<p begin="00:00:07.432" end="00:00:09.095" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:09.095" end="00:00:11.235" style="s2">with a musculoskeletal exam type</p>
<p begin="00:00:11.235" end="00:00:13.676" style="s2">is used to perform an<br />ultrasound examination</p>
<p begin="00:00:13.676" end="00:00:15.475" style="s2">of the biceps tendon.</p>
<p begin="00:00:15.475" end="00:00:17.318" style="s2">The patient is in a sitting position</p>
<p begin="00:00:17.318" end="00:00:20.061" style="s2">with the hand placed palm up on the knee.</p>
<p begin="00:00:20.061" end="00:00:22.230" style="s2">The transducer is placed transversely</p>
<p begin="00:00:22.230" end="00:00:23.766" style="s2">over the head of the humerus</p>
<p begin="00:00:23.766" end="00:00:28.067" style="s2">with the orientation marker<br />directed to the patient's right.</p>
<p begin="00:00:28.067" end="00:00:29.698" style="s2">The deltoid muscle is seen as</p>
<p begin="00:00:29.698" end="00:00:32.001" style="s2">the most superficial structure.</p>
<p begin="00:00:32.001" end="00:00:35.322" style="s2">The bright hyperechoic greater<br />and lesser tuberosities</p>
<p begin="00:00:35.322" end="00:00:38.758" style="s2">of the humerus surround the<br />oval-shaped biceps tendon.</p>
<p begin="00:00:38.758" end="00:00:40.408" style="s2">The transverse humeral ligament,</p>
<p begin="00:00:40.408" end="00:00:42.151" style="s2">which covers the biceps tendon,</p>
<p begin="00:00:42.151" end="00:00:44.621" style="s2">can be seen as a thin, bright line.</p>
<p begin="00:00:44.621" end="00:00:48.055" style="s2">The biceps tendon is seen<br />in the bicipital groove</p>
<p begin="00:00:48.055" end="00:00:51.014" style="s2">and can appear artificially bright or dark</p>
<p begin="00:00:51.014" end="00:00:53.628" style="s2">due to anisotropy, which<br />occurs if the transducer</p>
<p begin="00:00:53.628" end="00:00:55.700" style="s2">is rocked over the tendon.</p>
<p begin="00:00:55.700" end="00:00:57.933" style="s2">The transducer should<br />be moved down the arm</p>
<p begin="00:00:57.933" end="00:01:01.182" style="s2">to evaluate the tendon to<br />its musculotendinous junction</p>
<p begin="00:01:01.182" end="00:01:04.277" style="s2">and the insertion of the<br />pectoralis major tendon.</p>
<p begin="00:01:04.277" end="00:01:07.211" style="s2">The transducer is returned<br />to the starting position</p>
<p begin="00:01:07.211" end="00:01:10.990" style="s2">at the bicipital groove and<br />rotated 90 degrees clockwise</p>
<p begin="00:01:10.990" end="00:01:14.008" style="s2">to obtain a long axis view of the tendon.</p>
<p begin="00:01:14.008" end="00:01:15.976" style="s2">The fibular tendon should be scanned</p>
<p begin="00:01:15.976" end="00:01:20.143" style="s2">from proximal to distal to<br />the musculotendinous junction.</p>

<p begin="00:00:07.590" end="00:00:09.232" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:09.232" end="00:00:11.400" style="s2">with a musculoskeletal exam type</p>
<p begin="00:00:11.400" end="00:00:13.944" style="s2">is used to perform an<br />ultrasound examination</p>
<p begin="00:00:13.944" end="00:00:16.266" style="s2">of the acromioclavicular joint.</p>
<p begin="00:00:16.266" end="00:00:18.252" style="s2">The patient is in a sitting position,</p>
<p begin="00:00:18.252" end="00:00:21.021" style="s2">with the hand resting<br />palm up on the thigh.</p>
<p begin="00:00:21.021" end="00:00:23.733" style="s2">The transducer is placed longitudinally</p>
<p begin="00:00:23.733" end="00:00:25.973" style="s2">over the acromioclavicular area,</p>
<p begin="00:00:25.973" end="00:00:29.385" style="s2">with the orientation marker<br />directed to the patient's right.</p>
<p begin="00:00:29.385" end="00:00:31.893" style="s2">The acromioclavicular<br />joint is seen between</p>
<p begin="00:00:31.893" end="00:00:34.142" style="s2">the bright, hyperechoic acromion,</p>
<p begin="00:00:34.142" end="00:00:36.498" style="s2">and the distal clavicle.</p>
<p begin="00:00:36.498" end="00:00:40.181" style="s2">The supraspinatous muscle<br />is lateral to the acromion.</p>
<p begin="00:00:40.181" end="00:00:42.884" style="s2">The acromioclavicular<br />joint should be scanned</p>
<p begin="00:00:42.884" end="00:00:45.338" style="s2">in an anterior to posterior direction</p>
<p begin="00:00:45.338" end="00:00:47.883" style="s2">to evaluate the entire joint area.</p>
<p begin="00:00:47.883" end="00:00:50.773" style="s2">The patient can move their<br />arm in a cross-chest fashion</p>
<p begin="00:00:50.773" end="00:00:53.799" style="s2">to further evaluate the<br />integrity of the joint.</p>
<p begin="00:00:53.799" end="00:00:56.268" style="s2">Movement of the acromioclavicular joint</p>
<p begin="00:00:56.268" end="00:00:59.351" style="s2">should be minimal with this maneuver.</p>

<p begin="00:00:07.408" end="00:00:09.080" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:09.080" end="00:00:11.108" style="s2">with a musculoskeletal exam type</p>
<p begin="00:00:11.108" end="00:00:13.650" style="s2">is used to perform an<br />ultrasound examination</p>
<p begin="00:00:13.650" end="00:00:16.429" style="s2">of acromial impingement of the shoulder.</p>
<p begin="00:00:16.429" end="00:00:18.525" style="s2">The patient is in a sitting position</p>
<p begin="00:00:18.525" end="00:00:21.106" style="s2">with the patient's arm flexed 90 degrees,</p>
<p begin="00:00:21.106" end="00:00:23.311" style="s2">and the hand internally rotated.</p>
<p begin="00:00:23.311" end="00:00:25.636" style="s2">The transducer is placed transversely</p>
<p begin="00:00:25.636" end="00:00:27.911" style="s2">over the acromion and humeral head</p>
<p begin="00:00:27.911" end="00:00:31.310" style="s2">with the orientation marker<br />directed to the patient's right.</p>
<p begin="00:00:31.310" end="00:00:34.417" style="s2">The acromion and glenoid<br />tubercle of the humerus</p>
<p begin="00:00:34.417" end="00:00:38.100" style="s2">are seen as superficial,<br />bright, hyperechoic structures.</p>
<p begin="00:00:38.100" end="00:00:41.158" style="s2">The bird-beak shaped<br />supraspinatous and the bursa</p>
<p begin="00:00:41.158" end="00:00:43.667" style="s2">are just superior to the humerus.</p>
<p begin="00:00:43.667" end="00:00:46.494" style="s2">The patient is instructed<br />to slowly abduct the arm</p>
<p begin="00:00:46.494" end="00:00:47.973" style="s2">to evaluate the dynamic movement</p>
<p begin="00:00:47.973" end="00:00:50.305" style="s2">of the supraspinatous tendon and bursa</p>
<p begin="00:00:50.305" end="00:00:51.940" style="s2">under the acromion.</p>
<p begin="00:00:51.940" end="00:00:55.636" style="s2">The structures should pass<br />under the coracoacromial arch</p>
<p begin="00:00:55.636" end="00:00:58.217" style="s2">without the humerus<br />impacting the acromion,</p>
<p begin="00:00:58.217" end="00:01:01.186" style="s2">or without the subacromial<br />subdeltoid bursa</p>
<p begin="00:01:01.186" end="00:01:03.846" style="s2">bunching up with full abduction of the arm</p>
<p begin="00:01:03.846" end="00:01:06.513" style="s2">to exclude acromial impingement.</p>