HSS Ultrasound Case 75

Clinical History 68 year old female with progressively worsening left anterior shoulder pain Radiographs showed glenohumeral joint osteoarthritis with a radiodense focus adjacent to the proximal humeral shaft

Ultrasound of the Month – Case 75

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Ultrasound of the Month – Case 75

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Diagnosis: Biceps long head tenosynovitis with loose body in the tendon sheath.

Discussion The biceps tendon long head is a common source of anterior shoulder pain.

Usually due to repetitive overuse, the biceps tendon can undergo various pathologies, including tendinosis, tenosynovitis, split tears, dislocations, and ruptures.

All of these conditions can be accurately assessed on ultrasound.

Cortisone injection into the biceps tendon sheath is a percutaneous treatment option for anterior shoulder pain due to the biceps tendon long head.

Under ultrasound guidance, the position of the needle with respect to the target can be visualized in real time so that tendon sheath injection can be performed accurately and puncturing adjacent structures such as vessels, the subscapularis tendon, or the biceps tendon long head itself can be avoided.

Ultrasound also allows the radiologist to identify and address unexpected findings, such as soft tissue masses and fluid collections.

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