3-D Ultrasound ShoulderPictorial Review

Dr. Muhammad Bin ZulfiqarPGR III FCPS New Radiology Department

Services Hospital / Services Institute of Medical Sciences

Aim

• To give A Pictorial View.• To give a bird eye view to this fantastic imaging

technique.

• Please also take a review from Role of imaging in evaluation of shoulder pain my other presentation.

• 3D US and multiplanar imaging of the subscapularis tendon of the rotator cuff in a patient suffering from tendinitis. All three planes show signs of tendon irregularity, enlargement, and dishomogeneity. Multiple focal calcifications are seen in all planes throughout the entire tendon fibers. The use of 3D reconstruction of the same subscapularis tendon demonstrates more clearly the full extent of focal calcifications, tendon irregularity and enlargement, and tendon dishomogeneity..

• Multiplanar localization of a large calcific deposit at the insertion of the rotator cuff demonstrating posterior acoustic shadowing on the transverse and longitudinal planes. The coronal plane demonstrates the full size and extension of this calcific deposit within the fibers of the tendon. 3D US provides the opportunity to accurately pinpoint these calcifications and ensure that the needle is placed in the correct position to perform needle aspiration of these calcific deposits.

• Multiplanar and 3D representation of biceps tendinitis in a patient suffering from shoulder pain and weakness. Note the focal calcifications at the level of the insertion, enlarged and irregular biceps tendon, and effusion.

• 3D reconstruction with surface rendering of the long head of the biceps tendon with three macrocalcifications seen to the left side of the untorn tendon in a patient with tendinitis.

• Rotator cuff tears

• Multiplanar representation of a subscapularis tendon partial tear. All three planes demonstrate an area of an irregular anechoic defect in the upper surface of the tendon (on the bursal side of the rotator cuff) while inferiorly, the tendon remains intact.

• Multiplanar representation of a massive tear (more than 5 cm and involving more than one tendon) of the rotator cuff.

Biceps tendinitis associated with rotator cuff defect. The coronal plane readily demonstrates subtle tears and irregularities of the biceps tendon within an effusion. 3D reconstruction confirms the irregularities of this tendon and the large effusion is well-appreciated. Bottom right image demonstrates fluid collection and right coracobrachialis longus (CBL).

• Multiplanar and 3D imaging of a completely ruptured biceps tendon. This is a study of an elderly patient who, after having lifted a heavy load, presented with weakness of the arm and swelling at the level of the middle of the humerus. One must follow the length of the biceps tendon from its origin to its insertion with the muscle. With acute traumatic rupture of the biceps tendon, the muscle contracts and collapses upon itself distally while the tendon retracts as in the above case. All planes demonstrate a fluid collection within the biceps sheath, the absence of any tendon fibers throughout the fluid collection, and the collapsed biceps muscle beneath.

• A lengthways split results in two cords, giving the appearance of two tendons lying side by side over a variable length of the tendon, as may be seen in the multiplanar images above.

• This 3D reconstruction confirms the existence of a lengthways split within the biceps tendon. Two cords are seen lying parallel within the bicipital groove.

• Multiplanar demonstration of a post-traumatic partial tear on the bursal aspect of the rotator cuff (infraspinatus tendon). The coronal plane and 3D reconstruction demonstrate dramatically the full extent of this tendon tear (indicated by the arrows), which initially on the transverse and longitudinal planes seems less extensive.

• Multiplanar imaging, including 3D reconstruction, of a torn supraspinatus tendon with underlying tendinitis (with no history of trauma). Lower right, note the focal calcification at the insertion of the tendon into the greater tuberosity and smaller calcifications throughout the tendon. The intact portion of the remaining tendon is demonstrated beside the anechoic fluid-filled space where the tendon has broken. The free, frayed edges of the tendon are clearly visible.

• Above, 3D reconstruction of the infraspinatus tendon with both insertional and intrasubstance tears in an elderly patient who fell and hit his shoulder.

• multiplanar representation of a large hematoma in the same patient who is under anticoagulant therapy. The coronal plane allows correct measurement of the hematoma.

• 3D reconstruction with surface-rendering of a supraspinatus tendon clearly demonstrating a tear and the free, frayed edges. Note also the remaining tendon fibers intact.

• Above and below, post-traumatic multiplanar and enlarged 3D reconstruction of the supraspinatus tendon with small marginal tears that were better depicted using 3D reconstruction.

• 3D representation of a post-traumatic rupture of the supraspinatus tendon.

THANK YOU