 Hello everyone, Myself Dr. Ramco Singala, 2nd year Radio resident doctor from CUSA Medical College and Hospital, Surandhanagar. I am presenting a paper of role of ultrasound in evaluating baleful solder. Solder ultrasound has been in use for quite some time and is coincider, operator dependent and has proven accuracy in protocol assessment. Scanning the solder can be challenging and time consuming in the beginning. The use of a protocol driven examination, understanding of anatomy, tendon orientation and familiarity with imaging pitfalls can improve individual's performance. This paper presents a simplified approach to scanning the solder and also illustrates the pathological findings. My study includes 50 patients with complaints related to solder. There are various techniques for scanning the solder. Some operators refer to face the patient and other prefer to stand behind. It would be preferable to skin standing behind the patient and recommends following a protocol that a user is comfortable with. The probe should be held at its end with the edge of the hand resting on the patient's solder. In order to reduce stress and allow fine motor control, obtaining a brief history at the beginning of the examination can provide clues to underlying pathology. Good polyurethra sound equipment and a high frequency linear array probe is required. The more the transducer frequency which approves the resolution, the less is the depth penetration. Probe frequency selection depends on the patient's build, lower for obese patient and higher for thin patient. How much you adjust the machine control in settings as you scan is very much better of test. This image shows the position of the patient for evaluation of biceps brachymuscle. Keep the patient's arm in a neutral position and resting on the thigh and elbow flexed to 90 degrees. The tendon can be readily identified in the tubercular groove between the greater tubercle and laser tuber. This image shows probe placement to examine long head of bicep tendon in transverse plan and longitudinal plan. The hypoechoic appearance of the bicep tendon with area of increased Doppler signal as a result of tendon open. This image shows transverse scan of torn long head of bicep tendon with a empty bicep tendon. The longitudinal scan shows the convex superior margin of the retracted muscle belly, also called hip pain. The below image shows fluid knotted along the tendon of the biceps. This image shows the position of the patient for sub scapularis muscle evaluation. The arm is specifically external rotated and elbow flexed to 90 degrees, the sub scapularis can be examined in orthogonal plan. The sub scapularis can be seen emerging inferior to the coracoid process and inserting on the laser tuberosity. Image A shows transducer position for a transverse image of sub scapularis tendon. Image B shows corresponding transverse image of the sub scapularis tendon, not the hyper echoic tendon slips between the hypoechoic muscle fibers. Image C shows short axis view of the sub scapularis tendon with a partial thickness at a killer surface tier in its superior part. This image shows the position of the patient for evaluation of supraspinatus muscle. To visualize the supraspinatus muscle, the patients are asked to place their hands on their back pocket. This image shows longitudinal view of the supraspinatus tendon with an area of reduced ecogenicity due to any sort of trophies. At the site of tendon incenses are over the grata tuberosity, which is not to be confused with the tier. Image A full thickness rotator cuff tier is a defect in the tendon that ranges from the bursal to the articular margin. Typically these tiers occur at the footprint of the grata tuberosity where the tendon fibers insert and then propagate proximally. Full thickness rotator cuff tiers are proliferated small less than 1 centimeter, medium under 3 centimeter, large 3 to 5 centimeter and massive more than 5 centimeter according to D.O.U.N. Cofit classification. Measure in its longest dimension. The normal tendon ecogenicity is replaced by a hypoechoic or n-ecos defect and the length or degree of retraction of a full thickness tier in width is assessed. Since this information is needed by orthopedic surgeon for designing management and to diagnose prognostical outcome of this therapy. When fluid is present in the sub-ecromial sub-deltoid bursa and the glenohumeral joe interprobability of a rotator cuff tier is 95%. Other indirect signs of a partial or full thickness rotator cuff tiers are the sagging of bursa in the bright aspect of the humeral cartilage, which is caused by enhancement of the USDA signal due to fluid and loss of cuff tissue above the cartilage. A complete tier of the tendon involves the wall width of the tendon. A full thickness tier may be complete or may only involve the entire free edge or mid-substance. The massive cut tier occurs when the entire attachment of supress binators to the greater tuberosity is disrupted, allowing the tendon to retract proximally beneath the acromion. These tiers may extend to involve the infraspinators, sub-scapularis and the long hand-up biceps. Figure 7. Image source longitudinal view of the supress binators tendon with source full thickness tier of the tendon that reaches from the bursal to the articular margin with sagging of the over-line bursa. Image B source long-exist view of the right supress binators muscle, partial thickness articular surface tier and the bright anti-aspect of the humeral cartilage, also called cartilage interpain. Figure 8. Image B source full thickness tier in the entire free edge of the supress binators tendon. Tiny, ecogenic shadows due to blood particles are seen to move on dynamic compression, not irregularity or the greater tuberosity. Image B source short-exist view of left supress binators tendon. This is a full thickness tier in the mid-person of the tendon with sagging of the over-line bursa. Partial thickness tier. Partial thickness tier is a focal discontinuation which is limited to tiers affecting either side of the articular surface or the bursal surface of the tendon, but without communication of the tier to the opposite tendon surface. Partial thickness tiers have been classified by elements by the depth of the tier as grade 1 for tiers less than 3 mm, grade 2 for tiers 3 to 6 mm and grade 3 for the tiers greater than 6 mm. This can also be divided into high grade greater than 50% thickness or low grade less than 50% thickness. A cortical bone irregularity of the greater tuberosity is a sensitive sign of an articular side partial thickness tier. Occasionally, a partial tier may propagate proximally within the tendon surface substance causing a delaminating tier. A rim-rent tier is an articular surface tier near the footprint of the tendon. This image shows partial thickness tier of supra-spinator tendon. Image shows short-exist view. There is a partial thickness articular surface tier in the mid-substance of the tendon with a few intact fibers over-line. Image also shows partial thickness bursal surface tier of the supra-spinator tendon. Image also shows partial thickness intra-substance tier. Image also shows partial tier of supra-spinator tendon at a greater tuberosity. This by chance suggests percentage of the pathology in solder pen. 40% is because of supra-spinator tier, 26% is because of joint effusion, 13% is because of tendonosis, 9% is because of bursitis, 4% is because of intra-spinator tier and 70% is because of triceps tier. 70% is contains partial thickness tier and 30% full thickness tier. The USG image quality has substantially improved with technological advancement, producing spatial resolution exceeding that obtaining with MRI. USG gives the ability to provide direct correlation of the image in finding with the symptoms of the patient and helps with guiding interventional procedures. Thank you.