POCUS

What needs to be done to improve this image?

• Increase overall gain

• Adjust the time gain compensation (TGC)

• Nothing. There is a tear as outlined in the image.

• Apply heel-toe technique

Answer explanation

Apple heel-toe technique to get the biceps tendon perpendicular to the ultrasound beam to reduce or prevent anisotropy.

To apply heel toe technique, apply more pressure at the ____ end of the transducer.

• Superior

• Inferior

• Medial

• Lateral

Answer explanation

More pressure has to be applied at the inferior end to get the biceps tendon in a straight line, perpendicular to ultrasound beam.

Both images were taken from the same patient. What has been done to improve the appearance of the biceps tendon?

• Increase the gain

• Angle the probe

• Apply pressure

• Apply heel-toe technique

Answer explanation

Angle the probe so that the beam is perpendicular to the tendon.

What is the abnormality seen in this image?

• Normal tendon

• Tendinosis

• Full thickness tear

• Bursitis

Answer explanation

The supraspinatus tendon is thickened and heterogenous. This is suggestive of tendinosis.

Which arm positioning is best for assessing supraspinatus tendon?

• 
• 
• 
• 

Answer explanation

This modified Crass position exposes the supraspinatus tendon by bringing it out from under the acromion and maximizes its visualization.

This image is a typical appearance of

_______________ in transverse view.

• Long head of bicep tendon

• Subscapularis

• Supraspinatus

• Infraspinatus

Answer explanation

It is common to see vertical hypoechoic striations of the subscapularis muscle between the hyperechoic tendon bundles. This should not be misinterpreted as tear/tendinosis.

The abnormality seen in the longitudinal view of the supraspinatus tendon is:

• Osteophytes

• Tendinosis

• Complete tear

• Bursal thickening

Answer explanation

The deltoid muscle is closer to the humeral head, in the space normally occupied by the supraspinatus tendon, which is called as “non-visualization” of tendon.

Cortical bony irregularities are often seen in:

• Tendon tear

• Calcific tendinosis

• Severe tendinosis

• Bursitis

Answer explanation

An ability of the bone to react to mechanical stress causes cortical pits as well as hypertrophy, which are cortical irregularity.

Which of the following(s) are NOT indirect

 signs of tendon tear?

• Tendon thinning

• Cortical irregularity

• Presence of joint effusion and bursal fluid

• Convex tendon sign

Answer explanation

The convex outline of the tendon in transverse view suggests that the tendon is intact. On the other hand, concavity of the tendon outline suggest a tear.

The structure indicated by the arrow is:

• Deltoid muscle

• Tendon

• Bursa

• Ligament

Answer explanation

The subacromial bursa separates the superior surface of the supraspinatus tendon from the acromion, facilitates the normal movement of tendon.