Joseph Introcaso

Sonography of the postoperative shoulder

Fifty-three patients with 60 symptomatic shoulders underwent shoulder sonography for recurrent postoperative symptoms after either acromioplasty (10 shoulders) or repair of a full-thickness rotator cuff tear in addition to acromioplasty (50 shoulders). Because surgery distorts landmarks, an understanding of the surgical procedures and their characteristic sonographic appearances is essential. After acromioplasty, the characteristic sharp margination or the acromion was replaced by a less distinct, irregular surface. After repair of a cuff tear, characteristic sonographic appearances included visualization of a reimplantation trough and loss of the echogenic subdeltoid bursa. When the cuff was intact after surgery, echogenicity was abnormal in all cases (17 shoulders). Sonography accurately diagnosed recurrent cuff tears in all 26 shoulders in which surgical proof was available and confirmed an intact cuff in 10 of 11 cases. In one shoulder, a cuff hematoma was incorrectly interpreted as a full-thickness tear. These findings suggest that sonography is an effective procedure for evaluating a postoperative patient with recurrent shoulder symptoms.

Sonography of tendons

Musculoskeletal ultrasonography (MSUS) has been refined by improved examination techniques and higher frequency transducer technology. Sonography is the modality of choice in the screening of tendon disorders. The accuracy in diagnosing tendon lesions has improved with better understanding of the sonographic anatomy and the pathophysiology of tendons. The sonographic appearance of tears, tendon dislocations, tendinitis, tenosynovitis, insertion tendinopathy, ganglion cysts, and bursitis is described. Normal variants that mimic tendon disease are shown. The tendons of the shoulder, elbow, wrist, hand, knee, ankle, and foot are considered.

Sonographic Examination of the Musculoskeletal System

Two decades ago ultrasound was first applied to the evaluation of disorders of the musculoskeletal system [1]. This was limited to the diagnosis of popliteal cysts (Baker’s cysts), which took advantage of ultrasound’s inherent ability to easily demonstrate fluid collections. Later, ultrasound was applied to the evaluation of tendon pathology. However, limitations in image quality imposed by equipment available at that time reduced sensitivity and specificity of the technique. In the past few years we have seen tremendous advances in sonographic image quality based largely on improved high frequency transducer technology. This has greatly broadened the spectrum of sonographic applications in the diagnosis of musculoskeletal disorders, as well as allowing increased diagnostic accuracy in areas already established [2].