Shoulder joint ultrasound – ultrasonography of the structures of the shoulder joint: cartilaginous articular lip, articular capsule, muscle tendons and ligaments. It is prescribed for the diagnosis of osteoarthritis, rheumatoid and reactive arthritis, synovial cysts, shoulder injuries, bursitis, tendovaginitis. Scanning of the joint is carried out at rest and in the process of conducting dynamic tests: rotation, shoulder retraction. In the course of the study, the echogenicity and distinctness of the contours of the shoulder joint are evaluated, the presence of uncharacteristic inclusions (effusion, intra-articular bodies, marginal growths, calcifications) is revealed.
In rheumatology, shoulder joint ultrasound is indicated before radiography is performed for complaints of pain, stiffness, configuration change, swelling and compaction in the shoulder. Ultrasound can serve as a leading technique for uninformative radiography or MRI (for example, in the initial erosive processes of the bone). Before planning a joint puncture, ultrasound is performed to clarify the presence and amount of intra-articular effusion. Dynamic sonography is repeated during the treatment of various joint pathology.
Ultrasound is aimed at detecting traumatic, degenerative, inflammatory changes in the shoulder joint, swelling and violation of the integrity of ligaments, tendons and muscles, narrowing of the articular gap, changes in the structure and thickness of cartilage, detection of uneven contours of bones, indicating violations of the bone structure. Ultrasound monitors the dynamics of osteoarthritis, periarthritis, arthritis, synovitis, tendovaginitis, bursitis; synovial cysts, erosive defects of the articular and bone surfaces, effusion, marginal osteophytes, periarticular ossification, etc. diseases and changes are detected.
Shoulder joint ultrasound is used in traumatology to diagnose the pathology of the muscles of the rotator cuff of the shoulder. The sensitivity of ultrasonography in determining the complete rupture of the rotator cuff and its extent is 100%, and the specificity of the method is 86%. In the course of ultrasound, indications for further examination are established – arthrography, arthroscopy, thermography, scintigraphy. The technique is used for diagnostic puncture of the shoulder joint to obtain synovial fluid and its subsequent examination. Limitations to the shoulder joint ultrasound joint may be pronounced arthralgia and the inability to move in the joint.
Methodology of conducting
In the process of performing shoulder joint ultrasound, the patient sits with his free arm lowered along the body of the trunk, and the examined arm, bent at the elbow, is placed on his knees. During the study, they resort to external and internal rotation, the removal of the limb in the shoulder joint. For comparison, it is advisable to conduct a bilateral ultrasound of the joints. To exclude artifacts during scanning, the ultrasound sensor is positioned perpendicular to the structures under study; scanning is carried out along the longitudinal and transverse axes in the anterior, posterior and clavicular-acromial projections.
The study of the rotator (rotational) cuff of the shoulder, the contour of the head of the humerus, hyaline cartilage, tendons (supraspinatus, subacute and scapular muscles, long biceps head), posterior articular lip, acromio-clavicular articulation, cranio-acromial ligament, deltoid muscle and biceps. In the ultrasound assessment of the tendon-muscle components of the shoulder joint, attention is paid to their structure, echogenicity, fiber thickness; in the study of bone-cartilage components – to the contours, dimensions of the articular gap, the presence of marginal ossifications, effusion in the cavity, pannus. The use of Doppler techniques in the framework of shoulder joint ultrasound makes it possible to assess blood flow in the area of detected changes.
In the process of shoulder joint ultrasound, cartilage, bone, soft tissue components (tendons, muscles, ligaments) are visualized, which are inaccessible for X-ray evaluation. The possibilities of echography are limited when visualizing superficial or deep articular structures, subcarticular and intraarticular foci. Ultrasound is an accessible, informative and painless diagnosis that allows you to examine the shoulder joint in real time and while moving.