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Published online December 13, 2005, 10.1148/rg.e23
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Right arrow Musculoskeletal Radiology
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US of the Shoulder: Rotator Cuff and Non–Rotator Cuff Disorders1

Athanasios Papatheodorou, MD, Panagiotis Ellinas, MD, Fotios Takis, MD, Antonios Tsanis, MD, Ioannis Maris, MD and Nikolaos Batakis, MD, PhD

1 From the Departments of Radiology (A.P., P.E., F.T., A.T., N.B.) and Orthopedics (I.M.), Hellenic Red Cross Hospital, 1 Athanasaki St, GR-115 26, Athens, Greece. Presented as an education exhibit at the 2004 RSNA Annual Meeting. Received May 19, 2005; revision requested August 2; revision received September 22; accepted October 6. All authors have no financial relationship to disclose.

Figure 1
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  		Figure 1.  Biceps tendon, longitudinal view. The biceps tendon (arrows) is seen as an echogenic structure with an internal fibrillar pattern.

 

Figure 2
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  		Figure 2.  Biceps tendon, transverse view. The biceps tendon (arrows) lies within the bicipital groove, between the lesser (LT) and greater (GT) tuberosities and below the deltoid muscle.

 

Figure 3
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  		Figure 3.  Biceps tendon, transverse view. The tendon of the pectoralis major (arrows) lies anteriorly to the lower part of the LHBT.

 

Figure 4
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  		Figure 4.  Rotator interval, transverse view. The echogenic biceps tendon (BT) lies below the coracohumeral ligament (CHL, arrows) and between the supraspinatus (SS) and subscapularis (SSC) tendons.

 

Figure 5
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  		Figure 5.  Subscapularis tendon, longitudinal view. The subscapularis tendon (arrows) demonstrates an internal fibrillar pattern and lies below the deltoid muscle.

 

Figure 6
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  		Figure 6.  Subscapularis tendon and coracoid process, longitudinal view. The coracoid process (C) lies anteriorly to the subscapularis tendon. Fluid (arrow) is seen in the subcoracoid bursa.

 

Figure 7
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  		Figure 7.  Supraspinatus tendon, longitudinal view. The tendon is seen as an echogenic band superior to the humeral head, with a convex upper surface; it tapers toward the greater tuberosity. The arrow indicates a hypoechogenic area due to tendon anisotropy.

 

Figure 8
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  		Figure 8.  Subacromial-subdeltoid bursa, longitudinal view. The subdeltoid bursa (arrows) is seen as a thin hypoechoic line superior to the supraspinatus tendon. The echogenic line superior to the bursa represents subdeltoid fat.

 

Figure 9
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  		Figure 9.  Infraspinatus tendon, longitudinal view. The infraspinatus tendon (arrows) lies superior to the posterosuperior aspect of the humeral head. Double arrows outline the glenoid labrum.

 

Figure 10
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  		Figure 10.  Supraspinatus tendon, transverse view. The supraspinatus tendon (SS) lies anterior to the infraspinatus tendon (IS); there is no distinct border between the two tendons.

 

Figure 11
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  		Figure 11.  Acromioclavicular joint, longitudinal view. The acromioclavicular joint is the area between the acromion (A) and clavicle (C). The superior aspect of the joint capsule is seen as a hypoechoic band above the joint.

 

Figure 12
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  		Figure 12.  Coracoclavicular ligament, longitudinal view. The echogenic ligament (arrows) extends between the inferior aspect of the clavicle (CL) and the coracoid process (C).

 

Figure 13
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  		Figure 13.  Supraspinatus tendon, longitudinal view. The tendon demonstrates a heterogeneous echogenicity without any focal area representative of a tear. This pattern may indicate tendinosis or intrasubstance tear (17).

 

Figure 14
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  		Figure 14.  Subscapularis tendon, longitudinal view. This patient has multiple torn tendons. There is a complete subscapularis tendon tear. The area between the humerus and coracoid (C) is empty.

 

Figure 15
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  		Figure 15.  Supraspinatus tendon, longitudinal view, same patient as in Figure 14. A complete tear of the supraspinatus tendon is seen (tendon not visualized).

 

Figure 16
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  		Figure 16.  Infraspinatus tendon, longitudinal view, same patient as in Figure 14. A complete tear of the infraspinatus tendon is seen (tendon not visualized).

 

Figure 17
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  		Figure 17.  Supraspinatus tendon, longitudinal view. An articular-side partial-thickness tear appears as a distinct hypoechoic defect (arrow) at the tendon’s articular surface, abutting the articular cartilage.

 

Figure 18
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  		Figure 18.  Supraspinatus tendon, transverse view. Cortical bone irregularity (arrows) at the greater tuberosity is seen. (S = supraspinatus, I = infraspinatus.)

 

Figure 19
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  		Figure 19.  Supraspinatus tendon, longitudinal view. Hypoechoic fluid fills a full-thickness tear of the supraspinatus tendon (arrows), with loss of the normal outward convexity of the tendon at this site.

 

Figure 20
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  		Figure 20.  Supraspinatus tendon, transverse view. A full-thickness tear of the anterior aspect of the tendon fills with anechoic joint fluid.

 

Figure 21
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  		Figure 21.  Supraspinatus tendon, longitudinal view. A full-thickness tear is seen. Owing to the pressure applied with the transducer, the deltoid muscle abuts the humeral head.

 

Figure 22
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  		Figure 22.  Biceps tendon, transverse view. A hypoechoic joint fluid collection is seen around the biceps tendon.

 

Figure 23
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  		Figure 23.  Biceps tendon, longitudinal view. A hypoechoic joint fluid collection is seen around the biceps tendon.

 

Figure 24
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  		Figure 24.  Subscapularis tendon, longitudinal view. A fluid collection in the subdeltoid bursa (arrows) next to the coracoid is seen.

 

Figure 25
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  		Figure 25.  Greater tuberosity, transverse view. A massive fluid collection (FL) in the subdeltoid bursa is seen.

 

Figure 26
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  		Figure 26.  Biceps tendon, transverse view. A joint fluid collection (arrows) around the biceps tendon (double arrows) and an adjacent subdeltoid fluid collection are seen.

 

Figure 27
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  		Figure 27.  Subscapularis tendon, longitudinal view. A fluid collection in the subdeltoid bursa and areas of nodal synovial proliferation (arrows) are seen.

 

Figure 28
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  		Figure 28.  Supraspinatus tendon, transverse view. A gap in the mass of the tendon contain anechoic joint fluid and represents a full-thickness tear. The uncovered cartilage sign is the hyperechoic interface between the joint fluid and the cartilage covering the humeral head. There is also loss of the normal outward convexity of the supraspinatus tendon and dipping of the deltoid muscle.

 

Figure 29
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  		Figure 29.  Supraspinatus tendon, longitudinal view. Massive supraspinatus tendon tear with tendon nonvisualization and joint fluid collection. The stump of the supraspinatus tendon (arrows) is retracted.

 

Figure 30
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  		Figure 30.  Supraspinatus tendon, transverse view. A massive supraspinatus tendon tear is seen. Owing to the pressure applied with the transducer, the deltoid muscle lies atop the humeral head.

 

Figure 31
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  		Figure 31.  Supraspinatus tendon, longitudinal view. A thickened hypoechoic synovium (which lacks an internal fibrillar pattern), and not the supraspinatus tendon, lies atop the humeral head.

 

Figure 32
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  		Figure 32.  Supraspinatus tendon, longitudinal view. A recurrent massive tear of the supraspinatus tendon is seen in a patient who underwent surgery for repair of a partially torn supraspinatus tendon. Note the uncovered cartilage sign and the presence of synovial proliferation and debris above the humeral head cartilage.

 

Figure 33
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  		Figure 33.  Greater tuberosity, transverse view. Postoperative changes in the greater tuberosity describe the supraspinatus tendon reimplantation trough.

 

Figure 34
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  		Figure 34.  Subscapularis tendon, longitudinal view. A dense calcification (arrows) is seen within the tendon.

 

Figure 35
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  		Figure 35.  Supraspinatus tendon, longitudinal view. Two dense calcifications with posterior shadowing are seen near the insertion of the supraspinatus tendon.

 

Figure 36
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  		Figure 36.  Infraspinatus tendon, longitudinal view. A large calcification (arrows) is seen in the anterior part of the infraspinatus tendon.

 

Figure 37
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  		Figure 37.  Supraspinatus tendon, longitudinal view. A massive calcification with posterior shadowing obscures the supraspinatus tendon.

 

Figure 38
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  		Figure 38.  LHBT, longitudinal view. The biceps tendon is enlarged, with an inhomogeneous echotexture that represents tendinosis.

 

Figure 39
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  		Figure 39.  LHBT, longitudinal color Doppler view, same patient as in Figure 38. The tendon shows increased vascularity that represents tendinosis.

 

Figure 40
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  		Figure 40.  LHBT, transverse view, same patient as in Figure 38. The biceps tendon is enlarged, with an inhomogeneous echotexture and associated joint fluid effusion that represent tendinosis.

 

Figure 41
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  		Figure 41.  LHBT, longitudinal view. Chronic rupture results in partial nonvisualization of the tendon within the bicipital groove, which is filled with echogenic scar tissue.

 

Figure 42
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  		Figure 42.  LHBT, transverse view. Chronic rupture results in partial nonvisualization of the tendon within the bicipital groove. The bicipital groove is filled with echogenic scar tissue that simulates a normal tendon; nonetheless, the characteristic fibrillar pattern of a tendon is not seen.

 

Figure 43
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  		Figure 43.  Bicipital groove, transverse view. The subluxated LHBT (B, arrows) lies medially displaced in a deep position, while the bicipital groove (parallel arrows) is empty.

 

Figure 44
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  		Figure 44.  Bicipital groove, transverse view. The subluxated LHBT (BT) is surrounded by a hypoechoic joint fluid collection.

 

Figure 45
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  		Figure 45.  Bicipital groove, transverse view. The subluxated LHBT (arrows) lies medially to a shallow bicipital groove with a flattened medial surface.

 

Figure 46
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  		Figure 46.  Infraspinatus tendon, longitudinal view. Patient had history of recurrent anterior shoulder instability. A bone defect at the posterosuperior aspect of the humeral head (Hill-Sachs lesion) is seen.

 

Figure 47
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  		Figure 47.  Supraspinatus tendon, longitudinal view. The avulsed bone fragment (arrows) originating from the greater tuberosity (GRT) protrudes superiorly, and the supraspinatus tendon (SS) is slightly retracted.

 

Figure 48
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  		Figure 48.  Shoulder radiograph, anteroposterior view, same patient as in Figure 47. An avulsion fracture of the greater tuberosity is seen.

 

Figure 49
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  		Figure 49.  Acromioclavicular joint, longitudinal view. Degenerative changes with synovial thickening and bone prominences and erosions are seen.

 

Figure 50
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  		Figure 50.  Acromioclavicular joint, transverse view, same patient as in Figure 49. A degenerative hypoechoic synovial cyst is seen.

 

Figure 51
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  		Figure 51.  Acromioclavicular joint, longitudinal view. The distal clavicular end is dislocated superiorly in relation to the acromion because of a recent but not acute injury.

 

Figure 52
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  		Figure 52.  Coracoclavicular ligament, longitudinal view. In a patient with a recent clavicular dislocation, a small fluid collection (double arrows) in the middle portion of the coracoclavicular ligament (arrow) represents acute ligamentous injury (CL = clavicle, COR = coracoid).

 

Figure 53
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  		Figure 53.  Coracoclavicular ligament, longitudinal view. Increased coracoclavicular distance (CL = clavicle, C = coracoid) is a result of an old traumatic clavicular dislocation. Dystrophic calcifications (arrow) at the site of the ruptured ligament are seen.

 

Figure 54
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  		Figure 54.  Acromion, transverse view. An extra acromial epiphysis (OA = os acromiale) joins a proximal acromion (A).

 

Figure 55
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  		Figure 55.  LHBT, transverse view. Primary osteochondromatosis. A well-defined calcified nodule with posterior shadowing medially to the LHBT (arrows) is seen.

 

Figure 56
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  		Figure 56.  Longitudinal view parallel to the LHBT. Primary osteochondromatosis. Multiple well-defined calcified nodules of uniform size aligned parallel to the LHBT (not shown) are seen.

 

Figure 57
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  		Figure 57.  Radiograph of the shoulder, anteroposterior view. Primary osteochondromatosis. Multiple osteocartilaginous nodules of uniform size cluster inferiorly to the humeral head.

 

Figure 58
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  		Figure 58.  Supraspinatus tendon, longitudinal view. Degenerative osteoarthritic changes of the humeral head, with a hypoechoic subchondral bone cyst (arrows).

 

Figure 59
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  		Figure 59.  Subscapularis tendon, longitudinal view. Degenerative osteoarthritic changes, with a hypoechoic bone erosion (arrow) beneath the subscapularis tendon (SSC).

 

Figure 60
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  		Figure 60.  LHBT, longitudinal view. Degenerative osteoarthritic changes, with the presence of a calcified intraarticular loose body (arrow) within a small joint fluid collection anterior to the tendon.

 

Figure 61
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  		Figure 61.  Subscapularis tendon, longitudinal view. Amyloid arthropathy of the shoulder in a patient undergoing long-term hemodialysis. Hypoechoic subchondral bone amyloid deposition lesions with sclerotic margins within the lesser tuberosity are seen.

 

Figure 62
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  		Figure 62.  Infraspinatus tendon, transverse view. Amyloid arthropathy of the shoulder, with moderate subdeltoid bursa effusion (arrows).

 

Figure 63
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  		Figure 63.  Infraspinatus tendon, longitudinal view. Amyloid arthropathy of the shoulder, with hyperechoic foci (arrow) at the posterior labrum representing chondrocalcinosis due to renal osteodystrophy.

 

Figure 64
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  		Figure 64.  Biceps tendon, transverse view. Acute hemarthrosis. The patient had been with anticoagulants for atrial fibrillation and presented with an acute painful unilateral shoulder swelling. A massive echogenic subdeltoid bursa effusion with a swirling pattern is seen (arrow = biceps tendon, S = subscapularis tendon).

 

Figure 65
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  		Figure 65.  Subdeltoid bursa, longitudinal view. Acute hemarthrosis. A huge echogenic effusion with internal inhomogeneity is seen.

 

Figure 66
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  		Figure 66.  Infraspinatus tendon, longitudinal view. An echogenic line (arrow) within the cartilage covering the humeral head represents chondrocalcinosis.

 

Figure 67
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  		Figure 67.  Subdeltoid bursa, transverse color Doppler image. A bursal fluid collection with thickened walls and increased vascularity represents septic arthritis.

 

Figure 68
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  		Figure 68.  Subdeltoid bursa, transverse view. Septic arthritis is seen as an echogenic joint effusion with a small bursal fluid collection.

 

Figure 69
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  		Figure 69.  Infraspinatus tendon, longitudinal view. A subcutaneous lipoma is demonstrated as a lenticular solid mass with internal inhomogeneity and fine septation.

 

Figure 70
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  		Figure 70.  Subscapular fossa, longitudinal view. A lenticular mass is located beneath subcutaneous fat and shows a striated hyperechoic pattern that represents an intramuscular lipoma.

 

Figure 71
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  		Figure 71.  Anterior shoulder, transverse view, 3.5-MHz probe. An intraarticular space-occupying lesion replaces and distends the joint space. The mass extends between the humeral head (B) and scapular spine (S). It was proved to be a synovial sarcoma.

 

Figure 72
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  		Figure 72.  Anterior shoulder, transverse color Doppler image, 3.5-MHz probe. The intraarticular lesion is solid with increased vascularity and multiple amorphous calcifications (synovial sarcoma).

 

Figure 73
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  		Figure 73.  Radiograph of the shoulder, anteroposterior view. A soft-tissue opacity mass with calcifications within the joint displaces the humeral head inferiorly. The humeral head shows signs of invasion (synovial sarcoma).

 




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