Shoulder Scan - ENIMED AS · • The arm can be extended postriorly, and the palmar aspect of the...
Transcript of Shoulder Scan - ENIMED AS · • The arm can be extended postriorly, and the palmar aspect of the...
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Clinical Application Specialist Team All information in the presentation are highly confidential and no part of contents may be informed or transmitted without permission from ALPINION Medical Systems.
Shoulder Scan
Clinical Application Specialist Team
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Clinical Application Specialist Team
Fracture, dislocation and subluxations
Osteschondromatosis
Bursitis
Rotator cuff tears
Tendinosis
Subacromial impingement
Diagnostic Acumen
Biceps tendon ( ruptures )
Paralabral cysts
Adhesive capsulitis
Shoulder injections and
aspirations
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Clinical Application Specialist Team
Easy accessible / in-office use - Assessment of a joint or anatomic region, specific structure of interest
Dynamic /Real- time
-tendons are moving in real-time, functionality of structures, range of motion
Comparative
- look at the other side for comparison , contra lateral , unaffected area
No radiation exposure, safe
Benefits – MSK US
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Clinical Application Specialist Team
Anatomy Review
Soft and Hard Tissue
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Clinical Application Specialist Team
Tendons
Anatomy Review
• Identifiable ultrasound - dense connective tissue
is more hyperechoic (homogenous) than muscle
• Fibrillar pattern
• Can be evaluated throughout range of motion
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Clinical Application Specialist Team
Muscle
Anatomy Review
• appears hypoechoic
• Hypoechoic linear fibrillar striae seen within muscle
• Hypoechoic connective tissue surround muscle bundles
long & short axis view
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Clinical Application Specialist Team
Joint
Anatomy Review
• “Seagull sign” seen at joint spaces
• Joints are potential space
• Joints effusions ( fluid ) will be compressible
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Clinical Application Specialist Team
Shoulder
• Mostly performed MSK application • Anatomy is easy to see - Biceps tendon - Greater Tuberocity - Subscapularis - Lesser Tuberocity - Supraspinatus - Biciptal groove - Gleno-Hemeral joint - Deltoid muscle • Color & PD maybe useful in detecting hyperemia within the joint or
surrounding structures
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Clinical Application Specialist Team
Shoulder
Biceps Tendon: Scan tip • Neutral position - forearn in supination and resting on the thigh or with
the arm in slight external position • Biceps tendon looks oval shape at short axis view , it merges from under
the acromion, to the musculotendinous junction distally • Press caudal end of the transducer at longitudinal scan with fibrillar - used to detect fluid or - intra-articular loose bodies - tendon properly positioned within the bicipital groove, dislocated, or torn
Neutral Position
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Clinical Application Specialist Team
Biceps Tendon
GT LT
Del
SubS
BT
BG
↑
Med. Lat.
LT
GT
BT
Del
Cranial Caudal
BT
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Clinical Application Specialist Team
Rotator cuff
• Greater tuberosity
• Lesser tuberosity
• Bicipital groove
• Coracoid process
• Acromion
• Lateral end of clavicle
• Glenoid and labrum
Anatomy
- Subscapularis
- Supraspinatus
- Infraspinatus
- Teres minor
- Biceps
- A-C joint
- Labrum
Rotator cuff
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Clinical Application Specialist Team
Shoulder – Rotator cuff
Subscapularis tendon
• should be examined for signs of a tear, tendinosis, and or calcification • position – the elbow remain at the side, while the arm is placed in
extenal rotation - The subsscapularis is imaged from the musculotendinous junction to
the insertion on the lesser tuberocity of the humerus - Dynamic evaluation as the patient moves from internal to external rotation
External Rotation
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Clinical Application Specialist Team
Subscapularis Tendon - longitudinal
Del
Cartilage
◆
◆
GT
Cranial Caudal
▶
• Subscapularis tendon, multi penetrated structures, arise anterior along the inferior aspect of scapular insert into lessor tuberocity
• Bursa anterior to tendon, when you externally rotate the arm, you can make it show better
Deltoid
SubS
LT
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Clinical Application Specialist Team
Subscapularis Tendon - transverse
Del
Cartilage
◆
◆
GT
Cranial Caudal
▶
• Subscapularis tendon at transverse view, contour dot like formation
• The cuff should be compressed with the transducer to detect tears
• Dynamic evaluation of the rotator cuff also is useful
- evaluate rotator cuff for impingement or to assess the cuff tear extent
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Clinical Application Specialist Team
• transducer approximately 45⁰ between the sagittal and coronal planes to obtain a longitudinal view
• Then move anteriorly and posteriorly to completely visualize the tendons ★ Check point - Supraspinatus tendon; obvious fibrillar structured beak shape - bursal thicking or fluid of the subacromial-subdeltoid should be examined
Suprasupinatus Tendon - Longitudinal
Deltoid
SupraS
Cartilage ◆
◆
GT
Internal Rotation, flex forward
Cranial Caudal
▶
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Clinical Application Specialist Team
Suprasupinatus Tendon - Transverse
Del
Cartilage
◆
◆
GT
Cranial Caudal
▶
• The arm can be extended postriorly, and the palmar aspect of the hand can be placed against the superior aspect of the ileac wing with the elbow flexed and directed toward the midline
• Supraspinatus tendons are visualized by sweeping medially to the acromion and laterally to their insertion on the greater tuberocity of the humeral head
Deltoid SupraS
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Clinical Application Specialist Team
Suprasupinatus Tendon - Transverse
Del
◆
◆
GT
Caudal
▶
★ Check point
normal thickness 6mm~10mm
- Supraspinatus tendon insert anterior mid facet of the greater tuberocity
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Clinical Application Specialist Team
Infrasupinatus Tendon
Del
Cartilage
◆
◆
GT
Cranial Caudal
▶
• Transducer is placed at the level of the glenohumeral joint below the scapular spine
while the forarm rests on the thigh with the hand supinated
• The more posterior aspect of the infraspinatus and teres minor tendons should be examined
• Internal and external rotation may be helpful identifying the infraspinatusmuscle and tendon – detecting small joint effusions
• To visualize the teres minor tendon, the medial edge of the probe should be angled slightly inferiorly
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Clinical Application Specialist Team
Infrasupinatus Tendon
Del
Cartilage
◆
◆
GT
Cranial Caudal
▶ Deltoid
InfraS
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Clinical Application Specialist Team
Del
Med.
Posterior Labrum
• Transducer put the back of the posterior shoulder
• Gleno-humeral joint ; glenoid of scapular interact the humerus
• Posterior Labrum ; space between 2 structures, and triangular shape
• Start from lateral to medial, then external rotate the arm
Hand on the opposite shoulder
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Clinical Application Specialist Team
Del
InfraS HH
Gl
◆
◆
Med. Lat.
Posterior Labrum
Posterior labrum Triangular homogenous structure
★ Check point
• Hyperechoic
• Keep penetration throughout to the posterior labrum
• Needs this image for articular inject to patient having frozen shoulder
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Clinical Application Specialist Team All information in the presentation are highly confidential and no part of contents may be informed or transmitted without permission from ALPINION Medical Systems.
Knee Scan
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Clinical Application Specialist Team
Quadriceps tendinosis
Quadriceps tendon tear
Quadriceps muscle tear
Tear of patella tendon
Patella tendonitis
Knee effusion
Diagnostic Acumen - Knee
Pannus in rheumatoid arthritis
Patella bursitis
MCL tears
Baker’s cyst
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Clinical Application Specialist Team
Anterior Knee - Quadriceps tendon
Patella
Femur
Qt
Pff
Spf
▶
- Qt ; Quadriceps tendon or Suprapatellar tendon
- Pff ; Prefemoral fat pad - Spf ; Suprapatellar fat pad - ▶ ; Suprapatellar synovial recess
30˚ flexion
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Clinical Application Specialist Team
Anterior Knee – patella tendon
★ Check point - patella tendon - Hoffa fat pad: hypoechoic
Hoffa fat pad
deep infrapatella bursa
Tibia
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Clinical Application Specialist Team
Medial Knee – Medial Collateral Ligament
Patella
★ Check point - Medial collateral ligament - Meniscus - Tendon and bursa
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Clinical Application Specialist Team
Medial Knee – Medial Collateral Ligament
Patella
Tibia
Medial Meniscus
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Clinical Application Specialist Team All information in the presentation are highly confidential and no part of contents may be informed or transmitted without permission from ALPINION Medical Systems.
Wrist/Finger Scan
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Clinical Application Specialist Team
Joint effusion and synovitis
Rheumatoid arthritis erosions
Psoriatic arthritis
Tenosynovitis (de Quervain’s)
Tendon tears of wrist and fingers
Diagnostic Acumen - Wrist
Nerve entrapment ( carpal
tunnel syndrome)
Ligamentous injuries
( Gamekeeper’s thumb)
Scaphoid fractures
Cysts and masses ( ganglions)
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Clinical Application Specialist Team
Wrist
- In general, one should first recognize a given tendon and then follow it on short-axis planes down to the distal insertion
- Dynamic scanning of the extensor tendons cam be performed with the fingers hanging outside its edge to allow easy fingers movements
APL: abductor pollocis longus EPB: extensor pollicis brevis EPCB: extensor carpi radialis brevis ECRL: extensor carpi radialis longus EIP: extensor indicis proprius EDC: extensor digitorum longus EDQ: extensor digiti quinti proprius ECU: extensor carpi ulnaris : Lister’stubercle ( sonographic landmark )
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Clinical Application Specialist Team
Wrist – carpal tunnel
- fcr : flexor carpi radialis - Sca : scaphoid (radial side) - Arrow head : flexor retinaculum - fpl : flexor pollicis longus - Pis : pisiform (ulna side) - s : Flexor digitorum superficialis (4 tendons) - p : Flexor digitorum profundus (4 tendons)
- Tilting the probe back and forth may help to optimize depiction
- dynamic scanning during passive flexion and extension of the respective finger ★ Check point - discriminate Tendon from Nerve Clear honeycomb sign
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Clinical Application Specialist Team
Carpal Tunnel
Trans Long
Ultrasound Image
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Clinical Application Specialist Team
Trigger Finger - Pulley system
Anatomy
- FDS : Flexor digitorum superficialis - FDP : Flexor disitorum profundus - * : Palmar plate - FT : Flexor tendon
★ Check point - Good distnction of A1 pulley superficial resolution for thready flexor tendon -can show the tendon by finger movement ( flexion and extension )
A1 pulley
FDS FDP
* FT
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Clinical Application Specialist Team
Trigger Finger – Pulley system
A1 pulley
FDS FDP
* FT
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Clinical Application Specialist Team
Trigger Finger - Pulley system
- PIP : Flexor digitorum superficialis - DIP :
A1 pulley
FDS FDP
* FT