Diagnostic ultrasound ( PDFDrive )

892 PART III Small Parts, Carotid Artery, and Peripheral Vessel Sonography
commonly than the infraspinatus tendon, and more uncommonly
in the teres minor and subscapularis tendons. 83 Calcium deposits
may undergo resorption, and it is during this resorptive phase
that patients are most likely to be symptomatic. he hallmarks
of this phase on ultrasound evaluation are fragmented, nodular
or cystic echogenic deposits (Fig. 24.25), usually without shadowing,
and there may be associated neovascularity on color Doppler
assessment. 84 Associated bony osteolysis at the greater tuberosity
may be present and denotes a more clinically severe syndrome,
with more protracted pain and functional limitation. 85 More
dense arclike echogenic calciic deposits with clear posterior
acoustic shadowing are more likely to be asymptomatic or less
symptomatic. Ultrasound-guided treatment with direct needling
and barbotage leads to short- and long-term clinical improvement
in this condition. 86,87
LONG HEAD BICEPS TENDON
PATHOLOGY
he long head biceps tendon can be injured in the setting of
concomitant rotator cuf tear, shoulder dislocation, or overhead
sports. It has been noted by several authors that there is an
association between pathologies of the long head biceps tendon
and supraspinatus tendon, with coexistent injuries of these
structures in 22% to 79% of cases of injury to either
structure. 88
he long head biceps tendon is partly intraarticular and is
extrasynovial, with a tendon sheath at the intertubercular groove
that communicates with the glenohumeral joint. Because of this,
luid in the tendon sheath may relate to intraarticular processes,
particularly if associated with glenohumeral efusion. Inlammation
of the tendon sheath (tenosynovitis) should be considered,
however, if the tendon appears abnormal, if there is hyperemia
on color Doppler imaging, if there is no sign of alternative
FIG. 24.23 Subacromial-Subdeltoid Bursal Thickening. Image
shows increased luid in the subacromial bursa (straight arrow), and
thickening of the wall of the subacromial bursa (arrowheads). Note also
a small bursal-sided tear of the supraspinatus at its insertion (curved
arrow).
FIG. 24.25 Calciic Tendinitis of the Supraspinatus Tendon. Longaxis
image of the supraspinatus image demonstrates a hyperechoic
focus of calciication (arrowheads) within the supraspinatus tendon.
A
B
FIG. 24.24 Full-Thickness Supraspinatus Tendon Tear With Geyser Sign. (A) Image obtained at the acromioclavicular joint where the patient
felt a mass. The mass corresponds with a heterogeneous hypoechoic lesion (arrowheads) with internal debris and septation compatible with a
complex ganglion. (B) Long-axis image of the supraspinatus tendon in the same patient shows a full-thickness supraspinatus tendon tear (arrow)
in addition to thickening of the subacromial bursa.