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Objectives: In the literature, shoulder ultrasound (US) protocols rely on the widely accepted anatomical concept of the infraspinatus tendon (IST) running parallel and posterior to the supraspinatus tendon (SST). To assess the IST, authors currently recommend placing the transducer posteroinferior to the acromion; however the examination of the anterosuperior part of the IST remains problematic. The aim of our study was to apply recent anatomical knowledge to propose a simple protocol to assess the IST over its entire width including its anterosuperior margin., Materials and Methods: Six non-diseased shoulders from four cadavers were assessed in hyperextended internal rotation (HIR) position with US anterosuperolateral approach followed by dissection. Twelve healthy volunteers underwent similar US examination of the shoulder., Results: The IST is a thin, wide, strap-like tendon. The HIR position exposed the largest area of IST beyond the acromion; combined anterosuperolateral US approach enabled imaging of the IST over its entire width with transverse and longitudinal views. The anterosuperior margin of the IST was distinguishable from the SST., Conclusion: The anterosuperolateral US approach in HIR position enables an accurate assessment of the IST including the transverse plane. The limit between the SST and IST appears more clearly., Key Points: • The hyperextended internal rotation of the shoulder brings the infraspinatus tendon forward. • The infraspinatus tendon is visible with anterosuperolateral ultrasound approach. • The anterosuperior margin of the infraspinatus tendon is visible with this technique.

Objectives: The superior part of the rotator cuff consists of the anterior (SSa) and posterior (SSp) parts of the supraspinatus tendon, the infraspinatus (IS) tendon plus the articular capsule. An overlap of the distal SSp tendon by the anterior part of the IS one has been anatomically demonstrated; the insertion area of the IS is more anterior than currently believed. The aim of our study was to assess this complex architecture through standard MRI scans., Methods: Twenty-five healthy volunteers underwent a shoulder MRI. Three planes T2 fat saturation sequences were read in consensus by two radiologists. The SSa, the SSp, the IS tendons and the articular capsule were assessed for visibility. The patterns of demarcation of each structure from adjacent ones were assessed. The width and the thickness of each tendinous band were measured on sagittal images., Results: The SSa, the SSp and the IS tendons were distinguishable in all patients. The anterior part of the IS tendon overlapped the SSp tendon to reach a quite anterior insertion into the greater tuberosity of the humerus. The SSa, the SSp and the IS tendons were 6.5-3.4, 15.1-2.8 and 26.8-2.2 mm wide and thick, respectively., Conclusion: MR images of the normal superior rotator cuff are consistent with latest anatomical descriptions. The distal superposition of the IS over the SSp tendon should be considered regarding the linear increased signal areas and the commonly named "partial thickness ruptures" of the superior rotator cuff as well as the fatty infiltration of the IS muscle.

Objectives: The aim of this retrospective study was to measure the inferior glenohumeral capsule thickness of shoulders clinically affected by capsular contracture by comparison to the contralateral asymptomatic side., Methods: Bilateral shoulder ultrasound (US) examinations of 20 patients with clinically or MRI proven unilateral capsular contracture were retrospectively assessed. Inferior capsule evaluation was performed with a transducer placed within the axilla in maximally abducted shoulders. Measurements were symmetrically performed orthogonally to the inferior glenohumeral ligament (IGHL) in the axial plane; the coronal plane was used to ensure the tension of the IGHL. The significance of any difference in thickening was assessed with the Mann-Whitney test., Results: The average thickness was 4.0 mm in shoulders with capsular contracture vs. 1.3 mm in asymptomatic contralateral shoulders (P < 0.0001). Twenty per cent of patients with capsular contracture and inferior capsule thickness increase showed US features of other painful diseases of the rotator cuff., Conclusion: The thickness of the inferior capsule is measurable through ultrasound examination and appears to be increased in shoulders with capsular contracture. Exploration of the inferior aspect of the shoulder joint could be added to shoulder US examination protocols for capsular contracture assessment even if other rotator cuff abnormalities are diagnosed by US., Key Points: • Ultrasound is increasingly used to diagnose shoulder problems. • The thickness of the inferior glenohumeral ligament is measurable in the axilla. • The inferior glenohumeral ligament appears thickened in shoulders with capsular contracture. • Capsular contracture ultrasound features can be associated with other rotator cuff problems.

Sacrococcygeal dislocation is among the many causes of coccydynia. The etiological diagnosis of this fairly rare condition is difficult. Dynamic imaging is the only means of documenting the dislocation. We describe two cases of sacrococcygeal dislocation in patients presenting with coccydynia. Both patients reported a history of trauma in the more or less remote past, with no clear correlation with pain onset. Magnetic resonance imaging (MRI) of the sacrococcygeal junction showed local inflammatory lesions (bursitis, sacrococcygeal arthritis), providing a rationale for a local procedure. Analgesic therapy was inadequately effective and a local glucocorticoid injection into the sacrococcygeal junction was therefore recommended. One of the patients accepted this procedure and subsequently reported complete resolution of the symptoms., (Copyright © 2012 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.)