MUSCULOSKELETAL ULTRASOUND

DIAGNOSTICSONOGRAPHY

MUSC

ULOSKELETA

L ULTRASO

UND

DIAG

NO

STICSO

NO

GRA

PHY

THOMAS B. CLARK

www.mskus.com

Handbook of Diagnostic Ultrasound Table of Contents

Chapter 1 Shoulder

Chapter 2 Elbow

AnteriorBiceps Tendon (short)Biceps Tendon (long)Pectoralis Major TendonDeltoid Muscle

MedialCoracoacromial LigamentSubscapularis Tendon (long)Subscapularis Tendon (short)

SuperiorA-C JointSubacromial Impingement

Rotator CuffRotator Cuff (long)Rotator Cuff (short)Rotator Cuff Interval

PosteriorPosterior Glenohumeral JointSuprascapular Nerve in Infra Spinoglenoid NotchSuprascapular Nerve in Supra Spinoglenoid Notch

LateralLateral Epicondyle (long)Radial Humeral Joint

AnteriorDistal Biceps

MedialUlnar Collateral LigamentMedial EpicondyleUlnar Nerve (short)

PosteriorOlecranon Fossa (long)Olecranon Fossa (short)

Chapter 3 Wrist/HandFlexor

Flexor Carpi RadialisMedian Nerve (short)Median Nerve (long)

ExtensorExtensor CompartmentsDe Quervain’s Syndrome (1st compartment)Scapholunate LigamentTriangular Fibrocartilage Complex

Hand1st CMC Joint

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15-161718

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25-26

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3031

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42

Anterior Anterior Tibiofibular Ligament Anterior Talofibular Ligament Deep Peroneal NerveMedial Posterior Tibial Tendon Tibial NerveLateral Peroneus Brevis Sural Nerve (short) Peroneus Longus Tendon (long) Subtalar Joint

Suprapatellar Quadriceps Tendon Suprapatellar Pouch Femoral CondylesInfrapatellar Patellar Tendon (long) Patellar Tendon (short)Medial Patellofemoral Ligament Medial Collateral Ligament (long) Saphenous Nerve Pes Anserine BursaLateral Lateral Collateral Ligament Popliteus Tendon Iliotibial BandPosterior Baker’s Cyst (long) Baker’s Cyst (short) Peroneal Nerve (short)

Anterior Anterior Hip Joint Psoas Tendon Rectus Femoris Tendon Adductor Longus (long) Lateral Femoral Cutaneous NervePosterior Piriformis Obturator Internus Greater Trochanter (short)Spine Sacroiliac Joint Greater Occipital Nerve (short) Greater Occipital Nerve (long)

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525354

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85868788

Handbook of Diagnostic Ultrasound Table of Contents

Chapter 4 Hip/Pelvis/Spine

Chapter 5 Knee

Chapter 6 Ankle

Handbook of Diagnostic Ultrasound Table of Contents

Chapter 6 Ankle

Chapter 7 Physics, Knobology, Nomenclature

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9293

94

Physics, Knobology, Nomenclature 99

Posterior Achilles Tendon (long) Achilles Tendon (short) Posterior Talotibial JointPlantar Plantar Fascia (long) Plantar Fascia (short)Foot 1st MTP

3

ShoulderBiceps Tendon (Short)

Patient Position:

Doctor Position:

Probe Position:

patient seated on stool (facing US system pre-ferred), affected upper arm aligned with torso and elbow flexed 90 degrees and forearm supi-nated to align long head of biceps with humerus

sonographer seated on stool (facing US sys-tem preferred next to patient) with sonogra-pher slightly elevated from patient (ergonomic)

short axis to biceps tendon within the bicipi-tal groove and then scan caudally short axis slide of probe to the pectoralis major insertion

13

Shoulder Rotator Cuff (Short)

Probe Position:probe place 90 degrees from the rotator cuff long probe position (point probe rather than toward the navel rotate the probe 90 degrees toward the patient’s nose) (rotator cuff in short axis should appear with multiple septum that are present due to the three rotator cuff ten-don sheaths and their central tendon shadows or “wagon wheel” appearance)

Patient Position:seated on stool (backless stool is pre-ferred so to not restrict arm position) with shoulder completely internally rotated and extended (as far as patient can without significant joint pain) as well as elbow flexed so hand can reach possibly to opposite back pocket (pre-ferred shoulder position to expose rotator cuff from acromial shadow)

Doctor Position:sonographer seated on stool (also fac-ing US system preferred next to pa-tient) with sonographer slightly el-evated from patient (ergonomic)

74

Baker’s Cyst (Short)Knee

Probe Position:place the probe long axis to the criss cross of the semimembranosis and the medial gastrocnemius, proceed to rotate the probe 90 degrees short axis to the semimembra-nosis tendon and medial gastrocnemius myotendinous junction (semimembra-nosis appears almost anechoic due to an-isotrophy caused by the acute tendon fi-ber angle as it dives to its tibial insertion)

Patient Position:patient prone with a small bolster or pillow under the ankles

Doctor Position:doctor seated on exam stool on affect-ed side of patient facing the head of the exam table and US system (usually US system on same side table as doctor)

90

Achilles Tendon (Short)Ankle

Probe Position:place the probe short axis over the Achilles tendon at the level of the calcaneal insertion. Short axis lin-ear slide the probe distally to visualize calcaneal spurring and then short axis lin-ear slide the probe proximally (cephalad) visualizing the retrocalcaneal bursa, Kager’s fat pad and myotendinous junction of the soleus as it joins the Achilles (note the “winding” of the Achilles tendon fibers)

Patient Position:

Doctor Position:

patient prone with foot and ankle off the end of the table and foot moderately dorsiflexed

doctor seated on exam stool at the end of exam table and US system on the af-fected side of the exam table

47

Anterior Hip JointHip/Pelvis

Patient Position:

Doctor Position:

Probe Position:

patient supine with pillow un-der patients head but no pil-low or bolster under the knee on the affected side

doctor standing on af-fected side facing head of the patient and US system

probe placed long axis to the neck and head of femur, which is approximately 30 degrees off midline (4 o’clock on right or 8 o’clock on left), on the inguinal fold at the mid point between the pubic symphysis and the ASIS (anterior superior iliac spine)