Move your mouse over the image to see highlighted anatomy

Biceps tendon scan plane Biceps TS normal

Transverse Biceps tendon scan plane

Transverse Long Head Biceps

LS Biceps tendon scan plane BT LS normal

Longitudinal Biceps tendon scan plane

BT LS normal

Subscapularis scan plane Normal subscapularis

SSC scan plane

Normal subscapularis

shoulder anatomy Coraco-acromial ligament

Axial view of shoulder anatomy


Rotator cuff abduction Supraspinatus normal

Patient begins with arm by their side and abducts sideways to 90degrees. Look for bunching of bursa or tendon against the acromion or coraco-acromial ligament.

Normal supraspinatus LS

Ultrasound showing the normal subacromial bursa Ultrasound of the subacromial bursa

Normal sub acromial Bursa

The subacromial and subdeltoud bursae are intimately against, and indistinguishable from, the overlying deltoid muscle.

The subacromial bursa.

The bursae are subject to thickening and /or fluid.

This image shows both thickening and fluid. The measurement indicates how little is required to be symptomatic.

Supraspinatus scan plane Supraspinatus normal TS

SSP scan plane 2: Patient's hand behind their back.

Normal supraspinatus TS

Acromio-clavicular joint scan plane Acromio-clavicular joint normal

ACJ scan plane

AC joint normal

ISP scan plane Infraspinatus normal

Infraspinatus scan plane: Patient's hand towards unaffected shoulder.


ISP scan plane Pre and post abduction

Infraspinatus scan plane: Patient's hand towards unaffected shoulder.

Abduction: Hover mouse over to see supraspinatus pre and post abduction at the acromion.

grading of tendon pathologyClick to open a pdf showing a broad classification of tendon tears.  



Ultrasound is essentially used for the rotator cuff complex of the shoulder. Ultrasound is a valuable diagnostic tool in assessing the following indications;

  • Muscular, tendonous and some ligamentous damage (chronic and acute)
  • Bursitis
  • Joint effusion
  • Vascular pathology
  • Haematomas
  • Soft tissue masses such as ganglia, lipomas
  • Classification of a mass eg solid, cystic, mixed
  • Post surgical complications eg abscess, oedema
  • Guidance of injection, aspiration or biopsy
  • Some bony pathology.


It is recognised that ultrasound offers little or no diagnostic information for internal structures such as the gleno-humeral ligaments. Ultrasound is complimentary with other modalities, including plain X-ray, CT, MRI and arthroscopy.


Use of a high resolution probe (7-15MHZ) is essential when assessing the superficial structures of the shoulder. Careful scanning technique to avoid anisotropy (and possible misdiagnosis) Beam steering or compounding can help to overcome anisotropy in linear structures such as tendons. Good colour / power / Doppler capabilities when assessing vessels or vascularity of a structure. Be prepared to change frequency output of probe (or probes) to adequately assess both superficial and deeper structures.



Patient seated on chair in front of ultrasound machine. Have the patient's chair at an appropriate height to be ergonomically comfortable for you to scan.


For example images of pathology, click here to goto the shoulder pathology page.

  • Patient rests hand palm up on thigh.
  • Scan transversely over the anterior humeral head.
  • Visualize the bicipital groove. Identify the biceps tendon in the groove (if not identified it may be either torn or subluxed medially out of the groove). Follow down to the muscle belly.
  • Rotate into longitudinal and re-examine.
  • The tendon should be a uniform fibrillar structure, generally less than 5mm thick.
  • Examine dynamically in a transverse plane during internal/external rotation to ensure it doesn't sublux medially.


For example images of pathology, click here to goto the shoulder pathology page

  • Again in a transverse plane at the bicipital groove, externally rotate the patient's arm.
  • The SSC tendon will be visible inserting medial to the groove.
  • It will be seen as an elongated slightly convex tendon


For example images of pathology, click here to goto the shoulder pathology page

  • Position the patient palm up with their elbow flexed and pulled back passed their side so their hand is near their hip.

Identify the SSP tendon supero-lateral to the bicipital groove. In a coronal plane, the tendon emerges from beneath the acromion to insert on the greater tuberosity of the humerus.

It should be uniform, fibrillar & 'beak shaped' (convex superiorly).


For example images of pathology, click here to goto the shoulder pathology page

  • Ask the patient to place their affected hand across their chest towards the contralateral shoulder.

The ISP can be seen by placing the probe immediately inferior to the spine of the scapula and following the tendon to it's insertion postero-laterally on the humeral head.

It will have a similar appearance to subscapularis.


  • Biceps: assess it's stability within the bicipital groove during external rotation.
  • Subscapularis: assess for any overlying subdeltoid bursal bunching against coracoid during internal rotation
  • Supraspinatus: assess for bunching of the tendon &/or overlying subacromial bursa against the acromion or coraco-acromial ligament during abduction.
  • Ensure the patient does NOT hunch their shoulder or lean towards the contralateral side during abduction.
  • Posterior joint recess: during internal/external rotation, assess for a gleno-humeral joint effusion. This will be most evident during external rotation
  • Acromio-clavicular joint: During forward flexion with internal rotation look for boney contact or ganglia of the ACJ.


Document the normal anatomy and any pathology found, including measurements and vascularity if indicated.

A shoulder series should include the following minimum images:

  • Long head biceps tendon - long, trans
  • Subscapularis tendon
  • Coraco-acromial ligament
  • Supraspinatus tendon
  • Infraspinatus tendon
  • Acromio-clavicular joint
  • Posterior joint recess
  • Pre & post abduction views
  • Document the normal anatomy. Any pathology found in 2 planes, including measurements and any vascularity. Detail any limitation to range of movement and degree that pain or symptoms begin.

Direct radiology 
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