AANA Lab Course 1002 -3rd Annual Fellows/Chief Residents-Interpretation of Advanced Ultrasound Reading-Erin F. Alaia, M.D.

Interpretation of Advanced Ultrasound Reading-Erin F. Alaia, M.D.

Pdf Summary

Dr. Erin Alaia, Assistant Professor of Radiology at NYU School of Medicine, specializes in musculoskeletal ultrasound with a focus on shoulder imaging and injections. Her presentation covers therapeutic glenohumeral joint injections and shoulder ultrasound cases.<br /><br />Key points include the importance of proper positioning and transducer orientation—specifically, keeping the probe orthogonal to the glenohumeral joint and aligning the focal zone with the needle to optimize injection accuracy. Two main injection approaches are described: the posterior approach, which is easier and used for older patients but has a higher risk of extracapsular injection, and the lateral approach, preferred for younger patients due to less risk of extra-articular contrast spread, aided by the infraspinatus muscle acting as a barrier.<br /><br />Dr. Alaia emphasizes techniques to prevent anisotropy (imaging artifact) by maintaining the transducer at a right angle to the structure, such as the biceps tendon during therapeutic injections. She presents illustrative cases including a 65-year-old male with a full-thickness retracted supraspinatus tear, diagnosed via ultrasound, which is an effective alternative imaging modality for patients with pacemakers, claustrophobia, or postoperative cuffs. The Crass position is recommended for optimal visualization of the supraspinatus tendon.<br /><br />Additional cases include a 36-year-old male with a spinoglenoid notch paralabral cyst and a 64-year-old female with post-traumatic greater tuberosity fracture, demonstrating the utility of ultrasound in diverse clinical scenarios.<br /><br />In summary, Dr. Alaia stresses that the lateral approach is preferred for therapeutic injections, and highlights ultrasound's advantages in shoulder pathology diagnosis. Key technical considerations include attention to posterior capsular recess distention, use of the Crass position, and prevention of anisotropy for high-quality imaging outcomes.<br /><br />Contact: Erin.Fitzgerald@nyumc.org

Keywords

musculoskeletal ultrasound

shoulder imaging

glenohumeral joint injections

posterior injection approach

lateral injection approach

anisotropy prevention

supraspinatus tear

Crass position

spinoglenoid notch cyst

greater tuberosity fracture