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US of the Shoulder: Non–Rotator Cuff Disorders¹

¹ From the Cattedra "R" di Radiologia-DICMI, Università di Genova, Largo Rosanna Benzi 8, 16132 Genoa, Italy (C.M., F.P., L.E.D.); the Department of Radiology, Hôpital Cantonal Universitaire, Geneva, Switzerland (S.B., M.P.Z.); the Department of Radiology, Ospedale San Carlo, Genoa, Italy (N.P.); and the Department of Radiology, Istituto Giannina Gaslini, Genoa, Italy (M.V.). Recipient of a Cum Laude award for an education exhibit at the 2001 RSNA scientific assembly. Received May 20, 2002; revision requested June 13 and received July 26; accepted August 1. Address correspondence to C.M. (e-mail: martinoli@zeus.newnetworks.it).

View larger version (98K): [in a new window]   Figure 1a.  Rotator cuff interval. (a) Schematic illustrates the relationship of the CHL (green) to the subscapularis (SubS) and supraspinatus (SS) tendons. The ligament forms the roof of the intraarticular portion of the biceps tendon (orange). (b) Corresponding transverse 12-5-MHz US image demonstrates the flattened, echogenic intraarticular portion of the biceps tendon (arrow) anterior to the supraspinatus tendon (SS). The CHL (*) is seen as an echogenic band of tissue superficial to the biceps tendon. A thin hypoechoic layer (arrowheads) bulges from the deep edge of the supraspinatus tendon and intervenes between the ligament and the biceps tendon, a finding that may represent the capsular interface. (c) Transverse 12-5-MHz US image obtained in a 42-year-old man with a surgically confirmed lesion in the rotator cuff interval that involved the CHL and the fibers of the superior capsule shows hypoechoic fluid surrounding an intact biceps tendon (arrow). Note the absence of the CHL. SS = supraspinatus tendon.

View larger version (115K): [in a new window]   Figure 1b.  Rotator cuff interval. (a) Schematic illustrates the relationship of the CHL (green) to the subscapularis (SubS) and supraspinatus (SS) tendons. The ligament forms the roof of the intraarticular portion of the biceps tendon (orange). (b) Corresponding transverse 12-5-MHz US image demonstrates the flattened, echogenic intraarticular portion of the biceps tendon (arrow) anterior to the supraspinatus tendon (SS). The CHL (*) is seen as an echogenic band of tissue superficial to the biceps tendon. A thin hypoechoic layer (arrowheads) bulges from the deep edge of the supraspinatus tendon and intervenes between the ligament and the biceps tendon, a finding that may represent the capsular interface. (c) Transverse 12-5-MHz US image obtained in a 42-year-old man with a surgically confirmed lesion in the rotator cuff interval that involved the CHL and the fibers of the superior capsule shows hypoechoic fluid surrounding an intact biceps tendon (arrow). Note the absence of the CHL. SS = supraspinatus tendon.

View larger version (107K): [in a new window]   Figure 1c.  Rotator cuff interval. (a) Schematic illustrates the relationship of the CHL (green) to the subscapularis (SubS) and supraspinatus (SS) tendons. The ligament forms the roof of the intraarticular portion of the biceps tendon (orange). (b) Corresponding transverse 12-5-MHz US image demonstrates the flattened, echogenic intraarticular portion of the biceps tendon (arrow) anterior to the supraspinatus tendon (SS). The CHL (*) is seen as an echogenic band of tissue superficial to the biceps tendon. A thin hypoechoic layer (arrowheads) bulges from the deep edge of the supraspinatus tendon and intervenes between the ligament and the biceps tendon, a finding that may represent the capsular interface. (c) Transverse 12-5-MHz US image obtained in a 42-year-old man with a surgically confirmed lesion in the rotator cuff interval that involved the CHL and the fibers of the superior capsule shows hypoechoic fluid surrounding an intact biceps tendon (arrow). Note the absence of the CHL. SS = supraspinatus tendon.

View larger version (114K): [in a new window]   Figure 2a.  Biceps tendon groove. (a) Schematic illustrates how the biceps tendon (orange) is located between the greater tuberosity (GT) and the lesser tuberosity (LT) and covered by the THL (green). G = glenoid region of the scapula, SubS = subscapularis tendon. (b) Corresponding transverse 12-5-MHz US image demonstrates the THL (arrowheads) as a thin echogenic layer that overlies the biceps tendon (arrow). The bone groove has a normal size and shape. GT = greater tuberosity, LT = lesser tuberosity, SubS = subscapularis tendon.

View larger version (95K): [in a new window]   Figure 2b.  Biceps tendon groove. (a) Schematic illustrates how the biceps tendon (orange) is located between the greater tuberosity (GT) and the lesser tuberosity (LT) and covered by the THL (green). G = glenoid region of the scapula, SubS = subscapularis tendon. (b) Corresponding transverse 12-5-MHz US image demonstrates the THL (arrowheads) as a thin echogenic layer that overlies the biceps tendon (arrow). The bone groove has a normal size and shape. GT = greater tuberosity, LT = lesser tuberosity, SubS = subscapularis tendon.

View larger version (122K): [in a new window]   Figure 3a.  Biceps tendon dislocation. (a, b) Intact subscapularis tendon in a 27-year-old man with biceps tendon instability. Transverse 12-5-MHz US image (a) and corresponding gradient-recalled-echo (GRE) MR image (repetition time msec/echo time msec/flip angle = 400/12/90°) (b) demonstrate the biceps tendon (arrow) displaced superficial to the intact subscapularis tendon (* in a). Note that the intertubercular sulcus (arrowheads in a) is obtuse. (c, d) Full-thickness tear of the subscapularis tendon in a 58-year-old man with impingement syndrome. On a transverse 12-5-MHz US image (c) and corresponding GRE MR image (550/15/25°) (d), the torn subscapularis tendon (* in c) is retracted from its normal attachment point on the lesser tuberosity, and the biceps tendon (arrow) is dislocated medially out of the groove (arrowheads in c).

View larger version (159K): [in a new window]   Figure 3b.  Biceps tendon dislocation. (a, b) Intact subscapularis tendon in a 27-year-old man with biceps tendon instability. Transverse 12-5-MHz US image (a) and corresponding gradient-recalled-echo (GRE) MR image (repetition time msec/echo time msec/flip angle = 400/12/90°) (b) demonstrate the biceps tendon (arrow) displaced superficial to the intact subscapularis tendon (* in a). Note that the intertubercular sulcus (arrowheads in a) is obtuse. (c, d) Full-thickness tear of the subscapularis tendon in a 58-year-old man with impingement syndrome. On a transverse 12-5-MHz US image (c) and corresponding GRE MR image (550/15/25°) (d), the torn subscapularis tendon (* in c) is retracted from its normal attachment point on the lesser tuberosity, and the biceps tendon (arrow) is dislocated medially out of the groove (arrowheads in c).

View larger version (128K): [in a new window]   Figure 3c.  Biceps tendon dislocation. (a, b) Intact subscapularis tendon in a 27-year-old man with biceps tendon instability. Transverse 12-5-MHz US image (a) and corresponding gradient-recalled-echo (GRE) MR image (repetition time msec/echo time msec/flip angle = 400/12/90°) (b) demonstrate the biceps tendon (arrow) displaced superficial to the intact subscapularis tendon (* in a). Note that the intertubercular sulcus (arrowheads in a) is obtuse. (c, d) Full-thickness tear of the subscapularis tendon in a 58-year-old man with impingement syndrome. On a transverse 12-5-MHz US image (c) and corresponding GRE MR image (550/15/25°) (d), the torn subscapularis tendon (* in c) is retracted from its normal attachment point on the lesser tuberosity, and the biceps tendon (arrow) is dislocated medially out of the groove (arrowheads in c).

View larger version (175K): [in a new window]   Figure 3d.  Biceps tendon dislocation. (a, b) Intact subscapularis tendon in a 27-year-old man with biceps tendon instability. Transverse 12-5-MHz US image (a) and corresponding gradient-recalled-echo (GRE) MR image (repetition time msec/echo time msec/flip angle = 400/12/90°) (b) demonstrate the biceps tendon (arrow) displaced superficial to the intact subscapularis tendon (* in a). Note that the intertubercular sulcus (arrowheads in a) is obtuse. (c, d) Full-thickness tear of the subscapularis tendon in a 58-year-old man with impingement syndrome. On a transverse 12-5-MHz US image (c) and corresponding GRE MR image (550/15/25°) (d), the torn subscapularis tendon (* in c) is retracted from its normal attachment point on the lesser tuberosity, and the biceps tendon (arrow) is dislocated medially out of the groove (arrowheads in c).

View larger version (118K): [in a new window]   Figure 4a.  Pectoralis major tendon. (a) Schematic illustrates the relationship of the pectoralis major tendon (green) to the myotendinous junction of the biceps (B). The biceps muscle and biceps tendon are shown in red and orange, respectively. (b) Corresponding transverse 12-5-MHz US image obtained distal to the humeral tuberosities shows the pectoralis major tendon (arrowheads), which crosses the myotendinous junction of the biceps tendon (B) on its anterior aspect to insert onto the humeral shaft (H).

View larger version (101K): [in a new window]   Figure 4b.  Pectoralis major tendon. (a) Schematic illustrates the relationship of the pectoralis major tendon (green) to the myotendinous junction of the biceps (B). The biceps muscle and biceps tendon are shown in red and orange, respectively. (b) Corresponding transverse 12-5-MHz US image obtained distal to the humeral tuberosities shows the pectoralis major tendon (arrowheads), which crosses the myotendinous junction of the biceps tendon (B) on its anterior aspect to insert onto the humeral shaft (H).

View larger version (193K): [in a new window]   Figure 5a.  Pectoralis major tendon tear in a 37-year-old man who presented with pain after attempting to catch a heavy object. (a) Clinical photograph shows a palpable defect (arrow) in the anterior wall of the left axilla. (b) Transverse extended-field-of-view 12-5-MHz US image reveals hypoechoic fluid that fills the bed of the ruptured pectoralis major tendon (arrowheads). Note the medial retraction of the belly of the pectoralis major muscle (PM) and the anterior displacement of the myotendinous junction of the biceps tendon (B), which appears to be surrounded by fluid. D = deltoid muscle, H = humerus, Pm = pectoralis minor muscle.

View larger version (106K): [in a new window]   Figure 5b.  Pectoralis major tendon tear in a 37-year-old man who presented with pain after attempting to catch a heavy object. (a) Clinical photograph shows a palpable defect (arrow) in the anterior wall of the left axilla. (b) Transverse extended-field-of-view 12-5-MHz US image reveals hypoechoic fluid that fills the bed of the ruptured pectoralis major tendon (arrowheads). Note the medial retraction of the belly of the pectoralis major muscle (PM) and the anterior displacement of the myotendinous junction of the biceps tendon (B), which appears to be surrounded by fluid. D = deltoid muscle, H = humerus, Pm = pectoralis minor muscle.

View larger version (181K): [in a new window]   Figure 6a.  Posterior GHJ instability in a 17-year-old girl with posterior voluntary subluxation. IS = infraspinatus tendon, L = posterior labrum. (a) Transverse 12-5-MHz US image obtained over the posterior right shoulder during subluxation shows that the humeral head (HH) is more exposed and posterior to the level of the bony glenoid (G) (dotted line). (b) US image obtained after reduction of the subluxation shows the humeral head (HH) and the glenoid (G) in exact apposition.

View larger version (179K): [in a new window]   Figure 6b.  Posterior GHJ instability in a 17-year-old girl with posterior voluntary subluxation. IS = infraspinatus tendon, L = posterior labrum. (a) Transverse 12-5-MHz US image obtained over the posterior right shoulder during subluxation shows that the humeral head (HH) is more exposed and posterior to the level of the bony glenoid (G) (dotted line). (b) US image obtained after reduction of the subluxation shows the humeral head (HH) and the glenoid (G) in exact apposition.

View larger version (157K): [in a new window]   Figure 7a.  Hill-Sachs lesion in a 47-year-old man with recurrent anterior shoulder instability. (a) Transverse 12-5-MHz US image obtained over the posterior shoulder reveals a wide, deep, and irregular grooved defect (arrows) of the humeral head (HH). IS = infraspinatus muscle. (b) Radiograph helps confirm the presence of a Hill-Sachs lesion (arrow).

View larger version (135K): [in a new window]   Figure 7b.  Hill-Sachs lesion in a 47-year-old man with recurrent anterior shoulder instability. (a) Transverse 12-5-MHz US image obtained over the posterior shoulder reveals a wide, deep, and irregular grooved defect (arrows) of the humeral head (HH). IS = infraspinatus muscle. (b) Radiograph helps confirm the presence of a Hill-Sachs lesion (arrow).

View larger version (148K): [in a new window]   Figure 8a.  Avulsion fracture of the greater tuberosity in a 32-year-old man with anterior shoulder instability. (a, b) Longitudinal (a) and transverse (b) 12-5-MHz US images demonstrate interruption of the continuity of the humeral surface (arrowheads in b) and a small fragment of bone (arrow) displaced superiorly into the supraspinatus tendon (SS). (c) Radiograph helps confirm the presence of an avulsion fracture (arrow).

View larger version (165K): [in a new window]   Figure 8b.  Avulsion fracture of the greater tuberosity in a 32-year-old man with anterior shoulder instability. (a, b) Longitudinal (a) and transverse (b) 12-5-MHz US images demonstrate interruption of the continuity of the humeral surface (arrowheads in b) and a small fragment of bone (arrow) displaced superiorly into the supraspinatus tendon (SS). (c) Radiograph helps confirm the presence of an avulsion fracture (arrow).

View larger version (118K): [in a new window]   Figure 8c.  Avulsion fracture of the greater tuberosity in a 32-year-old man with anterior shoulder instability. (a, b) Longitudinal (a) and transverse (b) 12-5-MHz US images demonstrate interruption of the continuity of the humeral surface (arrowheads in b) and a small fragment of bone (arrow) displaced superiorly into the supraspinatus tendon (SS). (c) Radiograph helps confirm the presence of an avulsion fracture (arrow).

View larger version (159K): [in a new window]   Figure 9a.  Avulsion fracture of the lesser tuberosity in a 54-year-old woman with posterior shoulder instability. (a) Transverse 12-5-MHz US image obtained over the anterior shoulder shows a large fleck of bone (arrows) avulsed from the humeral head (HH). Note the deep defect (arrowheads) on the anterior surface of the humerus and the continuity of the avulsed bone with the subscapularis tendon (*). (b) Corresponding GRE MR image (500/15/20°) shows the avulsed bone fragment (arrows), the humeral defect (arrowheads), and the subscapularis tendon (*).

View larger version (144K): [in a new window]   Figure 9b.  Avulsion fracture of the lesser tuberosity in a 54-year-old woman with posterior shoulder instability. (a) Transverse 12-5-MHz US image obtained over the anterior shoulder shows a large fleck of bone (arrows) avulsed from the humeral head (HH). Note the deep defect (arrowheads) on the anterior surface of the humerus and the continuity of the avulsed bone with the subscapularis tendon (*). (b) Corresponding GRE MR image (500/15/20°) shows the avulsed bone fragment (arrows), the humeral defect (arrowheads), and the subscapularis tendon (*).

View larger version (153K): [in a new window]   Figure 10a.  Mild ACJ sprain in a 42-year-old woman with posttraumatic shoulder pain. Coronal (a) and sagittal (b) 13-10-MHz US images reveal a widened, echogenic joint space (arrowheads). A = acromion, C = clavicle.

View larger version (168K): [in a new window]   Figure 10b.  Mild ACJ sprain in a 42-year-old woman with posttraumatic shoulder pain. Coronal (a) and sagittal (b) 13-10-MHz US images reveal a widened, echogenic joint space (arrowheads). A = acromion, C = clavicle.

View larger version (127K): [in a new window]   Figure 11a.  Posttraumatic osteolysis of the clavicle in a 25-year-old man with a 6-month history of posttraumatic pain and tenderness over the ACJ. (a) Coronal 10-5-MHz US image demonstrates irregular erosion (arrowheads) of the distal end of the clavicle (C). A = acromion. (b) Radiograph helps confirm the presence of osteolysis (arrow).

View larger version (120K): [in a new window]   Figure 11b.  Posttraumatic osteolysis of the clavicle in a 25-year-old man with a 6-month history of posttraumatic pain and tenderness over the ACJ. (a) Coronal 10-5-MHz US image demonstrates irregular erosion (arrowheads) of the distal end of the clavicle (C). A = acromion. (b) Radiograph helps confirm the presence of osteolysis (arrow).

View larger version (163K): [in a new window]   Figure 12.  Fluid collections in the SA-SD bursa. (a) Transverse 12-5-MHz US image obtained over the posterior shoulder reveals a bursal fluid collection (*) overlying the infraspinatus tendon (IS). Note the coexistent joint effusion in the posterior recess () deep to the infraspinatus tendon. G = glenoid, HH = humeral head. (b) Coronal 12-5-MHz US image obtained over the lateral shoulder shows a bursal fluid collection (*) just inferior to the greater tuberosity (GT) and distal to the insertion of the supraspinatus tendon (SS). (c) Transverse 12-5-MHz US image obtained over the anterior shoulder demonstrates a bursal fluid collection (*) that extends superficial to the bicipital groove. Note the lack of fluid in the underlying biceps tendon sheath (arrow), a finding that reflects the absence of communication between the SA-SD bursa and the GHJ. GT = greater tuberosity, LT = lesser tuberosity.

View larger version (147K): [in a new window]   Figure 12.  Fluid collections in the SA-SD bursa. (a) Transverse 12-5-MHz US image obtained over the posterior shoulder reveals a bursal fluid collection (*) overlying the infraspinatus tendon (IS). Note the coexistent joint effusion in the posterior recess () deep to the infraspinatus tendon. G = glenoid, HH = humeral head. (b) Coronal 12-5-MHz US image obtained over the lateral shoulder shows a bursal fluid collection (*) just inferior to the greater tuberosity (GT) and distal to the insertion of the supraspinatus tendon (SS). (c) Transverse 12-5-MHz US image obtained over the anterior shoulder demonstrates a bursal fluid collection (*) that extends superficial to the bicipital groove. Note the lack of fluid in the underlying biceps tendon sheath (arrow), a finding that reflects the absence of communication between the SA-SD bursa and the GHJ. GT = greater tuberosity, LT = lesser tuberosity.

View larger version (142K): [in a new window]   Figure 12.  Fluid collections in the SA-SD bursa. (a) Transverse 12-5-MHz US image obtained over the posterior shoulder reveals a bursal fluid collection (*) overlying the infraspinatus tendon (IS). Note the coexistent joint effusion in the posterior recess () deep to the infraspinatus tendon. G = glenoid, HH = humeral head. (b) Coronal 12-5-MHz US image obtained over the lateral shoulder shows a bursal fluid collection (*) just inferior to the greater tuberosity (GT) and distal to the insertion of the supraspinatus tendon (SS). (c) Transverse 12-5-MHz US image obtained over the anterior shoulder demonstrates a bursal fluid collection (*) that extends superficial to the bicipital groove. Note the lack of fluid in the underlying biceps tendon sheath (arrow), a finding that reflects the absence of communication between the SA-SD bursa and the GHJ. GT = greater tuberosity, LT = lesser tuberosity.

View larger version (163K): [in a new window]   Figure 13a.  Rheumatoid arthritis in a 62-year-old woman with long-standing disease. (a) Transverse 12-5-MHz US image obtained over the posterior shoulder reveals a hypoechoic soft-tissue mass that represents synovial pannus within the posterior recess (arrowheads). In addition, there is a defect (arrow) of the posterior humeral head (HH), a finding that represents erosion. G = glenoid. (b) Corresponding GRE MR image (500/15/20°) demonstrates the soft-tissue mass (arrowheads).

View larger version (149K): [in a new window]   Figure 13b.  Rheumatoid arthritis in a 62-year-old woman with long-standing disease. (a) Transverse 12-5-MHz US image obtained over the posterior shoulder reveals a hypoechoic soft-tissue mass that represents synovial pannus within the posterior recess (arrowheads). In addition, there is a defect (arrow) of the posterior humeral head (HH), a finding that represents erosion. G = glenoid. (b) Corresponding GRE MR image (500/15/20°) demonstrates the soft-tissue mass (arrowheads).

View larger version (154K): [in a new window]   Figure 14a.  ACJ cyst in a 68-year-old man with a chronic rotator cuff tear. (a) Clinical photograph demonstrates a soft-tissue mass (arrow) that arises over the ACJ. (b) Coronal 12-5-MHz US image reveals a cystic mass (arrowheads) that arises from the ACJ. A = acromion, C = clavicle.

View larger version (134K): [in a new window]   Figure 14b.  ACJ cyst in a 68-year-old man with a chronic rotator cuff tear. (a) Clinical photograph demonstrates a soft-tissue mass (arrow) that arises over the ACJ. (b) Coronal 12-5-MHz US image reveals a cystic mass (arrowheads) that arises from the ACJ. A = acromion, C = clavicle.

View larger version (166K): [in a new window]   Figure 15a.  Intraarticular loose body in a 45-year-old woman. (a) Longitudinal 12-5-MHz US image of the shoulder obtained at the level of the sheath of the LBT (arrowheads) demonstrates a loose body (arrow) surrounded by anechoic fluid in the synovial space. (b) Corresponding radiograph shows the fragment with a typical laminated concentric appearance (arrow).

View larger version (107K): [in a new window]   Figure 15b.  Intraarticular loose body in a 45-year-old woman. (a) Longitudinal 12-5-MHz US image of the shoulder obtained at the level of the sheath of the LBT (arrowheads) demonstrates a loose body (arrow) surrounded by anechoic fluid in the synovial space. (b) Corresponding radiograph shows the fragment with a typical laminated concentric appearance (arrow).

View larger version (127K): [in a new window]   Figure 16a.  Intraosseous loculation of calcifying tendinitis in a 54-year-old man with boring shoulder pain. (a) Longitudinal 12-5-MHz US image of the supraspinatus tendon demonstrates calcific slurry (arrow) within the tendon. The calcific material extends into a deep cavity within the greater tuberosity (arrowheads). (b) Corresponding CT scan demonstrates the calcifications (arrow) and the cavity within the greater tuberosity (arrowheads).

View larger version (119K): [in a new window]   Figure 16b.  Intraosseous loculation of calcifying tendinitis in a 54-year-old man with boring shoulder pain. (a) Longitudinal 12-5-MHz US image of the supraspinatus tendon demonstrates calcific slurry (arrow) within the tendon. The calcific material extends into a deep cavity within the greater tuberosity (arrowheads). (b) Corresponding CT scan demonstrates the calcifications (arrow) and the cavity within the greater tuberosity (arrowheads).

View larger version (129K): [in a new window]   Figure 17a.  Intrabursal rupture of calcifying tendinitis in a 46-year-old woman with severe shoulder pain and tenderness. (a) Coronal 12-5-MHz US image obtained over the lateral shoulder reveals a thickened SA-SD bursa that contains fluid (*) and calcified material (arrow) just inferior to the greater tuberosity (GT) and distal to the insertion of the supraspinatus tendon (SS). (b) Corresponding radiograph shows calcified material (arrow) that lies in the dependent lateral portion of the SA-SD bursa.

View larger version (155K): [in a new window]   Figure 17b.  Intrabursal rupture of calcifying tendinitis in a 46-year-old woman with severe shoulder pain and tenderness. (a) Coronal 12-5-MHz US image obtained over the lateral shoulder reveals a thickened SA-SD bursa that contains fluid (*) and calcified material (arrow) just inferior to the greater tuberosity (GT) and distal to the insertion of the supraspinatus tendon (SS). (b) Corresponding radiograph shows calcified material (arrow) that lies in the dependent lateral portion of the SA-SD bursa.

View larger version (178K): [in a new window]   Figure 18.  Septic bursitis in a 37-year-old woman who presented with increasing shoulder pain and swelling after undergoing corticosteroid injection. Coronal 12-5-MHz US image obtained over the lateral shoulder demonstrates an SA-SD bursa (arrowheads) that is grossly distended by highly echogenic fluid. Aspiration revealed purulent material.

View larger version (187K): [in a new window]   Figure 19a.  Paralabral ganglion cyst. Coronal 12-5-MHz US images of the inferior GHJ show an abnormal hypoechoic area (arrowhead in a) in the inferior labrum (arrows in a) that represents an inferior labral tear. The tear is contiguous with a small paralabral cyst (arrows in b) that extends inferiorly. Note the humeral head (HH) covered by hypoechoic articular cartilage (* in b). G = glenoid.

View larger version (188K): [in a new window]   Figure 19b.  Paralabral ganglion cyst. Coronal 12-5-MHz US images of the inferior GHJ show an abnormal hypoechoic area (arrowhead in a) in the inferior labrum (arrows in a) that represents an inferior labral tear. The tear is contiguous with a small paralabral cyst (arrows in b) that extends inferiorly. Note the humeral head (HH) covered by hypoechoic articular cartilage (* in b). G = glenoid.

View larger version (106K): [in a new window]   Figure 20a.  Suprascapular nerve entrapment at the spinoglenoid notch in a 54-year-old man. Longitudinal 12-5-MHz US image obtained over the posterior shoulder (a) and corresponding coronal fat-saturated GRE MR image (700/15/20°) (b) reveal an oval cystic lesion (*) located deep to the infraspinatus tendon (IS) and medial to the glenoid (G), a finding that is consistent with a ganglion cyst. Note the thin neck of the cyst (arrowheads in a) directed toward the GHJ. H = humeral head.

View larger version (135K): [in a new window]   Figure 20b.  Suprascapular nerve entrapment at the spinoglenoid notch in a 54-year-old man. Longitudinal 12-5-MHz US image obtained over the posterior shoulder (a) and corresponding coronal fat-saturated GRE MR image (700/15/20°) (b) reveal an oval cystic lesion (*) located deep to the infraspinatus tendon (IS) and medial to the glenoid (G), a finding that is consistent with a ganglion cyst. Note the thin neck of the cyst (arrowheads in a) directed toward the GHJ. H = humeral head.

View larger version (80K): [in a new window]   Figure 21a.  Axillary nerve entrapment in a 24-year-old man with no obvious history of trauma. (a) Sagittal extended-field-of-view 12-5-MHz US image obtained over the posterior fossa demonstrates loss in bulk and increased echogenicity of the teres minor muscle (Tm), a finding that is consistent with fat atrophy. The infraspinatus muscle (IS) is preserved. D = deltoid muscle. (b) Corresponding US image obtained on the contralateral side shows a normal teres minor muscle (Tm) and infraspinatus muscle (IS). * = spine of the scapula, D = deltoid muscle.

View larger version (78K): [in a new window]   Figure 21b.  Axillary nerve entrapment in a 24-year-old man with no obvious history of trauma. (a) Sagittal extended-field-of-view 12-5-MHz US image obtained over the posterior fossa demonstrates loss in bulk and increased echogenicity of the teres minor muscle (Tm), a finding that is consistent with fat atrophy. The infraspinatus muscle (IS) is preserved. D = deltoid muscle. (b) Corresponding US image obtained on the contralateral side shows a normal teres minor muscle (Tm) and infraspinatus muscle (IS). * = spine of the scapula, D = deltoid muscle.

View larger version (171K): [in a new window]   Figure 22a.  Elastofibroma dorsi in a 46-year-old man with stiffness and clicking of the scapula. (a) Clinical photograph obtained with the patient’s arm abducted shows a mass effect in the dorsum (arrow). (b) Transverse 12-5-MHz US image reveals an elastofibroma dorsi (arrows). The mass exhibits a typical striated appearance created by hypoechoic stripes of fat (arrowheads) on an echogenic background (*), a finding that represents fibroelastic tissue.

View larger version (186K): [in a new window]   Figure 22b.  Elastofibroma dorsi in a 46-year-old man with stiffness and clicking of the scapula. (a) Clinical photograph obtained with the patient’s arm abducted shows a mass effect in the dorsum (arrow). (b) Transverse 12-5-MHz US image reveals an elastofibroma dorsi (arrows). The mass exhibits a typical striated appearance created by hypoechoic stripes of fat (arrowheads) on an echogenic background (*), a finding that represents fibroelastic tissue.