We have designed a digital application:
1.
To correlate in real time the virtual ultrasound transducer movement during the shoulder scanning with shoulder ultrasound images by means of interactive videos,
in order to learn and training the ultrasound shoulder exploration.
This digital aplication is based on fourteen ultrasound scans to include a proper and complete shoulder ultrasound exploration.
We show two video examples (20 Mb limited space) to understand the interface of the application.
The user will be able to move virtually the probe for training the ultrasound exploration.
- US scan 1: short axis of long biceps tendon (LBT) (from the proximal bicipital Groove to the proximal muscular belly,
lower the insertion of the muscle pectoralis major) ( Fig. 1 ).
- US scan 2: long axis of LBT (from the proximal bicipital Groove to mio-tendinous junction).
- US scan 3: long axis of subscapularis tendon (from upper to lower part of the tendon).
Scanning also the coraco-humeral space by dynamic rotation ( Fig. 2 ).
- US scan 4: short axis of subscapularis tendon with (from mio-tendinous junction to insertion into lesser tuberosity).
- US scan 5: long axis of supraspinatus and infraspinatus tendons with external rotation or Middleton position (from bicipital groove to mio-tendinous junction of infraspinatus) ( Fig. 3 ).
- US scan 6: short axis of supraspinatus and infraspinatus tendons with external rotation or Middleton position (from mio-tendinous junction to insertion into greater tuberosity).
- US scan 7: as US scan 6 but with internal rotation or Crass position.
- US scan 8: short axis of infraspinatus and teres minor muscles in infraspinatus fossa (from distal to proximal muscle).
Scanning also inferiorly the quadrilateral space with posterior cricumfllex humeral artery and axilar nerve).
- US scan 9: superior aspect of acromio-clavicular joint
- US scan 10: short axis of supraspinatus muscle in supraspinatus fossa (from proximal to mio-tendinous junction) ( Fig. 4 ).
- US scan 11: long axis of supraspinatus muscle in supraspinatus fossa (from anterior to posterior parts).
Scanning also the suprascapular notch with suprascapular nerve).
- US scan 12: long axis of infraspinatus tendon with anterior internal rotation (the hand over the contralateral shoulder).
Scanning also the posterior gleno-humeral joint by dynamic rotation and gleno-humeral ante-retroversion,
and medially,
the spine-glenoid notch with the exit of suprascapular nerve.
- US scan 13: lateral acromio-humeral space by dinamic gleno-humeral adbuction ( Fig. 5 ).
- Us scan 14: coraco-acromial ligament-humeral space by dynamic rotation and gleno- humeral ante-retroversion.
2.
To correlate the best ultrasound images of rotator cuff pathology from the PACS of our Institution with faithful 3D anatomic images, automatically obtained from the parameters of these ultrasound lesions.
3.
To apply this conversion into 3D anatomic representation from shoulder ultrasound images on the ultrasound shoulder exploration of any patient.
3D representation of the diferent rotator cuff tears could be obtained by the system from a file with data of 3D shoulder anatomic model, which integrates qualitative and quantitative parameters of the patient from the ultrasound explorarion:
a.
Qualitative parameters:
.
Age,
gender and weight.
.
Tendon involved: supraspinatus-infraspinatus.
subscapularis or LBT tendon.
.
Location of the rupture: articular or bursal surface,
intratendinous,
full-thickness.
.
Irregularity of the cortical surface of the greater tuberosity: slight,
mild and severe.
.
Bursitis: location
.
Muscle atrophy: muscle involved.
.
Fatty changes muscle: slight,
mild and severe.
b.
Quantitative parameters (supraspinatus-infraspinatus):
. Long axis distal point (dp): distance in mm from external edge of greater tuberosity to distal edge of the tear (zero in distal tears).
.
Short axis anterior point (ap): distance in mm from proximal edge of bicipital groove to anterior edge of the tear (zero in anterior supraspinatus tears).
.
Tear measurements (mm): long axis (L),
short axis (S),
thickness ratio (T) (tear thickness/tendon thickness) (one in full-thickness tears).
.
Ratio muscle: short axis muscular thickness/short axis fossa supraspinatus or infraspinatus thickness.
We show same examples to a better understanding of these measurements on real ultrasound cases,
with graphic correlation:
.
Characteristic articular side partial thickness tear ( Fig. 6 ).
.
Characteristic bursal side partial thickness tear ( Fig. 7 ).
.
Characteristic small full-thickness tear (cleft tear) ( Fig. 8 ).
.
Characteristic masive supraspinatus-infraspinatus tendon rupture( Fig. 9 )