PURPOSE: The purpose of this study was to document the sonographic morphology of the subscapularis footprint, particularly the 1st facet, of the non-pathologic subscapularis tendon and footprint, and analyze the correlation between the size of the 1st facet and the demographic variables. MATERIALS AND METHODS: Between March 2015 and December 2017, retrospectively data analysis was performed for the ultrasound (US) scans of 115 consecutive shoulder (mean age 53.4 years, range 23–74 years) with non-pathologic subscapularis tendon and footprint. The sonographic findings of the 1st facet of the subscapularis footprint was a very unique, flat, broad, and plane angle in the upward direction, which were distinguished from the other facets. On US, the transverse (medio-lateral) and longitudinal (superior-inferior) length of the 1st facet on axis of the humerus shaft were recorded. The demographic variables, including age, site, body height, weight, body mass index (BMI), and arm length, were reviewed. RESULTS: On US, the mean transverse length of the 1st facet was 12.75 mm (range 10.54–14.50 mm, standard deviation [SD] 0.712) and the mean longitudinal length was 12.22 mm (range 9.20–13.30 mm, SD 0.888). The transverse and longitudinal length of the size of the 1st facet were significantly greater in males than in females (p<0.001, p=0.001). Of the demographic data (body height, weight, BMI, arm length) that showed a significant positive linear correlation, the correlation with body height (transverse r=0.749, p<0.001; longitudinal r=0.642, p<0.001) showed the strongest relationship, and the correlation with the BMI was weakly related. The relationships between the size of the 1st facet to site/age were not statistically significant or appeared to have no linear correlation. CONCLUSION: The structural and morphologic features of the 1st facet of the subscapularis footprint on the US were identified. This will provide anatomic knowledge of an US examination for subscapularis tendon pathology.
Arm ; Body Height ; Body Weight ; Female ; Humans ; Humerus ; Male ; Pathology ; Retrospective Studies ; Shoulder ; Statistics as Topic ; Tendons ; Ultrasonography

Ultrasonography (US) is a useful diagnostic method that can be easily applied to identify the cause of shoulder pain. Its low cost, excellent diagnostic accuracy, and capability for dynamic evaluation are also advantages. To assess all possible causes of shoulder pain, it is better to follow a standardized protocol and to perform a comprehensive evaluation of the shoulder than to conduct a focused examination. Moreover, a proper dynamic study can enhance the diagnostic quality of US, especially when the pathology is not revealed by a static evaluation. The purpose of this article is to review the common indications for dynamic US of the shoulder, and to present the basic techniques and characteristic US findings.
Methods ; Pathology ; Shoulder Pain ; Shoulder* ; Ultrasonography*

BACKGROUND: Delaminated rotator cuff tear is known to be a degenerative tear having a negative prognostic effect. This study undertook to compare the anatomical and clinical outcomes of delaminated tears and single layer tears. METHODS: Totally, 175 patients with medium to large rotator cuff tears enrolled for the study were divided into 2 groups, based on the tear pathology: single layer tear (group 1) and delaminated tear (group 2). Preoperatively, length of the remnant tendon, muscle atrophy of supraspinatus (SS), and fatty degeneration of SS and infraspinatus (IS) muscles were assessed on magnetic resonance imaging (MRI). For follow-up, the repair integrity of the rotator cuff was evaluated by ultrasonography. Clinical outcomes were assessed by evaluating the Constant score (CS) and Korean Shoulder Score (KSS). RESULTS: Retears were detected in 6 cases of group 1 (6.5%) and 11 cases of group 2 (13.3%). Although higher in group 2, the retear rate was significantly not different (p=0.133). Preoperative MRI revealed length of remnant tendon to be 15.46 ± 3.60 mm and 14.17 ± 3.16 mm (p=0.013), and muscle atrophy of SS (occupation ratio) was 60.54 ± 13.15 and 56.55 ± 12.88 (p=0.045), in group 1 and group 2, respectively. Fatty degeneration of SS and IS in both groups had no significant differences. Postoperatively, no significant differences were observed for CS and KSS values between the groups. CONCLUSIONS: Delaminated rotator cuff tears showed shorter remnant tendon length and higher muscle atrophy that correlate to a negative prognosis. These prognostic effects should be considered during delaminated rotator cuff tear treatment.
Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Muscles ; Muscular Atrophy ; Pathology ; Prognosis ; Rotator Cuff ; Shoulder ; Tears ; Tendons ; Ultrasonography

PURPOSE: There has been few published on arthroscopy of metacarpophalangeal joint (MCPJ) despite increasingly being used worldwide. The purpose of this study was to investigate the effectiveness of arthroscopy for pathologies around MCPJ of the thumb. METHODS: Between September 2007 and June 2015, 56 patients (56 thumb) who underwent arthroscopy of the MCPJ were retrospectively studied. Preoperative diagnoses, which were made through physical examination, plain radiograph, stress radiography, ultrasound, and magnetic resonance images (MRI), were compared with arthroscopic findings. Therapeutic arthroscopic surgeries were performed according to the needs of each patient. Functional outcomes were assessed with physical examination as well as disabilities of the arm, shoulder and hand (DASH) score and Michigan Hand outcomes Questionnaire (MHQ) score at an average 7.3 months follow-up. RESULTS: Six patients who suspected with collateral ligament injuries in MRI confirmed different diagnoses under arthroscopy. At final follow-up, the mean range of flexion contracture of the MCPJ was 5°, and the mean range of further flexion was 52.7°. Grip and pinch strength averaged 87.2% and 79.3% of contralateral side. Mean DASH and MHQ score were improved from 48.1 and 44.6, preoperatively to 14.9 and 26.3, postoperatively (p<0.001, p=0.012, respectively). All patients were satisfied with their outcomes at final follow-up, except 4 patients who noted joint stiffness or chronic pain around the thumb. CONCLUSION: Our results revealed that arthroscopy is helpful for both diagnostic and therapeutic purposes of acute and chronic painful MCPJ of the thumb. However, further studies are needed to expand the applications of arthroscopy of MCPJ of the thumb.
Arm ; Arthroscopy* ; Chronic Pain* ; Collateral Ligaments ; Contracture ; Diagnosis ; Follow-Up Studies ; Hand ; Hand Strength ; Humans ; Joints ; Magnetic Resonance Imaging ; Metacarpophalangeal Joint* ; Michigan ; Pathology ; Physical Examination ; Pinch Strength ; Radiography ; Retrospective Studies ; Shoulder ; Thumb* ; Ultrasonography

Ultrasonography is a powerful and useful method for the examination of the various shoulder diseases. The use of high-resolution transducer and technical evolution allowed the improvement of the accuracy of detection of the rotator cuff disease. In addition to diagnostic tool, ultrasonography can be applied as an optimal guidance in many intervention therapy around shoulder. However, its limitation is that there is marked disparity between the operators' experience levels. This article describes stepwise methods for evaluating shoulder conditions, ultrasonographic findings of various shoulder pathology, and guidance techniques for intervention therapy.
Pathology ; Rotator Cuff ; Shoulder Pain* ; Shoulder* ; Transducers ; Ultrasonography*

In evaluating patients complaining of shoulder pain, ultrasonography is an emerging imaging tool due to convenience, low cost, high sensitivity and specificity. However, normative values of ultrasound dimensions of the shoulder to be compared with pathologic findings in Korean adults are not provided yet. We evaluated the ultrasound dimensions of the rotator cuff, long head of biceps tendon, deltoid muscle and acromioclavicular joint in Korean healthy adults. Shoulder ultrasonography was performed on 200 shoulders from 100 healthy adults. The dimensions of the thickness of rotator cuff (supraspinatus, infraspinatus, subscapularis tendon), deltoid muscle, long head of biceps tendon, subacromial subdeltoid bursa, and acromioclavicular joint interval were measured in a standardized manner. Differences in measurements among sex, age, and dominant arms were compared. The thickness of rotator cuff tendons (supraspinatus, infraspinatus, subscapularis) and deltoid muscle were significantly different between men and women. The thickness of subacromial subdeltoid bursa was significantly different between men and women for non-dominant side. In rotator cuff tendon measurements, the differences between dominant and non-dominant shoulders were not significant, which means the asymptomatic contralateral shoulder can be used to estimate the normal reference values. When stratified by age divided by 10 years, the measurements of supraspinatus, subscapularis and deltoid thickness showed tendency of increase with the age. The acromioclavicular joint interval, on the other hand, revealed decreasing tendency. This report suggests normative values of ultrasound dimensions of healthy Korean population with varying age, and can be useful as reference values in evaluating shoulder pathology, especially in rotator cuff tendon pathology.
Acromioclavicular Joint ; Adult* ; Arm ; Deltoid Muscle ; Female ; Hand ; Head ; Humans ; Male ; Pathology ; Reference Values ; Rotator Cuff* ; Sensitivity and Specificity ; Shoulder ; Shoulder Pain ; Tendons ; Ultrasonography*

Nowadays shoulder ultrasound is commonly used in the assessment of shoulder diseases and is as accurate as magnetic resonance imaging in the detection of several pathologies. Operator dependence is the main disadvantage of shoulder ultrasound. After adhering to a strict examination protocol, good knowledge of normal anatomy and pathologic processes and an awareness of common pitfalls, it can be used as a focused examination providing rapid, real-time diagnosis, and treatment by ultrasound-guided interventions in desired clinical situations. Also shoulder ultrasound can help the surgeon decide whether treatment will be surgical or nonsurgical. If arthroscopy is planned, sonographic findings help to counsel patients regarding surgical and functional outcomes. If a nonsurgical approach is indicated, ultrasound can be used to follow patients. This review article presents the examination techniques, the normal sonographic appearances and the main pathologic conditions found in shoulder ultrasound. And also addresses a simplified approach to scanning and ultrasound-guided intervention. Knowledge of optimal techniques, normal anatomy, dynamic maneuvers, and pathologic conditions is essential for optimal performance and interpretation of images.
Arthroscopy ; Diagnosis ; Humans ; Magnetic Resonance Imaging ; Pathologic Processes ; Pathology ; Shoulder* ; Ultrasonography*

Nowadays shoulder ultrasound is commonly used in the assessment of shoulder diseases and is as accurate as magnetic resonance imaging in the detection of several pathologies. Operator dependence is the main disadvantage of shoulder ultrasound. After adhering to a strict examination protocol, good knowledge of normal anatomy and pathologic processes and an awareness of common pitfalls, it can be used as a focused examination providing rapid, real-time diagnosis, and treatment by ultrasound-guided interventions in desired clinical situations. Also shoulder ultrasound can help the surgeon decide whether treatment will be surgical or nonsurgical. If arthroscopy is planned, sonographic findings help to counsel patients regarding surgical and functional outcomes. If a nonsurgical approach is indicated, ultrasound can be used to follow patients. This review article presents the examination techniques, the normal sonographic appearances and the main pathologic conditions found in shoulder ultrasound. And also addresses a simplified approach to scanning and ultrasound-guided intervention. Knowledge of optimal techniques, normal anatomy, dynamic maneuvers, and pathologic conditions is essential for optimal performance and interpretation of images.
Arthroscopy ; Diagnosis ; Humans ; Magnetic Resonance Imaging ; Pathologic Processes ; Pathology ; Shoulder ; Ultrasonography

The purpose of this study was to determine shoulder pain and shoulder ultrasonographic findings in poliomyelitis Wheelchair Basketball (WB) players. Three physicians performed physical examinations and interviewed WB players about their shoulder pain by using Wheelchair User's Shoulder Pain Index (WUSPI), Performance-Corrected WUSPI (PC-WUSPI), and Shoulder Pain and Disability Index (SPADI). One physician performed shoulder ultrasonography on WB players. All confirmed their International Wheelchair Basketball Federation (IWBF) classifications through Korean Wheelchair Basketball Federation (KWBF). Seventeen men and 6 women players were enrolled in the study, with 46 shoulders evaluated. Nine players had unilateral lower extremity weakness and 14 players were bilateral weakness. Six players used wheelchair for daily living, and 17 players used wheelchair only when playing WB. They were 44.35+/-5.42 years old on average. They had played WB for 11.09+/-9.49 years and trained 8.69+/-3.83 hours a week. PC-WUSPI was significantly correlated with age (p=0.014). There were no significant differences between time spent playing WB, training time for WB, types of poliomyelitis involvement, their use of wheelchair, and WUSPI, PC-WUSPI and SPADI. Tendon tear prevalence was significantly different with training time for WB (p=0.021). Most common abnormal shoulder ultrasonographic findings were subscapularis and supraspinatus tendinopathy. Tendinopathy and tendon tear prevalence did not differ significantly with age, time spent playing WB, types of poliomyelitis, and the use of wheelchair. High prevalence of shoulder pain and rotator cuff pathology were found by physical and ultrasonographic examination in the poliomyelitis wheelchair basketball players. Rotator cuff injury prevention program are needed for prevent shoulder pain and rotator cuff pathology.
Basketball* ; Classification ; Female ; Humans ; Lower Extremity ; Male ; Pathology ; Physical Examination ; Poliomyelitis* ; Prevalence ; Rotator Cuff ; Shoulder Pain ; Shoulder* ; Tendinopathy ; Tendons ; Ultrasonography* ; Wheelchairs*

The objectives of this study were: 1) to identify the ultrasonographic (US) abnormalities and 2) to compare the findings of physical examination with US findings in rheumatoid arthritis (RA) patients with shoulder pain. We studied 30 RA patients. Physical examination was performed systemically as follows: 1) area of tenderness; 2) range of passive and active shoulder motion; 3) impingement tests; 4) maneuvers for determining the location of the tendon lesions. US investigations included the biceps, the supraspinatus, infraspinatus, and subscapularis tendons; the subacromial-subdeltoid bursa; and the glenohumeral and acromioclavicular joints. Thirty RA patients with 35 painful and 25 non-painful shoulders were examined. The range of motion affected the most by shoulder pain was abduction. The most frequent US finding of shoulder joint was effusion in the long head of the biceps tendon. Among the rotator cuff tendons, subscapularis was the most frequently involved. Tendon tear was also common among non-painful shoulders. Physical examination used for the diagnosis of shoulder pain had low sensitivity and specificity for detecting abnormalities in the rheumatoid shoulder joint. In conclusion, US abnormalities showed frequent tendon tears in our RA patients. Physical examination had low sensitivity and specificity for detecting rotator cuff tear in the rheumatoid shoulder joint.
Adolescent ; Adult ; Aged ; Arthritis, Rheumatoid/complications/*ultrasonography ; Female ; Humans ; Male ; Middle Aged ; Physical Examination/*methods ; Reproducibility of Results ; Rotator Cuff/pathology/ultrasonography ; Shoulder/pathology/*ultrasonography ; Shoulder Joint/*ultrasonography ; Shoulder Pain/etiology/ultrasonography ; Tendons/pathology/ultrasonography