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the scapula. However, the tendon of primary interest does not get mapped as closely as desired. As anatomical analysis showed, it is only by external rotation possible to see the ventral part of the joint socket and its labrum. While at the neutral position the tuberculum minus occludes the view. Summing up it is through an external arm rotation and a medially applied 5 MHz sector sonic head possible to display the ventral part of the joint socket and its labrum with notedly lower echogenicity.
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Along with higher contrast resolution it has an elevated signal-to-noise ratio and significantly reduced inter- and intraobserver variability compared with conventional US. Additionally it is possible to nearly eliminate ordinary US artifacts, i.e. side-lobe, near-field artifacts, reverberation artifacts. As aforementioned THI has already led to enhanced abdominal, breast, vascular and cardiac sonography.
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Lift-off test is the established clinical test for examination of the subscapularis. The bear hug test (internal rotation while palm is held on opposite shoulder and elbow is held in a position of maximal anterior translation) for subscapularis muscle tears has high sensitivity. Positive bear-hug and
682:
THI involves the use of harmonic frequencies that originate within the tissue as a result of nonlinear wave front propagation and are not present in the incident beam. These harmonic signals may arise differently at anatomic sites with similar impedances and thus lead to higher contrast resolution."
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Mack et al. developed an ultrasonographic procedure with which it is possible to explore almost the complete rotator cuff within six steps. It unveils clearly the whole area from the subedge of the subscapularis tendon until the intersection between the infraspinatus tendon and musculus teres minor.
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For musculo-skeletal aspects THI has not been used that much, although this method features some useful potential. For example, for the still tricky discrimination between the presence of a hypoechoic defect and/or loss of the outer tendon convexity/non-visualization of the tendon, that is between
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The subscapularis tendon lies approximately 3 to 5 cm under the surface. Quite deep for ultrasonography, and therefore displaying through a highly penetrative 5 MHz linear applicator is worth a try. And it really turned out to ease a detailed examination of the muscle which just abuts to
570:
There is no singularly imaging device or technique for a satisfying and complete subscapularis examination, but rather the combination of the sagittal oblique MRI / short-axis US and axial MRI / long-axis US planes seems to generate useful results. Additionally, lesser tuberosity bony changes have
591:
One of six steps does focus on the subscapularis tendon. In the first instance the examinator guides the applicator to the proximal humerus as perpendicularly as possible to the sulcus intertubercularis. Gliding now medially shows the insertion of the subscapularis tendon.
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tendon absents itself from the shoulder joint through the rotator cuff interval, it is easily possible to distinguish between the supraspinatus and the subscapularis tendon. Those two tendons build the interval sling.
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has arrived at the conclusion that through THI it is possible to achieve a generally improved visibility of joint and tendon surfaces, especially superior for subscapularis tendon abnormalities.
717:
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Strobel, Klaus; Zanetti, Marco; Nagy, Ladislav; Hodler, Juerg (2004). "Suspected
Rotator Cuff Lesions: Tissue Harmonic Imaging versus Conventional US of the Shoulder1".
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been associated with subscapularis tendon tears. Findings with cysts seem to be more specific and combined findings with cortical irregularities more sensitive.
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Barth, Johannes R.H.; Burkhart, Stephen S.; De Beer, Joe F. (October 2006). "The Bear-Hug Test: A New and
Sensitive Test for Diagnosing a Subscapularis Tear".
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It is difficult to isolate the action of the subscapularis from other medial rotators of the shoulder joint; there is no satisfactory test for this muscle.
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Primarily in abdominal imaging, tissue harmonic imaging (THI) gets more and more valued and used additionally to conventional ultrasonography.
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Another fact typically for the subscapularis muscle is the fatty infiltration of the superior portions, while sparing the inferior portions.
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It arises from its medial two-thirds of the costal surface of the scapula, the intermuscular septa (which create ridges upon the scapula),
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Morag, Yoav; Jamadar, David A.; Miller, Bruce; Dong, Qian; Jacobson, Jon A. (2009). "The subscapularis: Anatomy, injury, and imaging".
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The muscle's fibers pass laterally from its origin before coalescing into a tendon of insertion. The tendon intermingles with the
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The subscapularis stabilises the shoulder joint by contributing to the fixation of the proximal humerus during movements of the
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Some fibers arise from tendinous laminae, which intersect the muscle and are attached to ridges on the bone; others from an
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The following sectional planes are defined for the sonographic examination of the different shoulder joint structures:
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Thelen M. et al.. Radiologische
Diagnostik der Verletzungen von Knochen und Gelenken. Stuttgart . Georg Thieme. 1993.
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Mack, L A; Matsen, F A; Kilcoyne, R F; Davies, P K; Sickler, M E (1985). "US evaluation of the rotator cuff".
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397:/the neck of the scapula. The subscapularis (supraserratus) bursa separates the subscapularis is from the
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The subscapularis medially (internally) rotates the humerus (acting here as a prime mover)
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Knowledge articles incorporating text from the 20th edition of Gray's
Anatomy (1918)
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394:) intervenes between the tendon and a bare area at the lateral angle of the scapula
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Same as the left, but the bones around the muscle are shown as semi-transparent.
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MRI. Partial rupture of the cranial subscapularis tendon at the insertion site
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The subscapularis is difficult to see from the front (labeled middle right)
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at the margins of the subscapularis' attachment (origin) on the scapula.
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Intertubercular sulcus with long head of biceps brachii (transversal)
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belly press tests indicate significant tearing of subscapularis.
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Intertub. sulcus with long head of biceps brachii (longitudinal)
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Longitudinal plane of the musculus subscapularis and its tendon
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Arthroscopy: The
Journal of Arthroscopic and Related Surgery
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Transverse section of thorax featuring subscapularis muscle
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387:(which communicates with the cavity of the shoulder joint
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851:, Springer Science & Business Media, Dec 16, 2013.
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In comparison to a checking MR Arthrography
Strobel K.
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Katthagen BD. et al.. Schultersonographie. Stuttgart.
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and adducts it. When the arm is raised, it draws the
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62:. Unsourced material may be challenged and removed.
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869:Simons, Stephen; Dixon, J Bryan (3 April 2017).
687:partial- and full-thickness rotator cuff tears.
711:Subscapularis muscle (shown in red). Animation.
412:and the lower two-thirds of the groove on the
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842:Shoulder Arthroscopy: Principles and Practice
525:It is a powerful defense to the front of the
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122:Learn how and when to remove this message
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358:The subscapularis is covered by a dense
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872:"Physical examination of the shoulder"
763:This article incorporates text in the
431:, which separates the muscle from the
246:Internally rotates and adducts humerus
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840:Milano, Giuseppe and Grasso, Andrea,
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346:and the front of the capsule of the
60:adding citations to reliable sources
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747:Diagram of the human shoulder joint
650:supraspinatus muscle (transversal)
647:infraspinatus muscle (longitudinal)
641:supraspinatus muscle (longitudinal)
632:subscapularis muscle (longitudinal)
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883:from the original on 20 April 2017
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644:supraspinatus muscle (transversal)
635:subscapularis muscle (transversal)
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148:Subscapularis muscle (in red).
47:needs additional citations for
1494:extensor carpi radialis longus
1421:flexor digitorum superficialis
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533:of the head of the humerus.
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1704:flexor digiti minimi brevis
809:Sinnatamby, Chummy (2011).
771:of the 20th edition of
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310:Anatomical terms of muscle
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1555:extensor pollicis longus
1550:extensor pollicis brevis
1545:abductor pollicis longus
615:Ventral sagittal lateral
475:lower subscapular nerves
675:Tissue harmonic imaging
612:Ventral sagittal medial
390:via an aperture in the
373:glenohumeral (shoulder)
225:lower subscapular nerve
221:Upper subscapular nerve
1709:abductor digiti minimi
1699:opponens digiti minimi
1666:flexor pollicis brevis
1515:extensor carpi ulnaris
1510:extensor digiti minimi
1451:flexor pollicis longus
859:. Accessed 2016-11-07.
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502:forward and downward.
459:shoulder-joint capsule
362:which attaches to the
330:is a large triangular
267:musculus subscapularis
71:"Subscapularis muscle"
1584:bicipital aponeurosis
1411:flexor carpi radialis
847:27 April 2021 at the
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537:Clinical significance
338:and inserts into the
1778:extensor retinaculum
1416:flexor carpi ulnaris
447:It inserts onto the
137:Subscapularis muscle
56:improve this article
1606:antebrachial fascia
1540:anatomical snuffbox
1351:triangular interval
1308:intermuscular septa
1200:infraspinous fascia
1195:supraspinous fascia
609:Ventral transversal
1808:palmar aponeurosis
1803:flexor retinaculum
1783:extensor expansion
1627:osborne's ligament
1505:extensor digitorum
1441:pronator quadratus
1341:quadrangular space
1275:articularis cubiti
939:Skeletal Radiology
624:Dorsal transversal
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209:Subscapular artery
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698:Additional images
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399:serratus anterior
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1164:subscapularis
1162:
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1154:infraspinatus
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1149:supraspinatus
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392:joint capsule
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376:joint capsule
374:
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328:subscapularis
317:
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73: –
72:
68:
67:Find sources:
61:
57:
51:
50:
45:This article
43:
39:
34:
33:
30:
19:
18:Subscapularis
1869:Rotator cuff
1793:
1768:
1736:
1725:intermediate
1687:medial volar
1588:
1525:
1475:superficial:
1474:
1431:
1392:superficial:
1391:
1372:compartments
1335:
1307:
1219:compartments
1163:
1144:rotator cuff
1055:(1): 243–9.
1052:
1048:
1042:
1026:
1010:
988:(1): 205–9.
985:
981:
975:
942:
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907:
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885:. Retrieved
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531:displacement
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279:A04.6.02.012
266:
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109:
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85:
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66:
54:Please help
49:verification
46:
29:
1171:teres major
1159:teres minor
542:Examination
465:Innervation
433:teres major
429:aponeurosis
256:Identifiers
1853:Categories
1769:posterior:
1737:interossei
1694:hypothenar
1484:mobile wad
1247:brachialis
753:References
112:April 2021
82:newspapers
1794:anterior:
1732:lumbrical
1535:supinator
1465:posterior
1257:posterior
1049:Radiology
982:Radiology
443:Insertion
420:) of the
354:Structure
188:Insertion
1594:extensor
1382:anterior
1270:anconeus
1229:anterior
1127:Shoulder
1069:14631052
967:13833846
959:20033149
924:17027405
887:19 April
881:Archived
877:UpToDate
845:Archived
769:page 440
506:Function
250:shoulder
1843:Anatomy
1367:Forearm
1313:lateral
1139:deltoid
1117:of the
1115:Muscles
1002:3898216
558:Imaging
500:humerus
481:of the
453:humerus
451:of the
422:scapula
364:scapula
344:humerus
342:of the
241:Actions
197:humerus
170:Details
96:scholar
1829:Portal
1759:fascia
1747:palmar
1742:dorsal
1656:thenar
1599:flexor
1576:fascia
1498:brevis
1336:spaces
1318:medial
1285:fascia
1242:biceps
1181:fascia
1067:
1034:
1018:
1000:
965:
957:
922:
855:
817:
777:(1918)
692:et al.
579:biceps
551:Gerber
518:, and
405:Origin
360:fascia
332:muscle
204:Artery
176:Origin
98:
91:
84:
77:
69:
1615:other
1526:deep:
1432:deep:
1329:other
963:S2CID
767:from
516:wrist
512:elbow
471:upper
385:bursa
314:[
303:13413
262:Latin
216:Nerve
103:JSTOR
89:books
1641:Hand
1496:and
1065:PMID
1032:ISBN
1016:ISBN
998:PMID
955:PMID
920:PMID
889:2017
853:ISBN
815:ISBN
549:The
520:hand
473:and
326:The
291:2460
274:TA98
150:Ribs
75:news
1214:Arm
1119:arm
1057:doi
1053:230
990:doi
986:157
947:doi
912:doi
298:FMA
286:TA2
195:of
58:by
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943:40
941:.
918:.
908:22
906:.
879:.
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829:^
785:^
514:,
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383:A
350:.
233:C6
231:,
229:C5
223:,
1831::
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1370:(
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1107:e
1100:t
1093:v
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416:(
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119:(
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110:(
100:·
93:·
86:·
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52:.
20:)
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