<p begin="00:00:07.776" end="00:00:09.436" style="s2">- [Voiceover] A Linear Array Transducer</p>
<p begin="00:00:09.436" end="00:00:11.573" style="s2">with a musculoskeletal exam type</p>
<p begin="00:00:11.573" end="00:00:14.127" style="s2">is used to perform an<br />ultrasound-guided injection</p>
<p begin="00:00:14.127" end="00:00:17.238" style="s2">of the shoulder joint<br />via a lateral approach.</p>
<p begin="00:00:17.238" end="00:00:19.758" style="s2">Alternatively, a Curved Array Transducer</p>
<p begin="00:00:19.758" end="00:00:21.847" style="s2">with a musculoskeletal exam type</p>
<p begin="00:00:21.847" end="00:00:24.285" style="s2">can be used in a large patient.</p>
<p begin="00:00:24.285" end="00:00:27.188" style="s2">The patient is in a<br />lateral decubitus position</p>
<p begin="00:00:27.188" end="00:00:29.487" style="s2">with the arm flexed across the body.</p>
<p begin="00:00:29.487" end="00:00:31.902" style="s2">The examiner is positioned<br />behind the patient</p>
<p begin="00:00:31.902" end="00:00:34.421" style="s2">and the transducer is placed posteriorly</p>
<p begin="00:00:34.421" end="00:00:37.277" style="s2">over the head of the humerus<br />with the orientation marker</p>
<p begin="00:00:37.277" end="00:00:39.413" style="s2">directed to the patient's right.</p>
<p begin="00:00:39.413" end="00:00:41.805" style="s2">The examination begins by locating</p>
<p begin="00:00:41.805" end="00:00:44.568" style="s2">the glenohumeral joint<br />space, which lies below</p>
<p begin="00:00:44.568" end="00:00:47.343" style="s2">the deep fibers of the<br />infraspinatus muscle</p>
<p begin="00:00:47.343" end="00:00:49.781" style="s2">and the glenoid labrum,<br />which appears as a bright,</p>
<p begin="00:00:49.781" end="00:00:53.101" style="s2">hyperechoic region in the<br />mid portion of the image.</p>
<p begin="00:00:53.101" end="00:00:55.876" style="s2">The humeral head can be seen<br />on the right of the screen</p>
<p begin="00:00:55.876" end="00:00:58.953" style="s2">as a rounded, bright hyperechoic image.</p>
<p begin="00:00:58.953" end="00:01:01.553" style="s2">The transducer is<br />adjusted so it is centered</p>
<p begin="00:01:01.553" end="00:01:03.992" style="s2">over the glenohumeral joint line.</p>
<p begin="00:01:03.992" end="00:01:05.559" style="s2">The needle is inserted in the skin</p>
<p begin="00:01:05.559" end="00:01:07.533" style="s2">just proximal to the transducer</p>
<p begin="00:01:07.533" end="00:01:10.087" style="s2">on the opposite side of<br />the orientation marker.</p>
<p begin="00:01:10.087" end="00:01:12.606" style="s2">The needle is slowly<br />advanced to lie in plane</p>
<p begin="00:01:12.606" end="00:01:15.126" style="s2">to the transducer beam,<br />and is seen as a bright,</p>
<p begin="00:01:15.126" end="00:01:17.645" style="s2">hyperechoic linear structure.</p>
<p begin="00:01:17.645" end="00:01:19.770" style="s2">The needle is slowly advanced under direct</p>
<p begin="00:01:19.770" end="00:01:22.463" style="s2">ultrasound visualization<br />until the tip is seen</p>
<p begin="00:01:22.463" end="00:01:24.599" style="s2">to lie within the shoulder joint space,</p>
<p begin="00:01:24.599" end="00:01:28.349" style="s2">where an injection or<br />aspiration can be done.</p>