RadteraUltrasound Shoulder (Rotator Cuff)
USNo contrastMSK
Indications
- Shoulder pain / suspected rotator cuff tear
- Suspected biceps tendon pathology
- Suspected subacromial-subdeltoid bursitis
- Suspected joint effusion
- Dynamic impingement assessment
- Post-operative cuff evaluation
Patient prep
- None
- Patient seated on rotating stool; examiner positions arm in modified Crass/Crass and neutral positions
Contrast
None / non-contrast
Technique
- High-frequency linear transducer 7-15 MHz
- Examine each structure in two orthogonal planes (long and short axis to tendon)
- Standardized positions: biceps (neutral), subscapularis (external rotation), supraspinatus (modified Crass), infraspinatus/teres minor (hand on opposite shoulder)
- Dynamic maneuvers for impingement and subluxation; compare to contralateral side as needed
Series / Sequences
| # | Series / Sequence | Plane | Notes |
|---|---|---|---|
| 1 | Long head biceps tendon | Transverse (short axis) and long axis | In bicipital groove; effusion, subluxation, tear |
| 2 | Subscapularis tendon | Long and short axis (arm external rotation) | Tear/tendinosis; dynamic biceps subluxation |
| 3 | Supraspinatus tendon | Long and short axis (modified Crass) | Most common tear site; measure tear dimensions |
| 4 | Infraspinatus and teres minor | Long and short axis | Tendinosis/tear |
| 5 | Acromioclavicular joint | Coronal | OA, capsular distension |
| 6 | Subacromial-subdeltoid bursa | As needed | Bursal fluid/thickening; dynamic impingement |
| 7 | Posterior glenohumeral joint / spinoglenoid notch | As needed | Effusion; paralabral cyst |
Key points
- Evaluate all four cuff tendons (supraspinatus, infraspinatus, subscapularis, teres minor) and biceps in two orthogonal planes
- Full-thickness tear: non-visualization or focal anechoic/hypoechoic defect through tendon; measure tear size
- Use standardized arm positions and dynamic maneuvers for impingement and biceps subluxation
- Compare with contralateral side for equivocal findings
References
• ACR-AIUM-SPR-SRU Practice Parameter for the Performance of a Musculoskeletal Ultrasound Examination
• AIUM Practice Parameter for the Performance of a Shoulder Ultrasound Examination
• Radiopaedia: Rotator cuff ultrasound link
• AIUM Practice Parameter for the Performance of a Shoulder Ultrasound Examination
• Radiopaedia: Rotator cuff ultrasound link
Source: Researched — verify against your institution
Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.