Figure 4

Sonographic findings with shoulder impingement. Dynamic musculoskeletal sonography of a 36-year-old man developed shoulder impingement syndrome after receiving hook plate fixation of a left distal clavicle fracture. The treated shoulder was passively and forwardly elevated from a neutral position towards 180° elevation. It was stopped at 120° when the patient reported intolerable pain. (A–C) At 90° forward elevations, bunching of supraspinatus tendon fibers (arrowheads) was noted accompanied with distention of the subacromial/subdeltoid bursa (arrow) signifying flowing fluid of bursitis. (D) Another remarkable finding is abnormal superior translation of humeral head with regard to the acromion obstructing its passage beneath the acromion. SSP, supraspinatus tendon; HH, humeral head; AC, acromioclavicular joint.