1. 23/03/2013
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+
1

2. 23/03/2013
Medical+Ultrasound+
Howry & Bliss, 1949
" Compound+waterFbath+scanner+
" Gun+turret+of+B29+Bomber+
Ultrasound+of+the+Shoulder+
Bunker T. Journal Bone Joint Surg 1985; 68B
Bunker T. Seminars in Orthopaedics 1987;2(4): 267-276
" 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+
2

3. 23/03/2013
Bunker,+1985+
Modern+portable+Ultrasound+
3

4. 23/03/2013
What+can+you+see+
Subacromial
AC Joint
Rotator
Bursa
Cuff
Greater
Tuberosity
Biceps
What+you+cannot+see+
Intra-articular
LHB
Labrum
4

5. 23/03/2013
Benefits+
" Cheap+
" Convenient+
" Quick+
" No+radia_on+
" Dynamic+
" Interac_ve+
" OfficeFBased+
Limita_ons+
" Operator+
Dependent+
Diagnos_c+F+When+to+use+it+
" Rotator+Cuff+ " Frozen Shoulder
" Impingement+
" AC Joint
" Tears+
" Calcific+Tendoni_s+ " Arthritis
" Biceps+(ExtraF " Osteolysis
ar_cular)+ " Instability
" HillFSachs+Lesions+ " Fractures
5

6. 23/03/2013
Impingement+Bursi_s+
Rotator+Cuff+Tear+
Calcific+Tendoni_s+
6

7. 23/03/2013
Biceps+Tendoni_s+
Dislocated+LHB+
Fracture+Greater+Tuberosity+
7

8. 23/03/2013
Fracture+Greater+Tuberosity+
HillFSachs+Lesion+
PostFop+Cuff+Repair+
8

9. 23/03/2013
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+
1. Subacromial Impingement
Guided
2. AC Joint
Injections
3. Biceps
Frozen Shoulder
Hydrodilatation /
- Primary
Distension
- Post Trauma / Surgery
Barbotage
Calcific Tendonitis
9

10. 23/03/2013
Subacromial Injection
Biceps Injection
Barbotage for Calcific
Deposit
10

11. 23/03/2013
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+
11

12. 23/03/2013
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
Ultrasound Scan
Report
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?
12

13. 23/03/2013
Suspected+Rotator+Cuff+Tear+
• First Visit
• Referral+for+Ultrasound+ Surgery
6 months
/ 3 weeks
6 months
2 months / 1 week
/ 3 weeks
Ultrasound Scan
OPD Review
1 week 2 months
/ 1 week
Report
Read Report
1 week
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+ • Exact Tear not known
" Inconvenience+ • Surgical Plan less clear
" Loss+of+earnings+ • Tears get bigger
" Con_nued+disability+ • 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+
13

14. 23/03/2013
Surgeon+with+
scanner:+
Learning+
Curve+
" 4+surgeons;+159+shoulders+
" Correlated+with+Arthroscopy+
" Surgeons+>+100+scans:+
" 94%+Sensi_vity+
" 88%+Specificity+
BESS+Guidelines+
14

15. 23/03/2013
BESS+Guidelines+
BESS+Guidelines+
Shoulderscan.com+
15