ultrasound of the shoulder 2012

23/03/2013

1

Ultrasound+Scanning+of+the+Shoulder+

– Lennard+Funk+lenfunk@shoulderdoc.co.uk+

UBUNTU+

•  �Ubuntu speaks+of+the+very+essence+of+being+human.+[We]+say+[...]+"Hey,+soFandFso+has+ubuntu."+Then+you+are+generous,+you+are+hospitable,+you+are+friendly+and+caring+and+compassionate.++

•  You share what you have.+It+is+to+say,+"My+humanity+is+caught+up,+is+inextricably+bound+up,+in+yours."+We+belong+in+a+bundle+of+life.++

•  We+say,+"A person is a person through other persons."+

What+is+Ultrasound+

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2

Medical+Ultrasound+

"  Compound+waterFbath+scanner+"  Gun+turret+of+B29+Bomber+

Howry & Bliss, 1949

Ultrasound+of+the+Shoulder+

"  1979+F+Seltzer+(Harvard)+Rhesus+monkeys+

"  1983+F+Bunker+F+first+USS+shoulder+(Exeter)+

"  1984+F+Craig+F+J+Clin+Ultrasound+"  1985+F+Bunker+presented+to+BOA+"  1987+F+Thesis+&+publica_on+(Bunker)+++++++++++F+100+shoulders+

Bunker T. Journal Bone Joint Surg 1985; 68B Bunker T. Seminars in Orthopaedics 1987;2(4): 267-276

23/03/2013

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Bunker,+1985+

Modern+portable+Ultrasound+

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4

What+can+you+see+

Rotator Cuff

AC Joint

Greater Tuberosity

Biceps

Subacromial Bursa

What+you+cannot+see+

Intra-articular LHB

Labrum

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5

Benefits+"  Cheap+"  Convenient+"  Quick+"  No+radia_on+"  Dynamic+"  Interac_ve+"  OfficeFBased+

Limita_ons+

"  Operator+Dependent+

Diagnos_c+F+When+to+use+it+

"  Rotator+Cuff+"  Impingement+"  Tears+"  Calcific+Tendoni_s+

"  Biceps+(ExtraFar_cular)+

"  HillFSachs+Lesions+

"  Frozen Shoulder "  AC Joint "  Arthritis " Osteolysis "  Instability

"  Fractures

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Impingement+Bursi_s+

Rotator+Cuff+Tear+

Calcific+Tendoni_s+

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Biceps+Tendoni_s+

Dislocated+LHB+

Fracture+Greater+Tuberosity+

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8

Fracture+Greater+Tuberosity+

HillFSachs+Lesion+

PostFop+Cuff+Repair+

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�Ultrasound is a highly accurate imaging study for evaluating the integrity of the rotator cuff in shoulders that have undergone an operation. Its accuracy for operatively treated shoulders appears to be comparable with that previously reported for shoulders that had not been operated on.�

Pectoralis+Major+

Interven_onal+

Guided Injections

1. Subacromial Impingement 2. AC Joint 3. Biceps

Hydrodilatation / Distension

Frozen Shoulder - Primary - Post Trauma / Surgery

Barbotage Calcific Tendonitis

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Subacromial Injection

Biceps Injection

Barbotage for Calcific Deposit

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When+not+to+use+it+

"  Shoulder+Instability+

"  Labral+Tears+"  Young+Athle_c++

OfficeFBased+Ultrasound+

Changing+world+

"  Consumer+society+"  Faster+diagnosis+"  Quicker+_me+to+treatment+&+recovery+"  Difficult+/+slow+access+to+Imaging+

23/03/2013

12

Suspected+Rotator+Cuff+Tear+

"   Does+he+have+a+rotator+cuff+tear?+

"   How+big+is+it?+

"  What+do+the+tendon+edges+look+like+

"  What+is+the+state+of+the+Long+Head+of+Biceps?+

Suspected+Rotator+Cuff+Tear+•  First Visit

•  Referral+for+Ultrasound+

2 months / 1 week

Report

Ultrasound Scan

Ultrasound+Report+•  There is a full thickness tear of the supraspinatus tendon.

•  The infraspinatus tendon is a bit thinned, but is probably intact.

•  Long head of biceps is not well seen.

How big is the tear? What is the quality of the cuff edges?

Is LHB subluxed / torn / partially torn / absent?

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Suspected+Rotator+Cuff+Tear+•  First Visit

•  Referral+for+Ultrasound+

Ultrasound Scan

2 months / 1 week

1 week

Report Read Report 1 week

OPD Review

2 months / 1 week

Surgery

6 months / 3 weeks

6 months / 3 weeks

There is a full thickness tear of the supraspinatus tendon.

The infraspinatus tendon is a bit thinned, but is probably intact.

Long head of biceps is not well seen.

Problems+

"   Time+

"   Inconvenience+

"   Loss+of+earnings+

"   Con_nued+disability+

•  Exact Tear not known

•  Surgical Plan less clear

•  Tears get bigger

•  Muscle degenerates

•  Bigger tears = worse results

Revolu_on+–+Office+Ultrasound+✤  Performed+by+Clinician+✤  Quick+✤  CostFEffec_ve+✤  One+Stop+Clinic+

✤  Immediate+Diagnosis+✤ Management+Plan+✤  Shorter+Wai_ng+Time+for+Surgery+

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Surgeon+with+scanner:+

Learning+Curve+

"  4+surgeons;+159+shoulders+"  Correlated+with+Arthroscopy+"  Surgeons+>+100+scans:+"  94%+Sensi_vity+"  88%+Specificity+

BESS+Guidelines+

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BESS+Guidelines+

BESS+Guidelines+

Shoulderscan.com+