The Shoulder

Long Head of the Biceps SAX

In SAX the Biceps Tendon is/is not positioned deep in the Bicipital Groove. There
is/is not excess fluid noted within the tendon sheath. There is/is not a halo sign
as seen with tenosynovitis. Bony irregularity/spur formation of the Greater and/or
Lesser Tuberosity margins is/is not demonstrated.
Long Head of the Biceps LAX
In LAX the Biceps Tendon has/does not have normal hyper-echoic fibrous
echotexture. It is/is not hypoechoic and thickened as seen with the process of
tendinosis. Color Doppler imaging does/does not produce non-pulsatile signal
from neo-vascularization. Static imaging does/does not reveal focal nonvisualization/interruption as with fiber failure/tear. Dynamic, isometric testing
reveals/does not demonstrate a partial tendon tear. Excess fluid is/is not
demonstrated within the tendon sheath.
Subscapularis Tendon SAX
The SAX Subscapularis tendon, with the patient arm in external rotation,
demonstrates/does not show hyper-echoic, fibrous echotexture. There are/are
not intra-tendinous tears. The tendon attachment on the Lesser Tuberosity
has/lacks the normal tapering conformity, and well-defined tendon footprint
associated with a stable tendon enthesis.
Subscapularis Tendon LAX
In LAX, the Subscapularis shows the mixed echoes of the hyper-echoic tendon slips
inter-digitating with hypoechoic muscle.
Acromio-Clavicular Joint
The cortical margins of the Acromion and Clavicle are/are not irregular with bone
proliferation/spurs. The Clavicle is/is not elevated above the Acromion suggestive of
shoulder separation. The AC ligament is/is not distended from the intra-articular
effusion. Geyser Sign is/is not present. Internal and external rotation dynamic
maneuvers are positive/negative for AC impingement (internal) and AC separation
(external).
Supraspinatus Tendon SAX
The Humeral cortex is/is not continuous/smooth/intact. The hyaline cartilage
interface is/is not a well-defined anechoic interface following the bony margin.
There is/is not a double contour sign suggestive of abnormal fluid deep to the
SSP, and associated with the full-thickness tendon tears. The tendon
demonstrates/does not show hyper-echoic, fibrous echotexture. There is/is not
poor or non-visualization of the tendon fiber at the articular, bursal or intrasubstance regions of the SSP as with partial thickness tears. There is/is not effusion
of the Sub-Deltoid bursa.

Supraspinatus Tendon LAX

The tendon attachment on the Greater Tuberosity has/lacks the normal tapering
conformity, and well-defines tendon footprint associated with a stable tendon
enthesis.

Infraspinatus Tendon SAX

The patient arm was in internal rotation and tight adduction to be imaged. The
tendon demonstrates/does not show hyper-echoic, fibrous echotexture. There
is/is not poor, or non-visualization of tendon fibers at the articular, bursal or intrasubstance regions. A well-defined tendon footprint is/is not demonstrated.
Gleno-Humeral Joint
The Humeral Head demonstrates/does not reveal continuous/smooth/intact
cortical margin. The visible/apical portion of the Glenoid Labrum is/is not
suggestive of labral defect/tear. The joint space is/is not well maintained. The
Teres Minor muscle/tendon is unremarkable. There is/is not sonographic evidence
of a dorsal ganglion in the Suprascapular Notch.
Anterior Impingement
Dynamic imaging with patient arm flexion/abduction reveals the Supraspinatous
gliding completely/incompletely with/without aberrant motion under the
Acromion.
Elbow
Anterior Elbow SAX
In SAX at the antecubital fossa/crease, the cortical margin of the distal Humerus
is/is not continuous/smooth/intact. The hyaline cartilage interface is/is not a welldefined anechoic interface following the bony margin. The combined interface of
the synovium and capsule is/is not a well-defined, homogenous, hyperechoic
band delineating the bony margin. No anterior joint effusion of synovial
proliferation. The Coronoid Fossa fat pad is/is not displaced superficially by intraarticular fluid.
Lateral Epicondyle LAX
In LAX the Humeral Lateral Epicondyle does/does not demonstrate cortical
irregularity and/or enthesophytes as seen with compromised tendon attachment.
The Common Extensor Tendon attachment has/lacks the normal tapering
conformity, and well-defined tendon footprint associated eith a stable tendon
enthesis. The distal/deeper margin of the epicondyle is the Radial Collateral
Ligament region. The RCL fibers are/are not intact.
Distal Biceps Tendon
The Distal Biceps tendon is viewed via lateral and dorsal sonographic windows. The

in the lateral approach the visible length of the tendon does/does not demonstrate
a hyperechoic, fibrous echotexture. Dynamic supination/pronation maneuvers
did/did not reveal evidence of fiber failure/tear. The dorsal view does/does not
reveal tapering contour of the tendon attachment, and anechoic tendon footprint on
the radial tuberosity.
Medial Epicondyle LAX
In LAX, the Medial Epicondyle does/does not demonstrate cortical irregularity
and/or enthesophytes as seen with compromised tendon attachment. The Common
Flexor Tendon attachment has/lacks the normal tapering conformity, and welldefined tendon footprint associated with a stable tendon enthesis. The
distal/deeper margin of the epicondyle is the Ulnar Collateral Ligament (anterior
band) region. The UCL fibers are/are not intact. There is/is not Ulnar cortical
disruption as seen with avulsion fracture in throwing athletes. Dynamic valgus
stress does/does not demonstrate excess joint play of >2mm.
Ulnar Nerve/Cubital Tunnel SAX
The Ulnar Nerve is/is not visualized deep within the Ulnar Groove and adjacent to
the bony Medial Epicondyle. Dynamic flexion maneuvers do/do not demonstrate
hypermobility of the nerve/sublaxation. Cross-sectional area of the nerve within the
groove is/is not greater than 10mm2.
Triceps Tendon LAX and SAX
In LAX the Triceps Tendon does/does not demonstrate the normal hyper-echoic,
fibrous echotexture. The Triceps intertion on the Olecranon Process has/lacks the
normal tapering conformity, and well-defined tendon footprint associated with a
stable tendon enthesis. The media and/or lateral muscle head have/do not have
the normal septa-muscle bundle pattern. There are/are not focal areas as with
muscle tear/trigger point. In SAX the Olecranon Fossa Fat Pad is/is not displaced
by fluid.
The Hand/Wrist
Median Nerve SAX and LAX
In SAX the Median Nerve was imaged at the Carpal Tunnel entry, and proximally in
the FDS/FDP interface. Cross-sectional measurements from both locations yielded a
WFR ratio greater than/less than 1.4. In LAX there was/was not
dilatation/fusion contour of the nerve proximal to tunnel entry.
Ulnar Nerve SAX
In SAX the Ulnar Nerve was imaged in Guyons Canal. Cross-sectional measurement
yielded a
mm2 value. A contra-lateral measurement provided a
mm2
value.
Extensor Pollicis Brevis and Abductor Pollicis Longus
In LAX the 1st compartment tendons were/were not hyper-echoic with a distinct

fibrillation pattern. There was/was not sonographic evidence of tendinitis (hypoechoic, thickened, neovascularization).
1st Carpal Meta-Carpal Joint LAX
In LAX, the 1st CMC was identified as the 3rd joint space from the Distal Radius.
There was/was not cortical irregularity of the carpal and/or meta-carpal margins.
Homogenous, non-compressible intra-articular synovial proliferation was/was not
visualized. Color Doppler imaging was positive/negative with non-pulsating signal
over the joint margin.
Ulnar Collateral Ligament LAX
In LAX the Ulnar Collateral Ligament of the Basal/Thumb joint, was hypo-echoic
intact/not disrupted in a static position deep to the hyper-echoic Adductor
Aponeurosis. Hyper-abduction stress did/did not reveal ligament discontinuity as
with Gamekeepers Thumb. Dynamic flexion of the thumb did/did not demonstate
the UCL about the Aponeurosis associated with Stener Lesion.

1st-5th Metacarpal-Phalangeal Joint

In LAX the _______ MCP does/does not demonstrate cortical irregularity/erosion as
in inflammatory arthritis and/or osteoarthritis. Homogenous, non-compressible
intra-articular aynovial proliferation was/was not visualized. Color Doppler
imaging was positive/negative with non-pulsatile signal over the joint margin.
Triangular Fibrocartilage Complex LAX
In LAX the TFCC was imaged with the patient wrist radially deviated/stressed. The
distal Ulnar Styloid is/is not elongated and/or irregular with bony degeneration. The
fibrocartilage itself does/does not demonstrate irregular, anechoic lines suggestive
of tears. The Meniscal Homologue is/is not intate by demonstration/absence of
fibrous echotexture superficial to the disc. The collateral ligaments are/are not
intact. The superficial Extensor Capri Ulnaris Tendon has/does not have a hyperechoic distinct fibrillary pattern.
The A1-A2 Pulley Ligament SAX
The bony contour of the Proximal Phalanx is/is not smooth and intact. The Volar
Plate is/is not thickened in its position deep to the flexor tendons (FDS, FDP). The
tendons do/do not demonstrate intra-sheath fluid as in tenosynovitis or
hypoechogenicity and thickening from tendinosis. The Annular ligament is/is not
hypertrophic, thickened, distended suggestive of constricting the excursion of the
tendon within the tunnel-like ligament.
The Hip
Anterior Hip LAX
In LAX the Femoral Head/Neck bony contour is hyper-echoic, smooth and intact.

The visible Acetabular Labrum in /is not suggestive of labral defect/tear. The
capsular condensation of ligament and capsular membrane does/does not
follow/duplicate the Femoral Head-Neck contour. There is/is not sonographic
evidence of capsular effusion.
Ilio-Psoas Tendon LAX and SAX
The IP tendon does/does not demonstrate hyper-echoic with a distinct fibrillary
pattern. Also, it does/does not demonstrate intra-sheath fluid as in tenosynovitis
or hypoechogenicity and thickening from tendinosis.
Gluteus Minimus and Gluteus Medius Tendons LAX
In LAX the GMin and/or GMed tendon(s) demonstrate hyper-echois distinct fibrillary
pattern. Also, it/they do(es)/do(es) not demonstrate hypoechogenicity and
thickening from tendinosis. The ilio-Tibial Band (ITB) does/does not present hyperechoic fibrous echotexture. There is/is not bursal effusion in the GMin and/or GMed
attachment area. Sub-Gluteus Maximus bursal effusion is/is not visualized.

Piriformis Muscle LAX

In LAX Piriformis Muscle is visualized from the Trochanteric insertion, medially into
the Sub-Gluteus Maximus interface. The Piriformis does/does not demonstrate
normal compact echotexture deep to coarse echos of GMax. Piriformis is/is not
hypoechoic, edematous. Comparative image of the contra-lateral muscle was/was
not performed. The Sciatic Nerve was/was not identified.
Sacro-Iliac Joint SAX
In SAX the SIJ(s) do/do not demonstrate hyper-echoic and/or hypo echoic echoes of
the SIJ ligaments/distal Multifidus. Intra-articular echoes were/were not visualized
extending deep into the joint margin as with active Sacro-Ileitis.
The Knee
Supra-Patellar LAX and SAX
In LAX and SAX the Supra-Patellar Bursa/Pouch did/did not demonstrate axcess
fluis effusion and/or intra-bursal debris from synovial hypertrophy and extracapsular migration. The SAX Sunrise view does/does not reveal osteophyte
formation at the Medial and/or Lateral Trochlear peaks. The hyaline cartilage
interface is/is not think/well defined, and does/does not follow/duplicate athe
Trochlear bony contour.
Infra-Patellar LAX and SAX
In LAX the two subcutaneous bursae(Pre-Patellar, Infra-Patellar) are/are not
effused/visible. The Patellar Tendon/Ligament does/does not demonstrate hyperechoic fibrous echotexture. The deep margin of the tendon/ligament are

positive/negative for Jumpers knee proximally and Deep Infra-Patellar Bursa

effusion distally. Hoffas Fat Pad, deep to the tendon/ligament does/does not show
sonographic changes of inflammation/edema. Contra-lateral imaging was/was not
performed for comparison.
Lateral Collateral Ligament and Lateral Meniscus and Ilio-Tibial Band LAX
In LAX the LCL is/is not intact at its Fibular attachment. The peripheral (posterolateral) margin of the lateral meniscus does/does not demonstrate
irregularity/distruption as in meniscal tear. Sub-ITB fluid collection at the Lateral
Femoral Condyle and attachment deformity at Gerdys Tubercle is/is not
demonstrated.
Medial Meniscus Medial Collateral Ligament and Pes Anserine Bursa LAX
In LAX the Menisco-Femoral and Superficial portions/interfaces of the MCL are/are
not intact with/without focal areas of non-visualization as with tears. The visible
Medial Meniscus does/does not demonstrate irregularity/disruption/anechoic clefts
as in meniscal tear. Dynamic Valgus stress does/does not produce excessive
meniscal excursion beyond the joint border. Tracing MCL distally along the Tibial
cortex does/does not reveal Pes Anserine Bursa effusion.

Popliteal Fossa SAX and Biceps Femoris Tendon LAX

In SAX there is/is not a fluid collection with the defining anatomic neck and seen
with Bakers Cyst. The Popliteal vein is/is not compressible with sonopalpatation to
rule in/out thrombosis. In LAX the Biceps Femoris Tendon attachment at the Fibula
does/does not demonstrate the normal tapering conformity, and well-defined
tendon footprint associated with a stable tendon enthesis. The BF traced proximally
to its muscle-tendon junction.
The Foot and Ankle
Anterior Ankle LAX and SAX
In LAX and SAX the Tibial margin is/is not smooth and intact. There is/is not
displacement of the intra-capsular fat pad by joint effusion. There extensor tendons
(EDL, EHL, TA) do/do not demonstrate hyperechoic distinct fibrillar pattern. Also,
they do/do not demonstrate intra-sheath fluid as in tenosynovitis or
hypoechogenicity and thickening from tendinosis.
ATFL Tib-Fib and Calcaneo-Fib Ligaments
ATFL, Tib-Fib, CFL ligaments do/do not demonstrate intact fibroud echotexture as
they/it span the joint space they support. Dynamic stress applies under real-time
imaging did/did not show excess joint opening greater than 2mm.
Peroneal Tendons LAX and SAX
The PB and PL do/do not demonstrate hyper-echoic with a distinct fibrillary pattern.

Also, it does/does not demonstrate intra-sheath fluid as in tenosynovitis or

hypoechogenicity and thickening from tendinosis. No sonographic evidence of
longitudinal split tear of PB as it wraps the malleolus. Dynamic eversion stress
did/did not PB subluxation over Lateral Malleolus.
Medial Ankle/Tarsal Tunnel LAX and SAX
In LAX and SAX Posterior Tibialis Tendon does/does not have a distint fibrillary
pattern. Also, it does/does not demonstrate intra-sheath fluid as in tenosynovitis
or hypoechogenicity and thickening from tendinosis. The Tibial Nerve is/is not
enlarged or entrapped. The FD and FHL tendons are unremarkable.
Achiles Tendon LAX and SAX
In LAX the Achilles does/does not demonstrate a hyper-echoic distinct fibrillary
pattern. Also, it does/does not demonstrate intra-sheath fluid as in tenosynovitis
or hypoechogenicity and thickening from tendinosis. The tendon attachment
has/lacks the normal tapering conformity, and well defined tendon footprint
associated with a stable tendon enthesis. There is/is not retro-calcaneal bursal
effusion or tear. In SAX the Achilles has/lacks the normal reniform shape near the
calcaneal margin.
Plantar Fascia LAX
In LAX the PF is/is not hyper-echoic and fibrous with a thickness measurement
greater than/less than 4mm. The fibro-faty heel pad is unremarkable.
Flexor Hallucis Longus and Plantar Plate LAX
The Plantar Plate does/does not demonstrate irregularity/disruption on dynamic
hyperextension imaging as seen with PP fracture/tear. The FHL Tendon
demonstrates a hyper-echoic w distinct fibrillary pattern.

Myofascial trigger points revealed in the Cervical Areas of Dry Needling? muscle by dry
needle technique with noted needle fibrillation, local twitch response, reproduction of
symptoms including but not limited to achiness, burning and electricity. This was
performed for Time?. Noted are typical tissue morphology characteristics of abnormal
density, palpable margins, contracted/fibrotic muscle and fascial tissue with resistance
to penetration. These characteristics reflect abnormal tissue function, innervation and
nervous system communication.

Myofascial trigger points revealed in the Lumbar Dry Needling muscle by dry needle
technique with noted needle fibrillation, local twitch response, reproduction of symptoms
including but not limited to achiness, burning and electricity. This was performed for
Time?.
Noted are typical tissue morphology characteristics of abnormal density,
palpable margins, contracted/fibrotic muscle and fascial tissue with resistance to
penetration. These characteristics reflect abnormal tissue function, innervation and
nervous system communication.

Myofascial trigger points revealed in the Dry Needling UE muscle by dry needle
technique with noted needle fibrillation, local twitch response, reproduction of symptoms
including but not limited to achiness, burning and electricity. This was performed for
Time?. Noted are typical tissue morphology characteristics of abnormal density,
palpable margins, contracted/fibrotic muscle and fascial tissue with resistance to
penetration. These characteristics reflect abnormal tissue function, innervation and
nervous system communication.
Myofascial trigger points revealed in the Lower Ext Dry Needling muscle by dry needle
technique with noted needle fibrillation, local twitch response, reproduction of symptoms
including but not limited to achiness, burning and electricity. This was performed for
Time?. Noted are typical tissue morphology characteristics of abnormal density,
palpable margins, contracted/fibrotic muscle and fascial tissue with resistance to
penetration. These characteristics reflect abnormal tissue function, innervation and
nervous system communication.
A functional movement screen was performed, with all of the following progressions
receiving passing scores: FMS Pass?.

DAY 1
Upper Extremity Exercises performed include: Side Lying Abduction, Plus with Dyna
Disc, Field Goals, Concentric/Eccentric ER, Modified Empty Can, T-curl-alternate
pronation/supination with hand for
Upper Extremity Exercises performed include: Subscapularis, ER Standing, Bilateral
BB3X3, Standing 3-way, Dynamic Blackburn, Scapular retraction-End range for Reps
and Sets x Time.