Musculoskeletal disorders involving the shoulder joint have become increasingly common. Previously, contrast-enhanced shoulder joint X-rays were the preferred diagnostic tool. However, nowadays, non-invasive imaging techniques have advanced, including shoulder joint ultrasound. This technique not only supports examination and diagnosis but is also used by physicians as part of the treatment for some conditions.
This article is professionally consulted by MD, Specialist level I. Nguyen Thanh Hai - Radiologist, Department of Diagnostic Imaging and Nuclear Medicine, Vinmec Times City International General Hospital.
1. What is the shoulder joint?
The shoulder joint plays a crucial role in enabling flexible movements involved in most body activities. However, it is vulnerable to damage due to various causes.
The shoulder joint is a large joint composed of several bones, muscles, and ligaments in the shoulder and arm area. Its main function is to coordinate movements in daily activities along with other joints.
Components of the shoulder joint include:
Bones:
- The humerus is the largest bone forming the shoulder joint, with a rounded head that fits into the shallow cavity of the scapula to allow easy rotation.
- The scapula (shoulder blade) is triangular and connects the clavicle and humerus to the front parts of the body.
- The clavicle (collarbone) is a small bone extending from the sternum to the acromion of the scapula, helping stabilize shoulder joint movements.
Ligaments:
- The coracoacromial ligament is the strongest ligament of the shoulder joint, attaching from the coracoid process of the scapula down to the greater and lesser tubercles of the humerus.
- The glenohumeral ligaments extend from the glenoid cavity to the humerus and are divided into superior, middle, and inferior parts, surrounding the shoulder joint.
- The coracoclavicular ligament connects the acromion and coracoid processes, forming the coracoid arch, and is well visualized on shoulder ultrasound.
2. What Is Shoulder Joint Ultrasound for Musculoskeletal Disorders?
Shoulder joint ultrasound is a non-invasive imaging technique that effectively helps examine certain injuries related to the shoulder. It typically uses a high-frequency linear probe (7.5 - 12 MHz).
The procedure is usually performed with the patient sitting upright, with positioning adjusted according to the physician’s instructions during the scan.
A comprehensive ultrasound examination covers both shoulders, starting with the asymptomatic or less symptomatic side, typically divided into three regions: anterior, middle, and posterior.
Some ultrasound findings that assist diagnosis include:
- Normal shoulder ultrasound: Shows the rotator cuff tendons and other tendons such as the biceps brachii, supraspinatus, infraspinatus, subscapularis, and teres minor muscles, along with joints and ligaments.
- Biceps brachii tendon: Patient is seated, with the palm turned up at the ceiling. The biceps brachii tendon is visualized as an oval shape in cross-section within the bicipital groove, with small hypoechoic fibers inside (fibrous tissue). In longitudinal view, it appears as parallel echogenic fibers.
- Pain in the front and center of the arm is suggestive of biceps brachii tendon tear. Signs of tendon tear include fluid around the torn area and thickened echogenicity at the rupture site. Other abnormalities include tendinitis, dislocation, or subluxation of the biceps tendon.
- Supraspinatus tendon: May show inflammation, partial or full-thickness tears.
- Dislocation: Ultrasound may reveal the humeral head displaced medially or laterally from the glenoid cavity.
- Other abnormalities detectable include synovial sheath inflammation, joint effusions, foreign bodies, deformities, or abnormal structures around the shoulder joint.
3. What are the benefits of shoulder joint ultrasound?
Beyond identifying lesions and aiding diagnosis, shoulder ultrasound supports effective treatment of various musculoskeletal disorders.
Certain injuries or inflammatory conditions confirmed by diagnosis can be treated with ultrasound guidance, such as bursitis, synovitis, and tendinitis.
Shoulder ultrasound is considered a safe and effective imaging modality for rapid evaluation of shoulder conditions and contributes to their management.
Its advantages include early detection of disorders, reducing the risk of severe complications later. However, it requires a skilled physician with detailed anatomical knowledge to identify abnormalities accurately during the scan.
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