The Veterinary Journal

The Veterinary Journal 173 (2007) 317324 www.elsevier.com/locate/tvjl

Ultrasonographic examination of important aspects of the bovine shoulder physiological ndings

Birgit Altenbrunner-Martinek
a

a,b,*

, Martina Grubelnik a, Johann Koer

Clinical Department for Small Animals and Horses, Clinic for Orthopaedics in Large Animals, University of Veterinary Medicine Vienna, Veterinarplatz 1, A-1210 Vienna, Austria b Clinical Department for Farm Animals and Herd Management, Clinic for Ruminants, VMU Vienna, Austria

Abstract The left and right shoulder region of 19 healthy cattle and the left and right shoulders of six bovine cadavers were examined ultrasonographically using a 7.5 MHz linear and a 3.5 MHz convex transducer. The lateral shoulder muscles were successfully imaged in all cases; the joint space appeared as a funnel shaped interruption of the hyperechoic bone surfaces of the distal part of the scapula and the proximal and lateral part of the humeral head. In healthy cattle, the synovial cavities of the scapulohumeral joint, the bicipital bursa and the infraspinous bursa could not be clearly dened. After experimental lling with water, the synovial cavities could be dierentiated as discrete anechoic zones. In this study, the normal ultrasonographic appearance of the soft tissue structures and bone surfaces of the scapula and proximal humerus is presented, providing basic reference data for the ultrasonographic evaluation of the bovine shoulder region. 2005 Elsevier Ltd. All rights reserved.
Keywords: Ultrasonography; Cattle; Shoulder joint; Synovial bursae; Centesis

1. Introduction Lameness is an important cause of decreased production and premature culling in cattle (Greenough et al., 1997). Diagnosis of orthopaedic disorders is based on clinical examination, radiography and bacteriological and cytological examination of aspirated synovial uid (Dirksen, 2002; Weaver, 1997). Joint diseases occur in cattle of all ages and breeds and can be divided into infectious and non-infectious arthritis. In cattle, shoulder lameness is uncommon and there exist only a few reports in the literature (Nuss, 2003; Ferguson, 1997). Lesions leading to shoulder lameness are usually unilateral and aect individual animals only (Buergelt et al., 1996) with fractures of the scapula, dis* Corresponding author. Tel.: +43 1 25077 5201; fax: +43 1 25077 5290. E-mail address: Birgit.altenbrunner-martinek@vu-wien.ac.uk (B. Altenbrunner-Martinek).

locations of the scapulohumeral joint and arthritis and bursitis of the bicipital bursa being responsible for most shoulder problems (Dirksen, 2002; Ferguson, 1982, 1997). Localised or diuse swelling of the shoulder region and pain are common ndings in all of these disorders (Ferguson, 1997). The use of ultrasonography for the diagnosis of septic arthritis has been well reported in cattle, horses and humans and is a useful tool in the assessment of joint disease and disorders of periarticular and/or other soft tissue structures (Chhem et al., 1994; Dik, 1996; Genovese et al., 1986; Koer, 1996a,b, 1999, 2000; Munroe and Cauvin, 1994; Tnibar et al., 1999). Anatomically, the shoulder joint is composed of the junction of the distal end of the scapula (cavitas glenoidalis) with the proximal end of the humerus (Nickel et al., 1996). No ligaments exist in the scapulohumeral joint. The large tendons of the infraspinous and supraspinous muscles on the lateral side, the subscapularis muscle on the medial aspect and the biceps brachii muscle on the cranial

1090-0233/$ - see front matter 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.tvjl.2005.09.007

318

B. Altenbrunner-Martinek et al. / The Veterinary Journal 173 (2007) 317324

aspect of the shoulder serve as functional ligaments. The present study was designed to describe the normal ultrasonographic appearance of the lateral aspects of the bovine shoulder and to identify anatomical landmarks useful for orientation of the examiner.

2. Materials and methods The left and right shoulder regions of the cadaver limbs of six cattle (two cows and four calves) were studied ultrasonographically. Only cattle that had been euthanased for non-orthopaedic reasons were used in the cadaver study. The front limb was detached from the thorax such that the soft tissue tautness of the lateral shoulder structures was maintained. The limbs were examined in a horizontal position on a table, with the scapula parallel to the table surface. In the rst phase of the study, the shoulders of six bovine cadavers showing no supercial evidence of disease were studied ultrasonographically. In two of these specimens, the scapulohumeral joint pouch and the bursa underlying the biceps brachii muscle and the infraspinous bursa were distended with water to mimic eusion. Using the anatomical landmarks described in the literature (Dirksen, 2002; Nickel et al., 1996), tap water was injected using a 0.65 30 mm hypodermic needle until marked distension of the synovial cavities could be seen. The distention was visualised as an increasing anechoic zone between the articular bone surface and the joint capsule surrounding the biceps tendon from both sides, or as an anechoic structure between the infraspinous tendon and the bone surface. Transverse and longitudinal sections (ca. 1 cm slices) of two frozen cadaver limbs were cut using a bandsaw. Comparison of these sections with the corresponding sonograms facilitated accurate ultrasonographic interpretation. Dissection of the described structures was undertaken both in the two sectioned specimens and in those with experimentally distended synovial cavities. During the second part of the study, ante-mortem examinations were performed on a total of 19 healthy animals comprising 12 cows (eight Simmental, two Brown Swiss, one Pinzgauer, one Tuxer) of mean age 5.04 years (range: 39 years), and mean weight 554 kg (range: 480637 kg), and seven calves (six bull calves, one female calf; ve Simmental, two Brown Swiss) of mean age 3.78 months (range: 18 months) and mean weight 107.28 kg (range: 50220 kg). All animals were clinically sound. The cattle were restrained in a crush and examined in the standing position. Sedation was not used. The shoulder area was clipped and shaved prior to examination and a generous quantity of coupling gel was applied. A Sonoline Sienna ultrasound unit (Siemens), equipped with a 7.5 MHz linear and a 3.5 MHz convex

transducer was used in the investigation. The soft tissue structures of the cranial and lateral aspects of the shoulder region were scanned in both transverse and longitudinal planes, beginning cranio-proximally and moving stepwise distally and caudally. Anatomical structures that were examined ultrasonographically included the scapular spine, the supraspinous and infraspinous fossae, the supraglenoid tubercle, the lateral aspect of the articular cartilage of the humeral head, the greater tubercle and the bone surface of the proximal part of the humerus, the supraspinous and infraspinous muscles, the tendon of origin of the biceps muscle and the bicipital bursa, the infraspinous tendon and its bursa and the joint space and joint pouch of the scapulohumeral joint. The position, echogenicity and degree of demarcation of the tendons and muscles as well as the appearance of the joint pouch and the synovial bursae were determined.

3. Results No dierences were found in the ultrasonographic appearance of the anatomical structures of the shoulder region between the cadaver limbs and those of live cattle. The appearance of the frozen anatomical sections and the ndings from the anatomical dissections of the bovine shoulders correlated well with the corresponding ultrasonograms. 3.1. Tendons and muscles The tendon of the biceps brachii muscle and the two elements of the infraspinous muscle were imaged successfully in all cadavers and live cattle. The biceps tendon and the supercial tendinous part of the infraspinous muscle were depicted as echogenic structures with a strong linear pattern of parallel bre bundles in longitudinal planes. The muscle-tendon transition could be readily visualised in both structures. The greater humeral tubercle and its adjacent intertubercular (bicipital) groove were localised via digital palpation and the transducer was positioned perpendicularly to this groove to obtain a transverse image of the tendon. In this transverse plane, the biceps tendon could be identied by its oval shaped and homogeneous echogenic appearance (Fig. 1). At the muscle-tendon transition a small cap of hypoechoic muscle bres could be seen cranially attached on the tendon. In the longitudinal plane, the origin of the biceps tendon at the supraglenoid tubercle appeared as cord of small parallel bre bundles arising from a hyperechoic convex bony structure. The examination of the origin of the biceps tendon in adult cows was dicult due to the prominent anatomical shape of the greater humeral tubercle which made it dicult to position the ultrasound probe at the correct

B. Altenbrunner-Martinek et al. / The Veterinary Journal 173 (2007) 317324

319

Fig. 1. Transverse scan of the tendon of the biceps brachii muscle at the level of the bicipital groove in a cow aged 3.5 years; 7.5 MHz linear transducer. The oval shaped, echogenic tendon (a) can be easily dierentiated from the surrounding, hypoechoic terminal branches of the supraspinous muscle (b). The bone surface (bicipital groove, c) is imaged as a hyperechoic line.

Fig. 2. Transverse scan of the insertion of the echogenic infraspinous tendon (a) at the humeral surface below the greater tubercle (b) in a cow aged 3 years; 7.5 MHz linear probe. The infraspinous tendon is covered by the deltoid muscle (d). The underlying bursa cannot clearly be visualised and only a small anechoic zone can be seen (c).

location. The supraspinous muscle had a moderate echogenicity and could be seen at the supraspinous fossa directly adjoining the hyperechoic bone surface. At the beginning of the bicipital groove the supraspinous muscle with its two branches were wrapped around the biceps tendon. In contrast to adult cattle, where the biceps tendon was oval shaped and perpendicular to the long axis of the extremity in the transverse plane, in calves the biceps tendon resembled a teardrop. Caudal to the scapular spine the infraspinous fossa covered by the two branches of the infraspinous muscle could be seen ultrasonographically. The deeper muscular part was more hypoechoic, characterised by anechoic areas interrupted by echogenic septa and covered the hyperechoic bone surface. The supercial tendinous portion had a homogeneous, echogenic appearance and passed over the lateral aspect of the humeral head and the greater tubercle to its insertion at the humeral surface below the greater tubercle. In the transverse plane, the infraspinous tendon appeared as a wide, at and echogenic structure (Fig. 2). In longitudinal planes, it could be dierentiated from the deltoid muscle that lies above due to its strong linear pattern of parallel bre bundles.

interruption of the hyperechoic bone surfaces of the scapula and the humeral head at the lateral aspect of the shoulder region (Fig. 3). Only a small portion of the articular surface at the cranial and lateral aspects of the shoulder could be seen in adult cattle. In these animals, a portion of the articular cartilage covering the humeral head could be visualised as a thin anechoic layer. In calves, the examination of a larger area was

4. Scapulohumeral joint, biceps bursa and infraspinous bursa When scanned in the longitudinal plane, the scapulohumeral joint space appeared as a clearly outlined

Fig. 3. Longitudinal ultrasonogram of the shoulder joint of a cow aged 3.5 years; 3.5 MHz convex transducer. The probe is positioned at the lateral aspect of the shoulder directly distal to the scapular spine. The joint space appears as a clearly outlined interruption of the hyperechoic bone surface of the scapula (a) and the humeral head (b). The hyperechogenic joint capsule (c) covers the bone surfaces.

320

B. Altenbrunner-Martinek et al. / The Veterinary Journal 173 (2007) 317324

possible facilitated by passive movement of the limb during examination. There was a greater thickness of articular cartilage in calves that was more heterogeneous in appearance and was interspersed with small hyperechoic spots (Fig. 4). In adult cattle, the scapulohumeral joint pouch could be imaged at the level of the joint space as a very small, triangular, anechoic area. The bicipital bursa and the bursa underlying the infraspinous tendon could only be visualised as a discrete anechoic border.

5. Scapula and humerus The bone surfaces of the scapula and the humerus showed the usual strong, hyperechoic reection characteristic for bone. They were visualised as linear hyperechoic structures that demonstrated acoustic shadowing distally. The continuity of the bone surface echo was disrupted by physiological bony protuberances such as the scapular spine (Fig. 5) and the greater tubercle. Careful scanning of these structures in transverse and longitudinal planes revealed them to be contiguous with the bone surface. These pseudo-disruptions are physiological and should not be mistaken for fractures. In the calves, the physes of the distal aspect of the scapula and those of the humerus between the greater tubercle and the humeral head (Fig. 6), and between the humeral head and neck (Fig. 4), were clearly seen as small anechoic zones interrupting the hyperechoic bone surface of the scapula and the humerus. In adult cattle, the surface of the greater tubercle appeared as a

Fig. 5. Transverse scan of the scapular spine (a) as small hyperechoic peak, the supraspinous (b) and infraspinous fossa (c) appear as hyperechoic lines. Subject was a 4-week old calf; 7.5 MHz linear probe.

Fig. 6. Longitudinal image of the cartilaginous growth plate between the greater tubercle and the humeral neck in a 4-week old calf; 7.5 MHz linear probe. The hyperechoic bone surfaces of the greater tubercle (a) and the neck (b) are interrupted by a narrow, anechoic area (arrow). The tendinous branch (c) of the infraspinous muscle can be identied by the hypoechoic bre bundles.

Fig. 4. Longitudinal scan of the shoulder joint of a 4-week old calf; 7.5 MHz linear probe. The transducer is positioned directly distal to the scapular spine. The distal part of the scapula (a) and humeral head (b) are covered by a thick hypoechoic layer of cartilage interspersed with small echogenic spots (c). The arrow marks the cartilaginous growth plate next to the neck of the humerus (d). The echogenic joint capsule (e) covers the bony structures.

hyperechoic convex line with acoustic shadowing distally, whereas in calves the (major) greater tubercle had a large cartilaginous component with a heterogeneous appearance interspersed with small echogenic spots. When scanned in transverse planes, the scapular spine appeared as a hyperechoic reection at the upper angle of an imaginary triangle, the two lower angles being formed by the supraspinous and infraspinous fossae. The sides of this imagined triangle could not be seen owing to an acoustic phenomenon caused by the angle of the ultrasound probe in relation to the bone surface. As soon as the angle of the probe was adjusted by directing it obliquely to the long axis of the extremity, the sides of the triangle could be seen.

B. Altenbrunner-Martinek et al. / The Veterinary Journal 173 (2007) 317324

321

6. Experimental lling of joints and synovial bursae in cadaver specimens Following experimental lling, the distended synovial cavities of the scapulohumeral joint and the underlying bursae of the biceps brachii and infraspinous muscles were imaged as clearly demarcated, anechoic zones. Due to the introduction of small air bubbles with the injection, the anechoic uid was interspersed with a small number of minute echogenic foci causing comettail artifacts. Injection of water caused distension of the shoulder joint pouch and elevation of the joint capsule from the hyperechoic articular bone surfaces (Fig. 7). The joint capsule had a heterogeneous echogenic appearance and was easy to dierentiate from the surrounding soft tissue structures when lled with 2040 mL of water (depending on the size of the cadaver limb). Injection of smaller amounts of uid produced insucient distension to allow clear visualisation of the pouch because the necessary pressure of the transducer on the skin surface pushed the uid into other parts of the spacious synovial cavity. In one of the cadaver specimens there was also a clearly demarcated eusion of the bicipital bursa after lling of the shoulder joint capsule. After lling the bicipital bursa with 15 mL of water in calves and 50 mL in adult cattle, an anechoic area surrounded the biceps tendon caudally, medially and laterally, while the cranial aspect remained free (Fig. 8). The bursa underlying the tendon of the infraspinous muscle appeared as an anechoic band between the hyperechoic bone surface of the humerus and the tendon, standing out from the cranial rim of the tendon (Fig. 9).

Fig. 8. Transverse scan of the bicipital bursa after experimental lling in a cadaver specimen of a 4-week old calf; 7.5 MHz linear transducer. The bicipital bursa (a) surrounds the tendon (b) medially and laterally. Due to the pressure of the transducer the uid caudal to the tendon has been pushed into other parts of the bicipital bursa.

Fig. 9. Transverse scan of the infraspinous bursa after experimental lling in a cadaver specimen of a 3-month old calf; 7.5 MHz transducer. The distended infraspinous bursa (c) can be seen as an anechoic area above the humeral surface below the greater tubercle (a); the echogenic tendon of the infraspinous muscle (b) is separated from the bone surface.

7. Discussion
Fig. 7. Longitudinal scan after experimental lling of the shoulder joint pouch in a cadaver specimen of a 3-month old calf; 7.5 MHz transducer. The distended scapulohumeral joint pouch (a) appears as anechoic zone above the articular surfaces (b), the joint capsule (c) is distinctly separated from the articular surface.

Lesions of the bovine shoulder region aect soft tissue as well as bony and cartilaginous structures. Radiography is useful for the detection of bone involvement, but is challenging in adult cattle and has been described

322

B. Altenbrunner-Martinek et al. / The Veterinary Journal 173 (2007) 317324

in the literature as nearly impossible (Bargai et al., 1989; Ferguson, 1997; Pharr and Bargai, 1997). Moreover, radiography is not useful for the determination of soft tissue involvement and early diagnosis of joint inammation (Bargai et al., 1989; Weaver, 1997). As a complementary diagnostic tool, ultrasonographic examination allows excellent visualisation of soft tissue structures. The normal ultrasonographic appearance of the digits, the carpus, the tarsus, the stie, the hip and the pelvic girdle of cattle has been previously reported (Flury, 1996; Grubelnik et al., 2001; Koer, 1995, 1996a,b, 1999, 2000; Koer and Edinger, 1995; Saule and Nuss, 2004; Schock et al., 1998). In the present study, the normal ultrasonographic appearance of important aspects of the shoulder region in young and adult cattle is presented, giving basic reference data for the investigation of disorders of the bovine shoulder. The main indication for diagnostic ultrasonography of the bovine shoulder is the evaluation of septic and traumatic disorders of the synovial, bony and tendinous structures. A similar ultrasonographic appearance in cadaver specimens and live cattle was noted. The ultrasonograms of the longitudinal and transverse planes correlated well with the corresponding slices of the two frozen cadaver specimens. Similar to other bovine regions, such as the carpus, the tarsus and the stie (Flury, 1996; Koer, 1999, 2000; Saule and Nuss, 2004), the tendons of the shoulder region have an echogenic structure in transverse and longitudinal planes. The muscle-tendon transition can easily be dierentiated because of the varying echogenicity from hypoechoic to anechoic that has also been described in other bovine locations (Flury, 1996; Koer, 1999, 2000; Koer and Edinger, 1995). An important nding of this study was that in healthy cattle the synovial cavities of the scapulohumeral joint, the bicipital and the infraspinous bursae cannot be clearly outlined ultrasonographically. In physiological conditions, the scapulohumeral joint pouch is only partially visualised as a very small anechoic area at the level of the joint space when scanned in the longitudinal plane. A clear dierentiation between the joint capsule and the surrounding soft tissues was only possible at the level of the joint space in the longitudinal plane; the more echogenic joint capsule was triangular in shape. This is similar to the ultrasonographic ndings described in the shoulders of dogs and horses (Kramer, 1992; Kramer and Gerwing, 1994; Stanek and Edinger, 1992; Tnibar et al., 1999). Experimental lling of the shoulder joint pouch, the bicipital bursa and the infraspinous bursa in the cadaver specimens was a useful tool to imitate the presence of eusion and to allow the pertinent synovial structures to be imaged and dierentiated. Normally, no uid appears in the deep aspect of the biceps brachii tendon. In descriptions of bicipital bursitis in horses, synovial uid distension between the

proximal tendon of the biceps brachii and the intertubercular groove has been described (Rantanen and McKinnon, 1998; Stanek and Edinger, 1992). Arthrocentesis for experimental lling of the joint pouch was performed in our study from the lateral aspect of the shoulder region following the guidelines described by Dirksen (2002) and Nickel et al. (1996). In the opinion of Nuss et al. (2002) centesis of the bovine shoulder joint should be carried out from the caudolateral into the caudal pouch by inserting the needle in a caudolateral to craniomedial direction. The authors advise that this is due to the large extension of the caudal pouch of the shoulder joint. That method was not used in the present study because the orientation from the caudolateral aspect seemed to us to be more dicult than the craniolateral aspect, where the cranial border of the infraspinous tendon can be used for better orientation. According to Nickel et al. (1996) arthrocentesis is performed by inserting the needle in a dorsolateral to ventromedial direction cranial to the infraspinous tendon, about 2 cm proximal to the greater tubercle. In our study, the shoulders of the cadavers used for the experimental lling of the synovial cavities had no orthopaedic problems. Under physiological conditions only a small amount of synovial uid is present in the bursa underlying the infraspinous muscle so inadvertently puncturing this structure would be unlikely. In clinical patients, ultrasonography should be carried out prior to centesis of synovial structures to avoid any accidental puncture. The method for arthrocentesis of the shoulder joint described by Nuss et al. (2002) is recommended for both joint eusion and bursitis of the synovial bursae. In one of the cadaver specimens there was a concurrent eusion of the bicipital bursa after experimental distention of the shoulder joint. A congenital communication between these synovial structures has been described in the literature (Nuss, 2000; Nuss et al., 2002). Further investigation is needed to clarify the frequency of these anatomical variations. Bicipital bursitis is an uncommon cause of lameness in horses, occurs rarely in small animals (Adamiak and Szalecki, 2003; Gilley et al., 2002; Rantanen and McKinnon, 1998; Stanek and Edinger, 1992) and is seldom described in cattle (Dirksen, 2002). Inammation of the bicipital bursa is believed to result from stretching or tearing of the bursal synovial tissue either during the cranial phase of the stride when the limb is fully extended or from direct trauma. Normally, no uid appears at the deep aspect of the biceps brachii tendon. In descriptions of bicipital bursitis in horses, synovial uid distension between the proximal tendon of the biceps brachii and the intertubercular groove has been described (Rantanen and McKinnon, 1998; Stanek and Edinger, 1992). The normal sonographic appearance of the infraspinous bursa has been described in horses (Stanek and

B. Altenbrunner-Martinek et al. / The Veterinary Journal 173 (2007) 317324

323

Edinger, 1992; Tnibar et al., 1999). When injected with water the infraspinous bursa in our cases could be imaged as an anechoic area similar to the results in horses (Tnibar et al., 1999). To our knowledge there are no published reports on disorders of the infraspinous bursa in cattle or in other species. Inclusion of ultrasound in the clinical examination of shoulder disorders in cattle may however reveal cases of infraspinous bursitis in the future. Clear distension and visualisation of the joint pouches, tendon sheaths and synovial bursae have been described in cases of arthritis, tenosynovitis and bursitis in humans, cattle and horses (Chhem et al., 1994; Grubelnik et al., 2001; Koer, 1995, 1996a,b, 1999, 2000; Mettenleiter, 1995). Similarly, distention of the synovial cavities in the bovine shoulder can be regarded as an indication of pathological change. In cases of septic traumatic arthritis and bursitis, detection of synovial eusion by palpation is challenging due to the prominent inammatory swelling of the subcutaneous and periarticular tissues (Dirksen, 2002; Ferguson, 1997). Comparable diculties have been reported for the digital, tarsal, carpal joints and tendon sheaths and for the stie joint in healthy cattle (Flury, 1996; Koer, 1995, 1999, 2000; Koer and Edinger, 1995). It is important to follow a standardised examination procedure for ultrasonography of the shoulder region in cattle as has been recommended for humans, horses and small animals (Hedtmann and Fett, 1988; Long and Nyland, 1999; Stanek and Edinger, 1992). For orientation in our study, the scapular spine and the greater tubercle were used as anatomical landmarks. The scapular spine can be directly visualised in most cases and is always palpable (Nickel et al., 1996). Starting at the scapular spine and moving the ultrasound probe proximal to distal the lateral aspects of the scapula and the humerus can be imaged and appear as linear to convex, hyperechoic reections with acoustic shadowing distally. This conforms to the ultrasonographic appearance of bony structures described in the literature (Dubs-Kunz, 1990; Reef, 1998). In contrast to adult cattle, where the greater tubercle and part of the minor tubercle appear as hyperechoic convex lines, at this location in calves we found a thick cartilaginous layer that appeared as anechoic areas surrounding small hypoechoic to echogenic reections. The basis for the evaluation of disorders of the bovine shoulder is an extensive knowledge of normal shoulder anatomy and ultrasonographic appearance. Localised or diuse swelling of the shoulder region and pain are common ndings in all disorders of the bovine shoulder such as fractures of the scapula, dislocations of the scapulohumeral joint and arthritis and bursitis of the bicipital bursae (Ferguson, 1997). Early identication and treatment of infectious arthritis and bursitis is essential for successful management and return to function (Trent and Plumb, 1991).

Inclusion of diagnostic ultrasound in the clinical examination of shoulder disorders in cattle should result in a more specic diagnosis that will lead to improved planning for surgical intervention and a more accurate prognosis.

8. Conclusion Useful aids for orientation in the bovine shoulder region can be easily identied as landmarks such as bone surfaces, the biceps or infraspinous tendon and the joint space. For joint examination, longitudinal planes are recommended as they allow a better overview. Both transverse and longitudinal planes are recommended for ultrasonographic examination of the lateral shoulder muscles and tendons. For orientation and identication of anatomical landmarks such as the scapular spine and the greater tubercle, the transverse plane is more suitable. Due to the prominent major tubercle and its anatomical shape, the examination of the biceps tendon is also better performed in the transverse plane. The origin of the biceps tendon at the supraglenoid tubercle can be more easily identied in longitudinal planes. The joint space and the joint pouch can be more readily identied in the longitudinal plane at the lateral aspect of the shoulder by positioning the transducer directly distal to the scapular spine. Dierentiation of the deeper-lying muscular and more supercial tendinous part of the infraspinous muscle is possible in both longitudinal as well as transverse planes. Imaging of the cartilaginous growth plates of the distal part of the scapula between the greater tubercle and the humeral head, and between the humeral head and neck, is best performed in longitudinal planes as it allows a better overview. The most important nding in the present study was that in healthy cattle the joint pouch and the bursae either could not be dierentiated at all or were only seen as small anechoic zones of synovial uid. This is an ideal precondition for the detection of eusion in cases of septic or traumatic arthritis and bursitis of the bovine shoulder region.

Acknowledgements The authors thank Professor W. Baumgartner, head of the Clinic for Ruminants, for making the cattle available, Dr. Ulrike Schildbock and Dr. Amy Nagy for their help with the translation into English.

References
Adamiak, Z., Szalecki, P., 2003. Treatment of bicipital tenosynovitis with double tenodesis. Journal of Small Animal Practice 44, 539 540.

324

B. Altenbrunner-Martinek et al. / The Veterinary Journal 173 (2007) 317324 Koer, J., Edinger, H., 1995. Diagnostic ultrasound imaging of the soft tissues in bovine distal limb. Veterinary Radiology and Ultrasound 36, 246252. Kramer, M., 1992. Die sonographische Anatomie des Schultergelenkes und seines Weichteilmantels beim erwachsenen Hund. Thesis, Fachbereich Veterinarmedizin, Universitat Gieen, Germany. Kramer, M., Gerwing, M., 1994. Die Sonographie des Schultergelenkes und seiner umgebenden Weichteile beim Hund. Teil A: Die sonographische Anatomie des Schultergelenkes und seines Weichteilmantels. Kleintierpraxis 39, 7180. Long, C.D., Nyland, T.G., 1999. Ultrasonographic evaluation of the canine shoulder. Veterinary Radiology and Ultrasound 40, 372 379. Mettenleiter, E., 1995. Das tarsalgelenk des pferdes sonographischer atlas. Schattauer, Stuttgart, Germany, pp. 811. Munroe, G.A., Cauvin, E.R., 1994. The use of arthroscopy in the treatment of septic arthritis in two highland calves. The British Veterinary Journal 150, 439449. Nickel, R., Schummer, A., Seiferle, E., 1996. Lehrbuch der Anatomie der Haustiere. 6th ed., Part 1, Paul Parey, Berlin, Germany, pp. 68 72, 74, 232, 372374, 402403. Nuss, K., 2000. Stadienorientierte Sequenztherapie der septischen und paraseptischen Monarthritis beim Rind. Habilitationsschrift, Ludwig Maximilians Universitat Munchen. Nuss, K., 2003. Septic arthritis of the shoulder and hip joint in cattle: diagnosis and therapy. Schweizer Archiv fur Tierheilkunde 145, 455463. Nuss, K., Hecht, S., Maierl, S., Weller, R., Matis, U., 2002. Zur Punktion der Gliedmaengelenke beim Rind. Teil1: Schultergliedmae. Tierarztliche Praxis 30, 226232. Pharr, J.W., Bargai, U., 1997. Radiology. In: Greenough, P.R., Weaver, A.D. (Eds.), Lameness in Cattle, third ed. W.B. Saunders, Philadelphia, USA, pp. 2440. Rantanen, N.W., McKinnon, A.O., 1998. Musculoskeletal ultrasonography. In: William, Wilkins (Ed.), Equine Diagnostic Ultrasonography. Williams and Wilkins, Baltimore, USA, pp. 492493. Reef, V.B., 1998. Equine Diagnostic Ultrasound. W.B. Saunders, Philadelphia, USA, p. 72, 153, 155. Saule, C., Nuss, K., 2004. Guide to ultrasound examination of the bovine carpus. In: 13th International Symposium and 5th Conference on Lameness in Ruminants, Maribor, Slovenija, pp. 224225. Schock, B., Nuss, K., Kostlin, R., 1998. Ultrasonographic examina tion of the stie in the calf. In: 10th International Symposium on Lameness in Ruminants, Lucerne, Switzerland, pp. 311313. Stanek, Ch., Edinger, H., 1992. Die sonographische Darstellung der Schulter des Pferdes. Pferdeheilkunde 8, 367375. Tnibar, M.A., Auer, J.A., Bakkali, S., 1999. Ultrasonography of the equine shoulder: technique and normal appearance. Veterinary Radiology and Ultrasound 40, 4457. Trent, A.M., Plumb, D., 1991. Treatment of infectious arthritis and osteomyelitis. Veterinary Clinics of North America, Food Animal Practise 7, 747778. Weaver, A.D., 1997. Joint conditions. In: Greenough, P.R., Weaver, A.D. (Eds.), Lameness in Cattle, third ed. W.B. Saunders, Philadelphia, USA, pp. 162180.

Bargai, U., Pharr, J.W., Morgan, J.P., 1989. Bovine Radiology. Iowa State University Press, Iowa, pp. 10, 51112. Buergelt, C.D., Sisk, D., Chenoweth, P.J., Gamboa, J., Nagus, R., 1996. Nutritional myodegeneration associated with dorsal scapular displacement in beef heifers. Journal of Comparative Pathology 114, 445450. Chhem, R.K., Kaplan, P.A., Dussault, R.G., 1994. Ultrasonography of the musculo-skeletal system. Radiologic Clinics of North America 32, 275289. Dik, K.J., 1996. Ultrasonography of the equine shoulder. Equine Practitioner 18, 1318. Dirksen, G., 2002. Krankheiten im bereich der schulter und des oberarmes. In: Dirksen, G., Grunder, H.D., Stober, M. (Eds.), Innere medizin und chirurgie des rindes, fourth ed. Paul Parey, Berlin, Germany, pp. 764770. Dubs-Kunz, B., 1990. Sonographie des Bewegungsapparates: Untersuchungstechnik, Befundung, Interpretation. Huber, Bern, Schweiz, pp. 2463, 6168, 95100. Ferguson, J.G., 1982. Management and repair of bovine humeral fractures. Compendium Continuing Education Practising Veterinarian 4, 128135. Ferguson, J.G., 1997. Surgical conditions of the proximal limb. In: Greenough, P.R., Weaver, A.D. (Eds.), Lameness in Cattle, third ed. W.B. Saunders, Philadelphia, pp. 262276. Flury, S., 1996. Ultrasonographische Darstellung des Tarsus beim Rind. Thesis, Fachbereich Veterinarmedizin, Universitat Bern, Schweiz. Genovese, R.L., Rantanen, N.W., Hauser, M.L., Simpson, B.S., 1986. Diagnostic ultrasonography of equine limbs. Veterinary Clinics of North America, Equine Practice 2, 145225. Gilley, R.S., Wallace, L.J., Hayden, D.W., 2002. Clinical and pathologic analyses of bicipital tenosynovitis in dogs. American Journal of Veterinary Research 63, 402407. Greenough, P.R., Weaver, A.D., Broom, A.D., Esslemont, R.J., Galindo, F.A., 1997. Basis concepts of bovine lameness. In: Greenough, P.R., Weaver, A.D. (Eds.), Lameness in Cattle, third ed. W.B. Saunders, Philadelphia, pp. 313. Grubelnik, M., Koer, J., Martinek, B., Stanek, Ch., 2001. Die sonographische Darstellung der Huftgelenkregion und des kno chernen Beckens beim Rind. Berliner und Munchner Tierarztliche Wochenschrift 115, 209220. Hedtmann, A., Fett, H., 1988. Atlas und Lehrbuch der Schultersonographie. Bucher des Orthopaden, Band 52. Koer, J., 1995. Die septische Arthritis des Krongelenkes beim Rind klinische, rontgenologische sowie sonographische Befunde und Behandlung. Berliner und Munchner Tierarztliche Wochenschrift 108, 281289. Koer, J., 1996a. Arthrosonography the use of diagnostic ultrasound in septic and traumatic arthritis in cattle-a retrospective study of 25 patients. British Veterinary Journal 152, 683698. Koer, J., 1996b. Ultrasonographic imaging of pathology of digital exor tendon sheath in cattle. Veterinary Record 139, 3641. Koer, J., 1999. Ultrasonographic examination of the stie region in cattle normal appearance. The Veterinary Journal 158, 2132. Koer, J., 2000. Ultrasonographic examination of the carpal region in cattle normal appearance. The Veterinary Journal 159, 8596.