Learning objectives
Review the sonographic anatomy of shoulder nerves and corresponding muscles,
with a focus on suprascapular,
axillary,
musculocutaneous,
long thoracic,
thoracodorsal and accessory nerves
Understand the role of sonography (US) in relation to conventional radiography,
CT and/or MR in the diagnosis process
Recognize the sonographic findings in common and uncommon pathology
Background
Shoulder pathology is not restricted to rotator cuff lesions.
Peripheral neuropathies are not uncommon and could be related to traumatic injury,
shoulder surgery,
infection or tumour,
but usually,
they result from entrapment,
a condition in which the nerve is stretched into an incompressible space.
Conventional radiography remains the first imaging step,
by evaluating glenohumeral and acromioclavicular joints,
cervical spine and by diagnosing shoulder fracture or dislocation,
cervical ribs,
or after shoulder surgery.
However,
different clinical circumstances may require specific imaging modality.
Although US may indicate...
Imaging findings OR Procedure Details
The first step in the diagnosis process is based on the knowledge of anatomical keys (Fig3)
The folowing slides will illustrate the suprascapular nerve (fig4 to 14),
subscapularis nerve (fig15 to 18),
the axillary nerve (fig19 to 22),
the musculocutaneous nerve (fig23 to 26),
the long thoracic nerve (fig27 to 29),
the thoracodorsal nerve (fig30 and 31),
the spinal accessory nerve (fig32 to 34)
The second step in the diagnosis process is based on the denervation findings (fig35 to 40)
The third step in the...
Conclusion
Shoulder US should not be limited by examination of the rotator cuff tendons.
Within the proper clinical setting and with accurate knowledge of the complex shoulder anatomy,
Radiography and US represent the first steps in the analysis process,
by diagnosing bone lesions or variations,
orthopaedic material position,
muscle denervation signs,
and by finding the involved nerve and sometimes the level and the nature of the lesion.
These two imaging modalities may contribute to avoid unnecessary or inappropriate modalities
References
Each reference is annotated on each slide