"Hourglass" Biceps Tendon: An Ultrasound "Mime" of Frozen Shoulder?

Advancing high-resolution musculoskeletal ultrasound: a histology- and anatomy-driven approach for enhanced shoulder imaging. Part 2: Anterior and lateral shoulder

Ultrasonography is a reliable imaging technique for the accurate diagnosis and evaluation of musculoskeletal disorders. Recent developments in ultrasound technology have significantly increased image resolution, making it possible to see anatomical features at almost microscopic dimensions. Current standards for standardized shoulder ultrasonography mostly depend on outdated machine types and configurations that may not fully utilize these high-resolution imaging capabilities. In this article, we give a clear and comprehensive introduction to high-resolution shoulder sonography, using histological and anatomical images from cadavers for comparison. Images collected using contemporary technology are shown, and international standard practices are considered. The examination and normal results are presented in a methodical manner, beginning posteriorly, moving frontally, then more anteriorly, and concluding with a lateral and optional axillary examination. This article focuses on the anterior and lateral shoulder.

Anatomical Analysis of Bicipital Groove and Its Spur Formation Using 3D-CT: A Retrospective Observational Study

Concomitant long head of biceps (LHB) pathologies commonly occur with rotator cuff tears, but LHB problems are often underestimated. There is a lack of studies on the correlation between bicipital groove morphology and biceps pathology, as well as the significance of bony spurs around the groove. This study analyzed the anatomical parameters of the bicipital groove and spur formation using 3D-CT in 111 patients. Biceps spurs were evaluated using 3D and 2D-CT images, and patients were grouped by age (below and above 55 years). The detection rate of biceps spur was higher with 3D-CT (54.0%) than with 2D-CT (42.3%). Spur incidence was significantly greater in older patients (60.3% vs. 45.8%). The average groove width was narrower in older adults (p = 0.006) and larger in men compared to women (p = 0.000). The average spur height was also greater in men (p = 0.039). Lateral spurs were the most common type that was observed. This study highlights the differences in bicipital groove morphology and spur formation by age and gender, with 3D-CT being more effective in detecting biceps spurs.

Assessing/Imaging the Subcoracoid Space: From Anatomy to Dynamic Sonography

In the pertinent literature, standardized sonographic protocols have been widely described to evaluate the different compartments of the shoulder. However, the subcoracoid space is a complex anatomical region-usually not included/described in basic ultrasound approaches. Accordingly, starting from its anatomy, we describe a two-phase dynamic ultrasound protocol to scan the subcoracoid space. This way, we aim to optimize the diagnosis and management of patients with anterior shoulder pain and subcoracoid effusion.

EURO-MUSCULUS/USPRM Dynamic Ultrasound Protocols for Shoulder

ABSTRACT

In this dynamic protocol, ultrasound examination of the shoulder using different maneuvers is described for several/relevant shoulder problems. Scanning videos are coupled with real-time patient examination videos for better understanding. The authors believe that this practical guide prepared by an international consensus of several experts (EURO-MUSCULUS: European Musculoskeletal Ultrasound Study Group and USPRM: Ultrasound Study Group of ISPRM [International Society of Physical and Rehabilitation Medicine]) will help musculoskeletal physicians perform a better and uniform/standard approach.

Ultrasound Features of Adhesive Capsulitis

Introduction

Adhesive capsulitis (AC), which is characterised by shoulder pain and a limited range of motion (ROM), is usually diagnosed on the basis of clinical suspicion, with imaging only being used to exclude other causes of similar symptoms. The aim of this study was to identify and describe the typical ultrasound (US) features of AC in a group of patients with shoulder pain and stiffness.

Methods

This was a cross-sectional study of 1486 patients with AC in which two experienced US specialists examined the axillary pouch (AP), the coracohumeral ligament (CHL), the superior glenohumeral ligament (SGHL), and the long head of the biceps tendon (LHBT), and dynamically visualised the infraspinatus tendon during passive external rotation (PER) during a US evaluation of shoulder ROM.

Results

AC was confirmed in 106 patients (7.1%). Thickening of the AP of more than 4 mm was observed in 93.4% of the patients, whereas 6.6% showed AP thickening of less than 4 mm but more than 60% of the thickening in the contralateral shoulder. Effusion within the LHBT sheath was detected in 71% of the patients, and thickening of the CHL or SGHL in 88%. The dynamic study of the infraspinatus tendon showed reduced sliding with folding towards the joint capsule in 73% of cases, thus changing the tendon’s profile from flat to concave during PER. The reduced tendon sliding was associated with a bouncing movement that returned the tendon to its baseline resting position in 41.5% of cases.

Conclusions

We believe a sufficiently experienced US specialist can confirm a clinical diagnosis of AC by carrying out a comparative study of APs, evaluating the thickness of the CHL and SGHL, and detecting reduced sliding of the infraspinatus tendon.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40744-021-00413-w.