Examination technique

Besides what has already been mentioned, it is compulsory to use some practical skills in order to avoid diagnostic pitfalls.

The patient must be positioned in a proper way to make the examination comfortable both for the patient and the operator, regardless of the examined anatomical region [8,9] (Fig. 1.6).

When studying the musculoskeletal system, particular attention must be paid to the angle of the ultrasound beam, which must be perfectly perpendicular to the examined structure. Otherwise, anisotropy-dependent artifacts (spatial asymmetry) may result in diagnostic errors, especially when studying fibrillar or fascicular structures such as tendons and nerves [10-13].

The anatomical regions where such artifacts occur more frequently are some of the tendon entheses and the corresponding pre-insertional segments, where the tendon has a curvilinear course (supraspinatus, brachial biceps or Achilles tendon).

Longitudinal and transverse scans and sometimes also oblique and unconventional views must be performed in order to make a detailed assessment of the musculoskeletal structures.

Another essential feature of ultrasound that makes it unique among other imaging techniques, is that it permits dynamic assessment and therefore extracts important functional information. US is the only imaging technique that allows a direct

Correct position of the patient for the assessment of the rotator cuff

interaction between operator and patient through active, passive or resisted movement with the advantage of direct anatomic and functional visualization.

Moreover, the operator can take advantage of a comparative bilateral study to increase diagnostic confidence.

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