Bony Dip seen during Shoulder Ultrasound

[Lena Truong]

Hello Stephen,

We seem to be noticing this dip in the bone while scanning Shoulders. Patient’s often have no history of dislocation or trauma as well. How do we report this on the worksheet, and what could it possibly be?

Kind regards,
Lena

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[Stephen Bird]

Hi Lena,

Firstly, welcome to the website, I hope you enjoy the material,

Thanks so much for posting this excellent case on the forum,

Yes, this is a classic finding,

And quite normal,

You also see it on MRI,

It is usually located at the back of the supra just where you are going into infra and it is where the joint capsule inserts into the humeral head.

It forms a type of “synovial herniation pit” at this location and I ignore them.

You can see similar appearances in many locations throughout the MSK system,

I see them under subscap commonly as well. They are always located where the hyaline cartilage ends and the enthesis beginning (by definition where the capsule inserts).

It is important not to confuse these with a Hill Sachs deformity.

So look carefully at the location of all bony defects and erosions etc. If you find one in this location I think it is nothing to worry about and just a normal anatomical finding,

Happy scanning,

Steve

[Lena Truong]

Thank you so much Steve 🙂

[Stephen Bird]

My pleasure,

When you have a chance chat to one of your MSK radiologists and they can show you the same appearance on a normal shoulder MRI,

Steve

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