E1992. Ultrasound-Guided Musculoskeletal Interventions in the Shoulder
  1. Connie Ju; University of California Los Angeles
  2. Benjamin Levine; University of California Los Angeles
  3. Varand Ghazikhanian; University of California Los Angeles
The etiologies of pain in the shoulder include commonly implicated afflictions such as rotator cuff disease, biceps tendinopathy, adhesive capsulitis, infection, or arthritis and are frequently attributable to varying anatomic subparts including the joints, bursa, tendons, or nerves. Therefore, targeted interventions in the shoulder are often indicated to address shoulder pain, perform diagnostic joint aspiration, or inject contrast prior to imaging. Ultrasound guidance is a dynamic modality for experienced practitioners to perform many permutations of shoulder interventions by allowing both flexible patient positioning and live trouble-shooting. Given the rising incidence of shoulder pathology in the aging population, a concomitant rise in ultrasound-guided interventions should also be anticipated. Thus, familiarity with ultrasound anatomy and technical approaches for image-guided interventions in the shoulder is crucial for both diagnostic and therapeutic patient care.

Educational Goals / Teaching Points
This educational exhibit will review relevant shoulder ultrasound anatomy with cross-sectional imaging correlation. Indications and technical considerations for common and advanced ultrasound-guided shoulder interventions including steroid and anesthetic injection, aspiration, irrigation and lavage, and nerve blocks will be discussed. Lastly, the exhibit will review expected pre- and postprocedural ultrasound findings.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit will provide a pictorial review of basic shoulder ultrasound anatomy including bony landmarks, rotator cuff musculature and tendons, biceps tendon sheath, rotator interval, bursae (subacromial-subdeltoid, scapulothoracic, subcoracoid), suprascapular and spinoglenoid notch, quadrilateral space, and triangular interval. Cross-sectional CT or MRI of the shoulder will be supplemented to facilitate understanding of ultrasound anatomy. We additionally provide an image-supplemented review of common and advanced ultrasound-guided shoulder interventions with a discussion of relevant indications and technical considerations.

The increasing incidence of shoulder pathology in the aging population suggests the demand for shoulder interventions will increase in the coming years. Ultrasound is a flexible, accurate modality that is readily used for numerous diagnostic and therapeutic procedures. By providing a comprehensive overview of the various ultrasound-guided interventions in the shoulder, the present review will allow radiologists and radiology trainees to become better informed and prepared when such interventions are indicated.