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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
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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
559:
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
580:
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.
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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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386:/the neck of the scapula. The subscapularis (supraserratus) bursa separates the subscapularis is from the
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Knowledge articles incorporating text from the 20th edition of Gray's
Anatomy (1918)
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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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840:, 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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51:. Unsourced material may be challenged and removed.
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858:Simons, Stephen; Dixon, J Bryan (3 April 2017).
676:partial- and full-thickness rotator cuff tears.
700:Subscapularis muscle (shown in red). Animation.
401:and the lower two-thirds of the groove on the
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831:Shoulder Arthroscopy: Principles and Practice
514:It is a powerful defense to the front of the
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111:Learn how and when to remove this message
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347:The subscapularis is covered by a dense
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861:"Physical examination of the shoulder"
752:This article incorporates text in the
420:, which separates the muscle from the
235:Internally rotates and adducts humerus
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829:Milano, Giuseppe and Grasso, Andrea,
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458:The subscapularis is supplied by the
16:Large triangle muscle of the shoulder
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335:and the front of the capsule of the
49:adding citations to reliable sources
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736:Diagram of the human shoulder joint
639:supraspinatus muscle (transversal)
636:infraspinatus muscle (longitudinal)
630:supraspinatus muscle (longitudinal)
621:subscapularis muscle (longitudinal)
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872:from the original on 20 April 2017
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633:supraspinatus muscle (transversal)
624:subscapularis muscle (transversal)
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802:(12th ed.). pp. 44–45.
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137:Subscapularis muscle (in red).
36:needs additional citations for
1483:extensor carpi radialis longus
1410:flexor digitorum superficialis
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446:and the anterior part of the
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522:of the head of the humerus.
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1693:flexor digiti minimi brevis
798:Sinnatamby, Chummy (2011).
760:of the 20th edition of
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299:Anatomical terms of muscle
1853:Muscles of the upper limb
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1544:extensor pollicis longus
1539:extensor pollicis brevis
1534:abductor pollicis longus
604:Ventral sagittal lateral
464:lower subscapular nerves
664:Tissue harmonic imaging
601:Ventral sagittal medial
379:via an aperture in the
362:glenohumeral (shoulder)
214:lower subscapular nerve
210:Upper subscapular nerve
1698:abductor digiti minimi
1688:opponens digiti minimi
1655:flexor pollicis brevis
1504:extensor carpi ulnaris
1499:extensor digiti minimi
1440:flexor pollicis longus
848:. Accessed 2016-11-07.
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491:forward and downward.
448:shoulder-joint capsule
351:which attaches to the
319:is a large triangular
256:musculus subscapularis
60:"Subscapularis muscle"
1573:bicipital aponeurosis
1400:flexor carpi radialis
836:27 April 2021 at the
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526:Clinical significance
327:and inserts into the
1767:extensor retinaculum
1405:flexor carpi ulnaris
436:It inserts onto the
126:Subscapularis muscle
45:improve this article
1595:antebrachial fascia
1529:anatomical snuffbox
1340:triangular interval
1297:intermuscular septa
1189:infraspinous fascia
1184:supraspinous fascia
598:Ventral transversal
1797:palmar aponeurosis
1792:flexor retinaculum
1772:extensor expansion
1616:osborne's ligament
1494:extensor digitorum
1430:pronator quadratus
1330:quadrangular space
1264:articularis cubiti
928:Skeletal Radiology
613:Dorsal transversal
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198:Subscapular artery
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687:Additional images
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388:serratus anterior
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1153:subscapularis
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365:joint capsule
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62: –
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56:Find sources:
50:
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40:
39:
34:This article
32:
28:
23:
22:
19:
1858:Rotator cuff
1782:
1757:
1725:
1714:intermediate
1676:medial volar
1577:
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1464:superficial:
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1381:superficial:
1380:
1361:compartments
1324:
1296:
1208:compartments
1152:
1133:rotator cuff
1044:(1): 243–9.
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977:(1): 205–9.
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268:A04.6.02.012
255:
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43:Please help
38:verification
35:
18:
1160:teres major
1148:teres minor
531:Examination
454:Innervation
422:teres major
418:aponeurosis
245:Identifiers
1842:Categories
1758:posterior:
1726:interossei
1683:hypothenar
1473:mobile wad
1236:brachialis
742:References
101:April 2021
71:newspapers
1783:anterior:
1721:lumbrical
1524:supinator
1454:posterior
1246:posterior
1038:Radiology
971:Radiology
432:Insertion
409:) of the
343:Structure
177:Insertion
1583:extensor
1371:anterior
1259:anconeus
1218:anterior
1116:Shoulder
1058:14631052
956:13833846
948:20033149
913:17027405
876:19 April
870:Archived
866:UpToDate
834:Archived
758:page 440
495:Function
239:shoulder
1832:Anatomy
1356:Forearm
1302:lateral
1128:deltoid
1106:of the
1104:Muscles
991:3898216
547:Imaging
489:humerus
470:of the
442:humerus
440:of the
411:scapula
353:scapula
333:humerus
331:of the
230:Actions
186:humerus
159:Details
85:scholar
1818:Portal
1748:fascia
1736:palmar
1731:dorsal
1645:thenar
1588:flexor
1565:fascia
1487:brevis
1325:spaces
1307:medial
1274:fascia
1231:biceps
1170:fascia
1056:
1023:
1007:
989:
954:
946:
911:
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806:
766:(1918)
681:et al.
568:biceps
540:Gerber
507:, and
394:Origin
349:fascia
321:muscle
193:Artery
165:Origin
87:
80:
73:
66:
58:
1604:other
1515:deep:
1421:deep:
1318:other
952:S2CID
756:from
505:wrist
501:elbow
460:upper
374:bursa
303:[
292:13413
251:Latin
205:Nerve
92:JSTOR
78:books
1630:Hand
1485:and
1054:PMID
1021:ISBN
1005:ISBN
987:PMID
944:PMID
909:PMID
878:2017
842:ISBN
804:ISBN
538:The
509:hand
462:and
315:The
280:2460
263:TA98
139:Ribs
64:news
1203:Arm
1108:arm
1046:doi
1042:230
979:doi
975:157
936:doi
901:doi
287:FMA
275:TA2
184:of
47:by
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818:^
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372:A
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222:C6
220:,
218:C5
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41:.
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