatory joint diseases, high resolution musculoskeletal ultrasound (hrMSUS or MSUS) is a superb, precise, and validated method. Many soft-tissue structures can be seen using high resolution musculoskeletal ultrasonography, and depending on the tissue under investigation, msus can also identify a variety of pathologic alterations employing mostly linear scan probes with frequencies ranging from 5 MHz to 24 MHz (up to 70 MHz when examining entheses, nails or the skin). Msk structures are assessed dynamically in real-time and static with the advantage of a multiplanar view. Msus is a helpful instrument for directed interventions at the msk system as well. This method has some limitations, including limited acoustic windows, difficulty detecting diseases in deep or large joints, a small field of vision, and a significant operator dependence. Attending theoretical and practical seminars, as well as individual research using books, websites, or social media, all qualify as training. Consolidating msus knowledge requires the use of high-quality ultrasound equipment and the performance of supervised normal and abnormal msus examinations throughout a training phase. The first focus of this textbook and atlas is to demonstrate a standardized ultrasound examination of the shoulder enhanced with basic anatomical (MRI-, CT-Scans; cadaver models) and arthroscopic images. The second focus is a thorough pictorial atlas of selected basic and advanced ultrasound pathologies. Giorgio Tamborrini Basel, 2023

Swiss Ultrasound Center and Institute for Rheumatology Basel, Consultant Rheumatologist University Hospital Basel, Switzerland uzrbasel.ch and irheuma.com Rheumatologist and Sonographer. EULAR teacher. EFSUMB Level III.

2. Basic clinical shoulder examination


David Haeni, Markus Wurm, Giorgio Tamborrini

2.1 Introduction


Pain is usually the first symptom referred by a patient with shoulder disorder. The clinical shoulder examination starts with an accurate medical history. It is fundamental to understand whether a trauma is present or not. The age, the professional and sport activities are important informations in order to understand the patient’s impairment. Duration and onset of pain should be asked in detail. Cervical nerve root disorders can be referred as radiating pain from the neck into the shoulder and should be excluded. Several scores are helpful for the functional assessment of the shoulder. The Constant-Murley Score13 is a 100 points scale composed by four parameters such as pain, activity of daily living, movement and strength. It is one of the most commonly used outcome measurement system by shoulder surgeons.

2.2 Inspection


The first step of the clinical examination is the inspection. Here we look for symmetry of anatomic landmarks such as ac joint, coracoid process and spina scapulae. We assess the presence of a scar due to previous surgery or any hematoma after a fall, that could be a sign of a fracture. A bruise on the anterior part of the shoulder with a positive Popeye sign (distal biceps muscle retraction) is a hallmark of a spontaneous long head of the biceps rupture. We should exclude any atrophy of the deltoid muscle (due to axillary nerve palsy or to prolonged rest) or of the supraspinatus and infraspinatus muscle, that could suggest a suprascapular nerve pathology21. On the posterior side of the shoulder we evaluate the scapulo-thoracic joint balance. Sometimes a functional dyskinesia18can be appreciated, very rarely secondary to long thoracic nerve palsy.

2.3 Range of motion


The following step is the range of motion assessment. We start with the active range of motion (ROM) and we complete the exam with the passive examination (Fig. 1 -4 ). We assess the flexion, the elevation (flexion in the plane of the spina scapulae), the abduction, the external rotation and the internal rotation. Active and passive external rotation restriction could be a sign of a frozen shoulder26 (also called adhesive capsulitis), a condition characterized by stiffness and pain and associated with diabetes mellitus. The pseudoparalysis of the shoulder is defined as the inability to actively elevate and bring the arm in flexion with full passive ROM15. This condition is secondary to massive cuff tear without neurological paralysis.

Fig. 1

flexion (anteversion):

m. pectoralis major, m. deltoideus (pars clavicularis), m. coracobrachialis, m. biceps branchii (caput longum).

extension (retroversion):

m. latissimus dorsi, m. teres major, m. deltoideus (pars spinalis), m. subscapularis, m. triceps brachii (caput longum).

Fig. 2

external rotation:

m. infraspinatus, m. teres minor, m. deltoideus (pars spinalis), m. biceps branchii (caput longum).

internal rotation:

m. subscapularis, m. latissimus dorsi, m. teres major, m. pectoralis major, m. deltoideus (pars clavicularis).

Fig. 3

abduction:

m. deltoideus (pars. acromialis), m. supraspinatus.

abduction – elevation:

m. serratus anterior, m. trapezius (pars. descendens), m. levator scapulae, m. rhomboideus

adduction:

m. pectoralis major, m. latissimus dorsi, m. teres major, m. coracobrachialis, m. biceps brachii (caput breve), m. deltoideus (pars spinalis and pars clavicularis).

Fig. 4

internal rotation: measurement of the vertebra promi