Shoulder anatomy on ultrasound

Case contributed by Brendan Cullinane
Diagnosis not applicable

Biceps apparatus

Long head of biceps tendon apparatus: transverse views of a normal biceps tendon above the bicipital groove (BCG) on the left and at the BCG on the right. 

The BCG is a vertical groove between the greater and lesser tuberosities of the humeral head. It is covered by the transverse humeral ligament (THL), which is essentially the coracohumeral ligament (CHL) at the BCG and holds the tendon in place. 

Superior to the BCG, the tendon is surrounded by the biceps pulley, which is formed from the CHL and superior glenohumeral ligament (SGL). The biceps pulley also holds the tendon in place. 

The subscapularis tendon inserts onto the lesser tuberosity adjacent to the BCG and pulley. Tearing of the subscapularis can disrupt the THL and/or the pulley leading to dislocation or varying degrees of subluxation of the biceps tendon out of the BCG. Dynamic assessment under ultrasound observation is crucial for establishing the integrity of the THL in the case of subluxation.

Supraspinatus tendon

Supraspinatus tendon: a transverse view of a normal supraspinatus tendon is shown in this image. Note the 3 major tissue layers of subcutaneous fat, deltoid muscle and tendon ruling out a large, full-thickness tear of the tendon. Also note the relatively homogeneous texture and brightness and the smooth contour of the tendon, ruling out degeneration (tendinosis) and more subtle tearing. The bursa is thin and anechoic, the articular cartilage is thick and smooth and the surface of the greater tuberosity is regular.

Case Discussion

Images representing normal anatomy of the rotator cuff on ultrasound.

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