Pictorial view of 3-D Ultrasound.

1. 3-D Ultrasound Shoulder
Pictorial Review
Dr. Muhammad Bin Zulfiqar
PGR III FCPS New Radiology Department
Services Hospital / Services Institute of Medical Sciences

2. Aim
• To give A Pictorial View.
• To give a bird eye view to this fantastic
imaging technique.
• Please also take a review from Role of imaging in evaluation of
shoulder pain my other presentation.

3. • 3D US and multiplanar imaging of the subscapularis tendon of the rotator cuff in a patient
suffering from tendinitis. All three planes show signs of tendon irregularity, enlargement,
and dishomogeneity. Multiple focal calcifications are seen in all planes throughout the
entire tendon fibers. The use of 3D reconstruction of the same subscapularis tendon
demonstrates more clearly the full extent of focal calcifications, tendon irregularity and
enlargement, and tendon dishomogeneity..

4. • Multiplanar localization of a large calcific deposit at the insertion of the rotator cuff
demonstrating posterior acoustic shadowing on the transverse and longitudinal
planes. The coronal plane demonstrates the full size and extension of this calcific
deposit within the fibers of the tendon. 3D US provides the opportunity to accurately
pinpoint these calcifications and ensure that the needle is placed in the correct
position to perform needle aspiration of these calcific deposits.

5. • Multiplanar and 3D representation of biceps tendinitis in a patient
suffering from shoulder pain and weakness. Note the focal
calcifications at the level of the insertion, enlarged and irregular
biceps tendon, and effusion.

6. • 3D reconstruction with surface rendering of the long head
of the biceps tendon with three macrocalcifications seen to
the left side of the untorn tendon in a patient with
tendinitis.
• Rotator cuff tears

7. • Multiplanar representation of a subscapularis tendon partial
tear. All three planes demonstrate an area of an irregular
anechoic defect in the upper surface of the tendon (on the
bursal side of the rotator cuff) while inferiorly, the tendon
remains intact.

8. • Multiplanar representation of a massive tear (more than 5
cm and involving more than one tendon) of the rotator cuff.

9. Biceps tendinitis associated with rotator cuff defect. The coronal
plane readily demonstrates subtle tears and irregularities of the
biceps tendon within an effusion. 3D reconstruction confirms the
irregularities of this tendon and the large effusion is well-
appreciated. Bottom right image demonstrates fluid collection and
right coracobrachialis longus (CBL).

10. • Multiplanar and 3D imaging of a completely ruptured biceps tendon. This is a study of an
elderly patient who, after having lifted a heavy load, presented with weakness of the arm
and swelling at the level of the middle of the humerus. One must follow the length of the
biceps tendon from its origin to its insertion with the muscle. With acute traumatic rupture
of the biceps tendon, the muscle contracts and collapses upon itself distally while the
tendon retracts as in the above case. All planes demonstrate a fluid collection within the
biceps sheath, the absence of any tendon fibers throughout the fluid collection, and the
collapsed biceps muscle beneath.

11. • A lengthways split results in two cords, giving the
appearance of two tendons lying side by side over
a variable length of the tendon, as may be seen in
the multiplanar images above.

12. • This 3D reconstruction confirms the existence
of a lengthways split within the biceps tendon.
Two cords are seen lying parallel within the
bicipital groove.

13. • Multiplanar demonstration of a post-traumatic partial tear on the
bursal aspect of the rotator cuff (infraspinatus tendon). The
coronal plane and 3D reconstruction demonstrate dramatically
the full extent of this tendon tear (indicated by the arrows), which
initially on the transverse and longitudinal planes seems less
extensive.

14. • Multiplanar imaging, including 3D reconstruction, of a torn supraspinatus
tendon with underlying tendinitis (with no history of trauma). Lower right,
note the focal calcification at the insertion of the tendon into the greater
tuberosity and smaller calcifications throughout the tendon. The intact
portion of the remaining tendon is demonstrated beside the anechoic
fluid-filled space where the tendon has broken. The free, frayed edges of
the tendon are clearly visible.

15. • Above, 3D reconstruction of the infraspinatus
tendon with both insertional and
intrasubstance tears in an elderly patient who
fell and hit his shoulder.

16. • multiplanar representation of a large hematoma
in the same patient who is under anticoagulant
therapy. The coronal plane allows correct
measurement of the hematoma.

17. • 3D reconstruction with surface-rendering of a supraspinatus
tendon clearly demonstrating a tear and the free, frayed
edges. Note also the remaining tendon fibers intact.

18. • Above and below, post-traumatic multiplanar and
enlarged 3D reconstruction of the supraspinatus tendon
with small marginal tears that were better depicted using
3D reconstruction.

19. • 3D representation of a post-traumatic rupture
of the supraspinatus tendon.

20. THANK YOU