Ultrasound has proven effective in diagnosing tendon pathology in the shoulder. The baseline ultrasound examination of the shoulder is well described and widely used in daily practice. In this work we offer some tools that may be added to the baseline for a better assessment of subacromial impingement. Our objectives are: . To demonstrate the importance of adding a dynamic study to routine ultrasound examination of the shoulder. . To describe and show the dynamic maneuvers for evaluating impingement with images and video of ultrasound...

Shoulder pathology and especially the shoulder impingement is one of the most frequently asked questions in musculoskeletal pathology. Impingement syndrome is characterized by painful functional limitation, produced by dynamic changes or compression. The supraspinatus tendon and subacromial–deltoid bursa are "impinged" between the humeral head, the acromion and the coracoacromial ligament (CAL). ( Fig. 1 ) Ultrasound examination of the shoulder with radiography should be the first choice of imaging and in most cases of tendon pathology it will not be necessary to perform additional imaging...

The ultrasound examination is performed using a high frequency linear-array transducers (10-13 MHz). The patient must be seated in front of the explorer and should be well positioned avoiding slouched or upright postures. In our study of shoulder pain we always start with the baseline assessment of the tendons of the long head of the biceps ( Fig. 2 ), the subscapular ( Fig. 3 ), the supraspinatus ( Fig. 4 ), the infraspinatus ( Fig. 5 ), and the glenohumeral and acromioclavicular joints (...

Ultrasound is well established as an excellent tool for studying the shoulder and also offers the possibility of improving the study of subacromial impingement by adding the dynamic study of the structures involved in this syndrome. In our opinion, the radiologist should be able to include the dynamic evaluation of the shoulder in an ordinary ultrasound study and it will only take a few minutes extra to do a good job.

First author: Montserrat DEL AMO MD PhD ESR / SERME Member Senior specialist. Radiology Dpt (MSK unit) Hospital Clinic Villarroel 170 Barcelona 08036 (Spain) University of Barcelona (UB) Phone+34932275412 Cell : +34630142424 Emails: [email protected] [email protected]

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