Shoulder USG

Introduction: Shoulder USG

Musculoskeletal Ultrasonography of the Shoulder/ Shoulder USG: The shoulder joint, a marvel of intricate anatomy and remarkable mobility, is prone to a spectrum of musculoskeletal pathologies. Musculoskeletal ultrasonography is a powerful diagnostic modality, offering real-time imaging of the shoulder’s soft tissue structures, aiding in the comprehensive assessment of various conditions affecting this complex joint.

The shoulder’s complexity arises from the harmonious interplay of muscles, tendons, ligaments, and nerves, each playing a crucial role in maintaining stability and facilitating the remarkable range of motion. Understanding this intricate anatomy forms the cornerstone of successful ultrasonographic evaluation.

Shoulder USG offers a dynamic, non-invasive approach, providing detailed imaging of the shoulder’s soft tissue structures. Its real-time capabilities allow for precise visualization of both static and dynamic movements, aiding in the assessment of pathology during active motion.

From rotator cuff tears and impingement syndromes to bicipital tendonitis and ligamentous injuries, ultrasonography unveils these pathologies with remarkable clarity. It enables the detection of subtle changes in tissue architecture, aiding in early diagnosis and subsequent treatment planning.

Aim of the Chapter:

In this chapter, we explore musculoskeletal ultrasonography’s role in evaluating the shoulder joint. Through detailed descriptions, visual aids, and clinical correlations, we delve into the nuances of shoulder anatomy, common pathologies, imaging techniques, and the interpretive skills necessary for a comprehensive assessment using ultrasonography.

Shoulder USG

Pathology, Clinical Evaluation & Intervention of Shoulder: PPT by Dr Shirish Amatya

Radiofrequency of Shoulder Joint

Shoulder USG: injection of Subcoracoid bursa

Posterior GH joint inj

Exploring Musculoskeletal Ultrasonography of the Shoulder

Shoulder ultrasonography is a valuable diagnostic tool for assessing various structures within the shoulder joint, including muscles, tendons, nerves, and ligaments. Let’s delve into the intricate details of the shoulder’s anatomy and common pathologies visualized through ultrasonography.

Muscles and Tendons:

Rotator Cuff Muscles and Tendons:

  1. Supraspinatus Muscle and Tendon:
    • Location: Superior to the scapula spine.
    • Role: Primary abductor of the arm.
    • Ultrasonography: Visualizes the tendon and potential tears.
  2. Infraspinatus Muscle and Tendon:
    • Location: Inferior to the scapula spine.
    • Role: External rotator of the arm.
    • Ultrasonography: Evaluation for tears or tendon pathology.
  3. Subscapularis Muscle and Tendon:
    • Location: Anterior aspect of the scapula.
    • Role: Medial rotator of the arm.
    • Ultrasonography: Assessing tendon integrity and tears.
  4. Teres Minor Muscle:
    • Location: Inferior border of the scapula.
    • Role: External rotation of the arm.
    • Ultrasonography: Evaluation for tears or abnormalities

Other important muscles

Long Head of Biceps Tendon:

  1. Location: Originates from the glenoid labrum.
  2. Role: Stabilizes the shoulder and aids in arm movements.
  3. Ultrasonography: Examination for tendonitis or tears.

Deltoid Muscles:

  • Location: Covers the shoulder joint.
  • Role: Assists in arm abduction and shoulder movements.
  • Ultrasonography: Notably assesses muscle thickness and potential pathologies.

Nerves and Ligaments:

Nerve Supply:

  1. Suprascapular Nerve:
    • Course: Innervates the supraspinatus and infraspinatus muscles.
    • Ultrasonography: Identification and assessment for entrapment or pathology.
  2. Axillary Nerve:
    • Innervation: Supplies the deltoid and teres minor muscles.
    • Ultrasonography: Evaluation for compression or damage.
  3. Lateral Pectoral Nerve:
    • Supply: Innervates the pectoralis major muscle and anterior joint capsule.
    • Ultrasonography: Tracing the location where the nerve can be ablated safely.


  1. Transverse Humeral Ligament:
    • Location: Covers the bicipital groove.
    • Function: Holds the long head of the biceps tendon in place.
    • Ultrasonography: Assessment for tears or instability.
  2. Glenohumeral Ligaments:
    • Function: Provide stability to the shoulder joint.
    • Ultrasonography: Examination for ligamentous laxity or pathology.
  3. Coracohumeral, Coracoacromial, and Coracoclavicular Ligaments:
    • Location: Provide structural support around the coracoid process.
    • Ultrasonography: Assessment for injuries or abnormalities.

Impingements and Pathologies:

Subcoracoid and Subacromial Impingements:

  • Subcoracoid Impingement:
    • Cause: Compression beneath the coracoid process.
    • Ultrasonography: Detects impingement-related changes or injuries.
  • Subacromial Impingement:
    • Cause: Compression beneath the acromion.
    • Ultrasonography: Visualizes structural changes, tendon thickening, or bursa inflammation.

Shoulder ultrasonography provides a non-invasive means to evaluate and diagnose various shoulder pathologies, aiding in treatment planning and management decisions. Understanding the anatomy and potential pathologies detected through ultrasonography assists healthcare professionals in offering optimal care for shoulder-related issues.

Further Reading