Diagnostic ultrasound ( PDFDrive )

894 PART III Small Parts, Carotid Artery, and Peripheral Vessel Sonography
FIG. 24.27 Longitudinal Split Tear of the Long Head of Biceps Tendon. Short-axis image demonstrates a hypoechoic cleft (arrow) through
the long head of biceps tendon, dividing it into two components.
FIG. 24.28 Acromioclavicular Joint Osteoarthritis. Image of the acromioclavicular joint demonstrates osteophyte formation at the distal
clavicle (arrow) and capsular thickening and hypertrophy (arrowhead).
may have glenohumeral efusion. his is best assessed posteriorly,
and a thickness of 3 mm or more from the humeral head
to the capsule may represent efusion and/or synovial thickening 95
(Fig. 24.29). Ultrasound is particularly sensitive to detection of
luid in the posterior glenohumeral recess when patients are
scanned with the arm in external rotation 52 (see Video 24.4).
Use of color Doppler, particularly power Doppler, 96 is helpful to
elucidate synovial hyperemia and can help separate thickened
synovium from complex intraarticular luid. Bone erosions may
also be present, characterized by bony cortical surface rounded
or steplike deformations, oten at the humeral head margins. 97,98
Ultrasound may be used as a complementary technique to
radiographs in assessment for erosions, because it may detect
radiographically occult erosions, 94 although overall, MRI has
greater sensitivity and can be used for problem solving. 99 In
ankylosing spondylitis, acromioclavicular synovitis is common.
Patients with inlammatory arthritis may also be afected by
subacromial-subdeltoid bursitis, in addition to rotator cuf and
biceps tendon tears.
FIG. 24.29 Glenohumeral Joint Effusion. Image of the posterior
shoulder shows increased luid within the joint (arrow) in this patient
with osteoarthritis.