<p begin="00:00:07.103" end="00:00:08.828" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:08.828" end="00:00:11.759" style="s2">with a musculoskeletal exam type is used</p>
<p begin="00:00:11.759" end="00:00:13.738" style="s2">to perform an ultrasound-guided injection</p>
<p begin="00:00:13.738" end="00:00:16.776" style="s2">of the shoulder via a medial approach.</p>
<p begin="00:00:16.776" end="00:00:18.887" style="s2">Alternatively, a curved array transducer</p>
<p begin="00:00:18.887" end="00:00:21.114" style="s2">with a musculoskeletal exam type</p>
<p begin="00:00:21.114" end="00:00:23.299" style="s2">can be used in a large patient.</p>
<p begin="00:00:23.299" end="00:00:25.945" style="s2">The patient is in a<br />lateral decubitus position</p>
<p begin="00:00:25.945" end="00:00:27.930" style="s2">with the arm flexed across the body.</p>
<p begin="00:00:27.930" end="00:00:30.634" style="s2">The examiner is positioned<br />behind the patient,</p>
<p begin="00:00:30.634" end="00:00:33.293" style="s2">and the transducer is placed posteriorly</p>
<p begin="00:00:33.293" end="00:00:34.898" style="s2">over the head of the humerus,</p>
<p begin="00:00:34.898" end="00:00:37.985" style="s2">with the orientation marker<br />directed to the patients' right.</p>
<p begin="00:00:37.985" end="00:00:40.210" style="s2">The examination begins by locating</p>
<p begin="00:00:40.210" end="00:00:42.036" style="s2">the glenohumeral joint space,</p>
<p begin="00:00:42.036" end="00:00:43.669" style="s2">which lies below the deep fibers</p>
<p begin="00:00:43.669" end="00:00:46.969" style="s2">of the infraspinatus muscle<br />and the glenoid labrum,</p>
<p begin="00:00:46.969" end="00:00:48.298" style="s2">which appears as a bright,</p>
<p begin="00:00:48.298" end="00:00:51.812" style="s2">hyperechoic region in the<br />mid portion of the image.</p>
<p begin="00:00:51.812" end="00:00:53.408" style="s2">The humeral head can be seen</p>
<p begin="00:00:53.408" end="00:00:55.476" style="s2">on the right of the screen as a rounded,</p>
<p begin="00:00:55.476" end="00:00:57.556" style="s2">bright hyper-reflective image.</p>
<p begin="00:00:57.556" end="00:01:00.535" style="s2">The transducer is<br />adjusted so it is centered</p>
<p begin="00:01:00.535" end="00:01:02.968" style="s2">over the glenohumeral joint line.</p>
<p begin="00:01:02.968" end="00:01:04.721" style="s2">The needle is inserted in the skin,</p>
<p begin="00:01:04.721" end="00:01:07.303" style="s2">just proximal to the transducer.</p>
<p begin="00:01:07.303" end="00:01:08.863" style="s2">The needle is slowly advanced,</p>
<p begin="00:01:08.863" end="00:01:11.199" style="s2">to lie in-plane to the transducer beam,</p>
<p begin="00:01:11.199" end="00:01:12.479" style="s2">and is seen as a bright,</p>
<p begin="00:01:12.479" end="00:01:14.824" style="s2">hyperechoic linear structure.</p>
<p begin="00:01:14.824" end="00:01:16.443" style="s2">The needle is slowly advanced</p>
<p begin="00:01:16.443" end="00:01:18.387" style="s2">under direct ultrasound visualization,</p>
<p begin="00:01:18.387" end="00:01:20.059" style="s2">until the tip is seen to lie</p>
<p begin="00:01:20.059" end="00:01:21.475" style="s2">within the shoulder joint space,</p>
<p begin="00:01:21.475" end="00:01:25.392" style="s2">where an injection, or<br />aspiration, can be done.</p>

<p begin="00:00:07.103" end="00:00:08.828" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:08.828" end="00:00:11.759" style="s2">with a musculoskeletal exam type is used</p>
<p begin="00:00:11.759" end="00:00:13.738" style="s2">to perform an ultrasound-guided injection</p>
<p begin="00:00:13.738" end="00:00:16.776" style="s2">of the shoulder via a medial approach.</p>
<p begin="00:00:16.776" end="00:00:18.887" style="s2">Alternatively, a curved array transducer</p>
<p begin="00:00:18.887" end="00:00:21.114" style="s2">with a musculoskeletal exam type</p>
<p begin="00:00:21.114" end="00:00:23.299" style="s2">can be used in a large patient.</p>
<p begin="00:00:23.299" end="00:00:25.945" style="s2">The patient is in a<br />lateral decubitus position</p>
<p begin="00:00:25.945" end="00:00:27.930" style="s2">with the arm flexed across the body.</p>
<p begin="00:00:27.930" end="00:00:30.634" style="s2">The examiner is positioned<br />behind the patient,</p>
<p begin="00:00:30.634" end="00:00:33.293" style="s2">and the transducer is placed posteriorly</p>
<p begin="00:00:33.293" end="00:00:34.898" style="s2">over the head of the humerus,</p>
<p begin="00:00:34.898" end="00:00:37.985" style="s2">with the orientation marker<br />directed to the patients' right.</p>
<p begin="00:00:37.985" end="00:00:40.210" style="s2">The examination begins by locating</p>
<p begin="00:00:40.210" end="00:00:42.036" style="s2">the glenohumeral joint space,</p>
<p begin="00:00:42.036" end="00:00:43.669" style="s2">which lies below the deep fibers</p>
<p begin="00:00:43.669" end="00:00:46.969" style="s2">of the infraspinatus muscle<br />and the glenoid labrum,</p>
<p begin="00:00:46.969" end="00:00:48.298" style="s2">which appears as a bright,</p>
<p begin="00:00:48.298" end="00:00:51.812" style="s2">hyperechoic region in the<br />mid portion of the image.</p>
<p begin="00:00:51.812" end="00:00:53.408" style="s2">The humeral head can be seen</p>
<p begin="00:00:53.408" end="00:00:55.476" style="s2">on the right of the screen as a rounded,</p>
<p begin="00:00:55.476" end="00:00:57.556" style="s2">bright hyper-reflective image.</p>
<p begin="00:00:57.556" end="00:01:00.535" style="s2">The transducer is<br />adjusted so it is centered</p>
<p begin="00:01:00.535" end="00:01:02.968" style="s2">over the glenohumeral joint line.</p>
<p begin="00:01:02.968" end="00:01:04.721" style="s2">The needle is inserted in the skin,</p>
<p begin="00:01:04.721" end="00:01:07.303" style="s2">just proximal to the transducer.</p>
<p begin="00:01:07.303" end="00:01:08.863" style="s2">The needle is slowly advanced,</p>
<p begin="00:01:08.863" end="00:01:11.199" style="s2">to lie in-plane to the transducer beam,</p>
<p begin="00:01:11.199" end="00:01:12.479" style="s2">and is seen as a bright,</p>
<p begin="00:01:12.479" end="00:01:14.824" style="s2">hyperechoic linear structure.</p>
<p begin="00:01:14.824" end="00:01:16.443" style="s2">The needle is slowly advanced</p>
<p begin="00:01:16.443" end="00:01:18.387" style="s2">under direct ultrasound visualization,</p>
<p begin="00:01:18.387" end="00:01:20.059" style="s2">until the tip is seen to lie</p>
<p begin="00:01:20.059" end="00:01:21.475" style="s2">within the shoulder joint space,</p>
<p begin="00:01:21.475" end="00:01:25.392" style="s2">where an injection, or<br />aspiration, can be done.</p>