**2.2 Ultrasound examination technique**

Sonographic evaluation of the shoulder can be performed with the following steps [2]:


**17**

*Imaging of Tendons*

**2.3 Supraspinatus tendon**

*DOI: http://dx.doi.org/10.5772/intechopen.84521*

imaging, where the tendon is viewed longitudinally.

paralleling the tendon superiorly.

indicates a full-thickness tear (**Figure 1**).

retraction of musculotendinous junction [7].

**2.4 Long head of biceps brachii tendon**

with adjacent cortical irregularity of the greater tuberosity.

The supraspinatus tendon arises from the supraspinous fossa, runs between the undersurface of the acromion and the top of the humeral head, and inserts into the most superior facet of the greater tuberosity of the humerus. On MRI, the entire length of the supraspinatus tendon can be seen well in the coronal oblique plain, running at an angle of approximately 45° [7]. The musculotendinous junction of the tendon normally is located just lateral to the acromioclavicular joint. On sagittal oblique images, the supraspinatus tendon is imaged in cross section, which is valuable to confirm the status of the tendon when abnormalities are seen in the plane of

The normal sonographic appearance of the supraspinatus tendon is hyperechoic and fibrillar with a convex superior margin at the level of the superior facet of the greater tuberosity of the humerus [8]. It parallels the curved contour of the humeral head, flattening out as it inserts into the greater tuberosity. The subacromial-subdeltoid bursa should be seen as a single thin hyperechoic line

The supraspinatus tendon is the most commonly affected when compared to the other tendons of the shoulder [8]. There are multiple pathologies that may limit the space within the coracoacromial arch, producing impingement of this tendon. Abnormalities from impingement range from tendon degeneration to partial-thickness or full-thickness tears. Most partial-thickness tears occur in the articular aspect of the tendon, rather than on the bursal surface. Tears are usually located distally, either near its attachment to the greater tuberosity or in the critical zone located approximately 1 cm proximal to its insertion, and start in the anterior portion as rim rent tears and spread posteriorly [7]. Rim rent tears refer to disruption of the insertional fibers on the greater tuberosity. Complete disruption of the fibers with communication between the joint and the overlying bursa

Tendon degeneration usually demonstrates increased signal intensity on T1WI and T2WI, although not as high signal as fluid. However, a partial thickness tear demonstrates increased signal intensity on T2WI similar to fluid. Indications of a full thickness tear include: tendon discontinuity, fluid signal in tendon gap, and

The long head of biceps brachii tendon originates from the supraglenoid tubercle of the scapula, courses intra-articularly to the entrance of the bicipital groove and continues caudally, inserting along the radial tuberosity of the proximal radius. On MRI, portions of this tendon can be evaluated on coronal oblique images, from its origin at the superior labrum and inferiorly in the bicipital groove. The portion that is located within the bicipital groove is seen on axial images as a round or oval structure, and sometimes it may blend with the low signal intensity cortex of the humerus, making it difficult to identify. It is normal to find a small amount of fluid

Tears in ultrasound are demonstrated as anechoic or hypoechoic defects, although acute tears will more likely appear anechoic like fluid [8]. As a supraspinatus tendon tear enlarges, tendon retraction and volume loss occur, with loss of the normal superior convex shape. The length or degree of retraction of a full thickness tear can be measured on longitudinal views oriented parallel to the long axis of the cuff and the width can be measured on transverse views oriented perpendicular to the long axis of the cuff [2]. On the other hand, tendinosis is usually less defined, and may be associated with increased tendon thickness, and not usually associated
