so i'm going to display how we examine the shoulder with the ultrasound first we find the biceps tendon and that's a cross-section of it in the groove of the humerus you can identify the subscapularis tendon by having the patient externally rotates his hand so just keep your elbow up there you go and come backwards that is subscapularis overlying the biceps tendon moving upwards and medial you see the cleaner humeral joint the anterior view coming lateral you can identify the hero head underneath the acromion and when you turn it 90 degrees you should be able to see the supraspinous tendon and the sub deltoid bursa which is the black line above the tendon or it's going to extend your arm to the side and you see the tendon disappear underneath the acromion you can put your arm down and you can access the subacromial space through this view as well by just going between the tendon and the acromion posteriorly you could find the humeral head and you can identify the infraspinatus muscle inserting on the humeral head and ask the patient to rotate his arm again and you'll see the muscle and tend to move with the bone going medial you'll find the posterior joint capsule and that's at the center of the screen and now we're going to find the superscapular nerve and perform a super scapular nerve wall i'll tell you when the pictures okay just pulling you off okay so the first muscle is a trapezius and the supraspinatus is underneath the super scapular nerve is under the trans-scapular notch and there's a blood vessel next to the nerve which you may or may not see so i'm going to put the pinch okay pinch you can see the needle coming in [Music] they feel some pressure in the shoulder while we're working i'm doing a little anesthesia above the ligament i'm going to pull back the needle i'm going to take a different angle to get more proximal and i'm going to pierce the ligament again to move a little bit further from the nerve but still get the anesthesia in the proper location there we go see the needle tip above the nerve and blood vessel you're right mm-hmm breathe almost you can breathe i'm breathing i'm trying not to move you're doing great i'm used to people moving so hold on
