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1、肩部超声检查,Objectives,Discuss the normal ultrasound appearance of the shoulder and the individual structures Describe the AIUM standard shoulder exam Discuss the uses of dynamic imaging,Shoulder,The Standard Examination,Sonography of Shoulder,Complex structure containing Muscles Tendons Bursa Bone Labru
2、m Fixed and Dynamic evaluations,Sonography of Shoulder,Physician Practice Guideline is established by AIUM & ACR for the Shoulder U/S Biceps tendon Subscapularis tendon Supraspinatus tendon Infraspinatus tendon Teres minor Dynamic evaluation,肱二头肌肌腱评估,肩胛下肌评估,冈上肌评估,crass position,冈上肌 各向异性,动态评估,肩锁关节,Bi
3、ceps Tendon- Short Axis,Transverse,Acute Tendinopathy,Chronic Tendinopathy,Biceps Tendon - Long Axis,Long Axis,Normal Long Axis,Normal Biceps LA,Biceps Tendon - Long Axis,Long Axis,Chronic Tendinopathy,Acute Tendinopathy,Fluid in tendon sheath,Long Head of Biceps Tendon,Normal internal/external moti
4、on,Normal long axis appearance,Is there subluxation of the Long Head of Biceps Tendon?,Subscapularis Tendon,Instruct patient to place their arm in full EXTERNAL rotation Sagittal view (Short axis),Short Axis Subscap,Short Axis view of Subscap,Subscapularis Tendon,Instruct patient to place their arm
5、in full EXTERNAL rotation Transverse view (Long axis),Long Axis Subscap,Long Axis view of Subscap,Subscapularis Tendon,Instruct patient to place their arm in full EXTERNAL rotation Transverse view (Long axis) Sagittal view (Short axis),Long Axis Subscap,Short Axis view of Subscap,Supraspinatus Tendo
6、n,Instruct patient to place their arm in INTERNAL rotation Place hand in back pocket (Long axis)45 degrees Coronal/ Sagittal,SST WNL,SST Normal Long Axis view,Supraspinatus Tendon,Instruct patient to place their arm in INTERNAL rotation Place hand in back pocket (Short axis) 90 degrees Rotation of l
7、ong axis,SST Short Axis WNL,SST, internal shoulder rotation SA view,Supraspinatus Tendon,Instruct patient to place their arm in INTERNAL rotation Place hand in back pocket (Long axis)45 degrees Coronal/ Sagittal (Short axis) 90 degrees Rotation of long axis,SST WNL,SST with Tendinopathy,Supraspinatu
8、s Tendon-Long Axis,Subacromial Bursa,Supraspinatous, birds beak view (insertion),GT,Supraspinatus Tendon-Short Axis,WNL,SAB,Dynamic Motion,Good Humeral Head Depression,Rotten Humeral Head Depression Poor Posture, Weak Scapula Stability,Infraspinatus Tendon,Instruct patient to place their arm in full
9、 INTERNAL rotation Place hand in back pocket Similar to Supraspinatus, but moved posteriorly (Long axis)45 degrees Coronal/ Sagittal (Short axis) 90 degrees Rotation of long axis,Infraspinatus Tendon,Instruct patient to place their arm in full INTERNAL rotation Place hand in back pocket Similar to S
10、upraspinatus, but moved posteriorly (Long axis)45 degrees Coronal/ Sagittal,Long Axis appearance of IST,Normal appearance of IST,Contralateral Comparison Long Axis Views,Left SST is WNL,Right SST Thickened chronic Tendinopathy,AC Joint,AC Joint,AC Joint,AC Joint,If the person is very thin, you might
11、 need standoff/interface disc,AC Joint,Arthritic Changes but no effusion,Less evidence of DJD, but effusion present,Summary,Many structures in the shoulder are superficial and can be examine accurately with MSK ultrasound Diagnostic Ultrasound should incorporated static and dynamic image If you examine many normal shoulders, then you will soon be able to pick-up even subtle changes,