肌骨超声诊断指南肩部

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1、肌骨超声技术指南--肩部(欧洲肌骨放射学)Althoughpatient’spositioningforshoulderUSvarieswidelyacrossdifferentCountriesandInstitutionsreflectingmultifacetedopinionsandexperiencesofdifferentexaminers,westronglyrecommendtoexaminethepatientwhileseatedonarevolvingstool.Thispositiona

2、llowstheexaminertoreachtheanterior,lateralandposterioraspectsoftheshoulderwiththeprobebysimplyaskingthepatienttorotateonthechair.不同的国家和机构给病人进行肩部超声检查时所采取的体位各不相同，体现了不同诊查者不同的观点和经验，但是，我们强烈推荐让病人坐在转凳上进行检查。这个体位能够让诊查者只要让病人转动一下凳子就能够使用探头扫查到肩的前面、侧面和后面。longheadofthebice

3、pstendon二头肌腱长头Placethearminslightinternalrotation(directedtowardsthecontralateralknee)withtheelbowflexed90°,palmup.Startbyfindingthelongbicepstendoninbetweenthegreaterandlessertuberosities–Useshortandlong(morelimitedutility)axisplanestoexaminethebiceps.肘部屈曲9

4、0°，手臂轻度内旋（指向对侧膝部），掌心向上。先在大、小结节之间找到肱二头肌长头腱，采用短轴和长轴（作用有限）切面检查二头肌。Shifttheprobeuptoexaminethebicepsinitsintraarticularcourseanddowntoreachthemyotendinousjunction(levelofthepectoralismajortendon).向上移动探头检查二头肌关节内的走行，向下移动探头探测肌-腱连接部（胸大肌肌腱水平）。Legend:SubS,subscapulari

5、stendon;SupraS,supraspinatustendon;Arrow,longheadofthebicepstendon;LT,lessertuberosity;GT,greatertuberosity;SH,shortheadofthebiceps;LH,longheadofthebiceps;H,humeralshaft;Arrowheads,pectoralismajortendon图例：SubS肩胛下肌肌腱；SupraS冈上肌肌腱；箭号，肱二头肌长头；LT小结节；GT大结节；SH二头肌短头；

6、LH二头肌长头；H肱骨干；箭头，胸大肌肌腱3subscapularistendonRotatethearmexternallyfixingtheelbowontheiliaccresttoshowthesubscapularistendonanditsinsertiononthelessertuberosity(slightsupinationofthehandmaybehelpfultoneutralizethetendencytoliftandabducttheelbowfromthelateralc

7、hestwall).3肩胛下肌肌腱将肘部固定于髂嵴处，上肢外旋可显示肩胛下肌肌腱及其小结节附着部。（手掌轻度后旋可有助于抵抗肘部上抬和外展离开侧胸壁的力量）Thistendonshouldbeevaluatedalongitslong-(transverseplanes)andshort-(sagittalplanes)axisduringpassiveexternalandinternalrotationwithhangingarm.Sweepthetransducerupanddownoverthesu

8、bscapularisuntilitsfullwidthisdemonstrated.评价该肌腱应该在手臂上举状态下被动外旋和内旋时沿其长轴切面（横切面）和短轴切面（矢状切面）进行扫查。在肩胛下肌表面上下扫查，直至整块肌肉都能全部显示。Legend:Arrow,longheadofthebicepstendon;dashedline,insertionofthesubscapulari