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Musculoskeletal Ultrasound
Marnix T van Holsbeeck, Joseph H Introcaso
1:
Physical Principles of Ultrasound Imaging
INTRODUCTION
FUNDAMENTAL PRINCIPLES
EQUIPMENT
IMAGING
Doppler Flow Imaging
Extended Field-of-View Imaging
Tissue Harmonic Imaging
TRANSMISSION ULTRASOUND
CONTRAST-ENHANCED ULTRASOUND
ULTRASOUND-BASED ELASTOGRAPHY
CONCLUSION
2:
Artifacts in Musculoskeletal Ultrasound
INTRODUCTION
THE GOOD
Shadowing
Enhanced Through-Transmission
Comet Tail Artifact
THE BAD
Refraction
Reverberation
Anisotropic Reflectors
Speed of Sound Artifact
Beamwidth Artifact
THE UGLY
Motion Artifact
Electrical Noise
3:
Sonography of Muscle
INTRODUCTION
EXAMINATION TECHNIQUE
NORMAL SONOGRAPHIC ANATOMY
MUSCLE PATHOLOGY
Muscle Atrophy/Hypertrophy
Intramuscular Pathology
Muscle Rupture
Hematoma
Healing of Muscle Rupture
Myositis Ossificans
Myositis
Compartment Syndrome
Rhabdomyolysis
Tumors
Muscle Boundary or Fascial Lesions
Muscle Hernia
Shin Splints or Medial Tibial Stress Syndrome
Runner's Knee or Iliotibial Band Friction
Plantar Fascia Rupture
SUMMARY
4:
Sonography of Tendons
INTRODUCTION
EXAMINATION TECHNIQUE
Equipment
Scanning Technique
SONOGRAPHIC TENDON ANATOMY
SONOGRAPHIC DIAGNOSIS OF TENDON PATHOLOGY
Tendons with a Synovial Sheath
Tenosynovitis
Tendon Rupture
Tendon Luxation
Tendons Without a Synovial Sheath
Tendinosis
Tendon Rupture
Calcific Tendinitis
MOVIE LEGEND
5:
Sonography of Bursae
INTRODUCTION
EXAMINATION TECHNIQUE
NORMAL SONOGRAPHIC BURSAL STRUCTURE
PATHOLOGY OF BURSAE
Noncommunicating Bursae
Acute Traumatic Bursitis
Chronic Traumatic Bursitis
Hemorrhagic Bursitis
Chemical Bursitis
Rheumatoid, Seronegative Arthritis, and Septic Bursitis
Other Inflammatory Bursitis
Bursal Tumors and Tumor-Like Lesions
Communicating Bursae
Bursal Fluid and Intra-articular Disease
Bursal Fluid and Tendon Disease
Baker's Cyst
Loose Body Entrapment
Baker's Cyst in Children
Ultrasound's Role in Treatment
6:
Sonography of Ligaments
INTRODUCTION
EXAMINATION TECHNIQUE
NORMAL SONOGRAPHIC STRUCTURE OF LIGAMENT
LIGAMENT PATHOLOGY
Intra-Articular Ligaments
Extra-Articular Ligaments
Acute and Subacute Ligament Injury
Chronic Ligament Injury
MOVIE LEGEND
7:
Sonography of Peripheral Nerves
INTRODUCTION
UPSIDE OF ULTRASOUND IMAGING
DRAWBACKS OF ULTRASOUND IMAGING
EXAMINATION TECHNIQUE
NORMAL SONOGRAPHIC ANATOMY OF PERIPHERAL NERVES
NERVE PATHOLOGY
Trauma
Why Image in Trauma?
Blunt or Penetrating Trauma
Iatrogenic Injury
Entrapment Neuropathy
Superficial Radial Nerve
Femoral Nerve
Lateral Femoral Cutaneous Nerve
Sciatic Nerve
Tibial Nerve
Common Peroneal Nerve
Neurofibromatosis Type 1 and Neurogenic Tumor
Neurofibromatosis Type 1 (von Recklinghausen's Disease)
Solitary Neurogenic Tumor: Peripheral Nerve (Neurofibroma)/Nerve Sheath (Schwannoma) Tumor—Malignant Peripheral Nerve Sheath Tumor
Diffuse Peripheral Nerve Hypertrophy
Hereditary Motor and Sensory Neuropathy
Chronic Inflammatory Demyelinating Polyradiculoneuropathy
Infectious Neuropathy
Leprosy
Miscellaneous
Fibrolipohamartoma
Carotid Body and Vagal Glomus Tumor (Paraganglioma)
Glomus Tumor of the Hand and Foot (Neuromyoarterial Glomus Tumor/Glomangioma)
Metabolic Diseases
Postirradiation Changes
8:
Pathophysiology and Common Patterns of Disease
INTRODUCTION
MUSCLE RUPTURE
TENDON RUPTURE
Tendon Degeneration
TENDINOSIS
CHRONIC OVERUSE AND MESENCHYMAL SYNDROME
LIGAMENT TEARS
NERVE INJURY
MOVIE LEGENDS
9:
Sonography of Large Synovial Joints
INTRODUCTION
EXAMINATION TECHNIQUE
NORMAL SONOGRAPHIC ANATOMY
SONOGRAPHY OF ARTICULAR PATHOLOGY
Joint Effusion
Transient Synovitis
Follow-up of Joint Effusions
Septic Arthritis
Effusions in Trauma
Synovial Edema and Pannus
Synovial Metaplasia or Tumor
Cartilage Pathology
Cartilage Structure
Cartilage Disease
Loose Bodies
Crystals
PERIARTICULAR DISEASE
Aneurysms, Pseudoaneurysms, and Dissections
Popliteal Entrapment Syndrome
Venous Pathology
Nerve Lesions
10:
Pediatric Musculoskeletal and Spinal Sonography
INTRODUCTION
DEVELOPMENTAL DYSPLASIA OF THE HIP
Background
Sonography
Technique
Anatomy and Pathology
Coronal
Transverse
Anterior Approach
Clinical Applications
EPIPHYSEAL ALIGNMENT AND FRACTURES
EXTREMITY DEFORMITIES
INFLAMMATION AND INFECTION
FIBROMATOSIS COLLI
BRACHIAL PLEXUS
SPINAL CANAL
Technique and Normal Anatomy
Tethered Spinal Cord
Appearance and Causes of Tethered Cord
Associated Caudal Malformations
NORMAL VARIANTS AND HYDROMYELIA
Meningocele and Myelomeningocele
MOVIE LEGENDS
11:
Sonography of the Dermis, Hypodermis, Periosteum and Bone
INTRODUCTION
EXAMINATION TECHNIQUE
NORMAL SONOGRAPHIC ANATOMY
PATHOLOGIC FINDINGS
Skin Cysts
Verruca Vulgaris
Dermal Neurofibromas
Hemangiomas and Vascular Malformations
Pseudoaneurysm
Mondor's Disease
Common Malignant Skin Tumors
Basal Cell and Squamous Cell Carcinomas
Melanoma
Dermatofibrosarcoma Protuberans
Skin Metastases
INTRODUCTION
EXAMINATION TECHNIQUE
NORMAL SONOGRAPHIC ANATOMY
PATHOLOGIC FINDINGS
Osteomyelitis and Periostitis
Fractures
Acute Fractures
Stress- and Insufficiency Fractures
Pediatric Trauma
Fracture Healing
Bone Tumors
NORMAL VARIATION AND MEASUREMENT
MOVIE LEGENDS
12:
Sonography of Rheumatoid Disease
INTRODUCTION
EARLY DIAGNOSIS AND DISEASE ACTIVITY
SYNOVIAL PANNUS AND FLUID
BURSAL INVOLVEMENT
CARTILAGE
EROSIVE DISEASE
ENTHESITIS
DIFFERENTIAL DIAGNOSIS
FOLLOW-UP OF RHEUMATOID ARTHRITIS
SCANNING TECHNIQUES
Shoulder
Acromioclavicular and Sternoclavicular Joints
Elbow
Hand
Sacroiliac Joint
Hip
Knee
Ankle Foot
COMPLICATIONS OF RHEUMATOID DISEASE
Infection
Periarticular Complications of Rheumatoid Disease
ULTRASOUND-GUIDED INTERVENTIONS
LIMITATIONS OF THE ULTRASOUND EXAMINATION
ADVANTAGES OF THE ULTRASOUND EXAMINATION
CONCLUSION
13:
Evaluation of Foreign Bodies
INTRODUCTION
EXAMINATION TECHNIQUE
ULTRASOUND VERSUS RADIOGRAPHY
SPECIFIC MATERIALS
DIAGNOSTIC AND THERAPEUTIC APPROACH TO FOREIGN BODIES (FIG. 13.30)
SUMMARY
14:
Sonographic Evaluation of Orthopedic Implants and Postoperative Pain Syndromes
INTRODUCTION
ARTHROSCOPY COMPLICATIONS
Pain Syndromes Following Therapeutic Arthroscopy
Pain Following Diagnostic Arthroscopy
SUTURE GRANULOMAS
HETEROTOPIC OSSIFICATION
FRACTURE FIXATION IMPLANTS OR OSTEOTOMY IMPLANTS
Infection
Failure
Hardware Impingement and Soft Tissue Erosion
PROSTHESES
Metal-on-Polyethylene Prostheses
Metal-on-metal Prostheses
Timeline of Changes
Acute Complications
Chronic Complications
Soft Tissue Complications
Gluteus Tendon Avulsion
Iliopsoas Tendon Impingement
Arthrofibrosis
Quadriceps and Patellar Tendon Tears
Fabellar Snapping and Fabellar Impingement
Subscapularis Tear after Shoulder Replacement
15:
Interventional Musculoskeletal Ultrasound
INTRODUCTION
EXAMINATION TECHNIQUE
APPLICATIONS
Aspiration of Soft Tissue
Hematoma
Seroma
Abscess and Phlegmon
Cellulitis and Fasciitis
Calcium
Ganglion
Aspiration of Joint
Injection of a Synovial Space
Injection of a Tendon
Dry Needling
Hydrostatic Decompression
Sclerosing Agents and Electrocoagulation
Prolotherapy
Autologous Blood, Platelet-Rich Plasma, and Skin Derived Fibroblast Injection
Synovial Biopsy
Ultrasound-Guided Core Biopsy
Soft-Tissue Mass
Bone Lesion
Presurgical Hookwire Localization
IMAGE-GUIDED SURGERY
THE FUTURE OF MUSCULOSKELETAL ULTRASOUND INTERVENTION
MOVIE LEGENDS
16:
Sonography of the Shoulder and Upper Arm
INTRODUCTION
A CLINICALLY ORIENTED EXAMINATION
Pain
Age
Movement
Weakness
Observation
Contralateral Side
APPROACHING THE SHOULDER
Bony Landmarks
Muscular Landmarks and Recesses
ULTRASOUND SYSTEM CONSIDERATIONS
SONOGRAPHIC TECHNIQUE AND ANATOMY
Patient Position
Long Head of Biceps Tendon/Rotator Cuff Interval
Imaging Planes: Biceps Tendon
Sonographic Anatomy: Biceps Tendon
Sonographic Anatomy: Rotator Cuff Interval
Short Head of Biceps Tendon
Imaging Planes
Sonographic Anatomy
Pectoralis Major
Imaging Planes
Sonographic Anatomy
Subscapularis
Imaging Planes
Sonographic Anatomy
Dynamic Assessment: Subscapularis
Supraspinatus
Imaging Planes
Sonographic Anatomy
Shoulder Bursae
Imaging Planes
Sonographic Anatomy
Coracoacromial Arch
Imaging Planes
Sonographic Anatomy
Supraspinatus: Dynamic Assessment for Subacromial Impingement
Humeral Depression
Tendon/Subdeltoid Bursal Assessment
Infraspinatus
Imaging Planes
Sonographic Anatomy
Posterior Glenoid Labrum
Imaging Planes
Sonographic Anatomy
Suprascapular Nerve
Imaging Planes
Sonographic Anatomy
Teres Minor
Imaging Planes
Sonographic Anatomy
Acromioclavicular Joint
Imaging Planes
Sonographic Anatomy
Anterior Labrum
Imaging Planes
Sonographic Anatomy
SONOGRAPHIC APPEARANCES OF SHOULDER PATHOLOGY
Pathophysiology of Rotator Cuff Disease
Subacromial Impingement
Rotator Cuff Degeneration/Load-Induced Tendinopathy
Rotator Cuff Tendon Pathology: A Continuum
Tendinosis
Enthesopathy
Rotator Cuff Tears
Partial-Thickness Tears
Ultrasound Diagnosis of a Partial Tear
Full-Thickness Tears
Primary Signs of Full Thickness Tear
Secondary Signs of Full Thickness Tear
Detection of Muscle Atrophy
Other Considerations in the Ultrasound Diagnosis of Tears
Inherent Limitations of the Technique
Tears in Other Shoulder Tendons
Rotator Cuff Arthropathy
Calcifying Tendinitis
Pathogenesis
Sonographic Evaluation of Calcific Tendinitis
Acromioclavicular Joint
ACJ Inflammation
ACJ Injury
ACJ in Chronic Rotator Cuff Disease
ACJ Cysts
Bony Abnormality
Os Acromiale
Tumors
Fractures
Fractures of the Greater Tuberosity
Fractures of the Humeral Head
Subacromial Bursa
Bursal Thickening
Bursal Fluid
Communicating Abnormalities
Noncommunicating Abnormalities
Postoperative Shoulder Assessment
Postrotator Cuff Repair: Ultrasound Appearances
Post Shoulder Arthroplasty: Ultrasound Appearances
Diseases of the LHBT
Biceps Tendinosis
Biceps Tendon Tears
Biceps Subluxation/Dislocation
Frozen Shoulder
Clinical Examination of the Frozen Shoulder
Ultrasound Appearances of Adhesive Capsulitis
Instability
Anterior Instability
Posterior Instability
Arthropathy
Rheumatoid Arthritis
Pigmented Villonodular Synovitis of the Shoulder
Amyloid
Shoulder Neuropathy
Suprascapular Nerve
Axillary Nerve
Soft Tissue Masses of the Shoulder
Shoulder Intervention with Ultrasound Guidance
Subacromial Injection
Platelet-Rich Plasma
Aspiration of the Shoulder Joint
Hydrodilatation
Injection of the ACJ
Aspiration of Calcific Tendinitis
Other Intervention
Three-Dimensional/Four-Dimensional Ultrasound of the Shoulder
Multiplanar Imaging: A New Third Plane
Postexamination Analysis
Remote Analysis
Fusion Technologies
Literature
Communication of Results
CONCLUSION
MOVIE LEGENDS
17:
Sonography of the Elbow and Forearm
INTRODUCTION
ULTRASOUND OF ELBOW
Technical Guidelines and Scanning Technique
Anatomy, Surface Landmarks, and the Ultrasound Examination of the Elbow
Anterior Elbow
Medial Elbow
Lateral Elbow
Posterior Elbow
Pathology
Tendinosis and Epicondylitis
Joint Effusion
Tendon Ruptures
Collateral Ligament Tears
Nerve Entrapment and Nerve Pathology
Masses
ULTRASOUND OF FOREARM
Technical Guidelines and Scanning Technique
Anatomy, Surface Landmarks, and the Ultrasound Examination
Volar (Flexor) Forearm Compartment
Mobile Wad of Henry or LateraL Forearm Compartment
Dorsal (Extensor) Forearm Compartment
Pathology
Masses
Entrapment
Traumatic Injury
18:
Sonography of the Wrist and Hand
INTRODUCTION
TECHNICAL GUIDELINES AND SCANNING TECHNIQUE
ANATOMY AND SURFACE LANDMARKS OF WRIST AND HAND
Dorsal Wrist
Palmar Wrist
Ulnar Wrist
The Digits and the Midhand
Nail Bed and Pulp of the Distal Digits
Variations that can Mimic Pathology
PATHOLOGY
Masses
Dorsal Wrist Pain
Ulnar-Sided Wrist Pain
Tendon Dysfunction
Pain or Dysfunction of Ligaments
Nerve Disease
Unexpected Trauma Findings
Joint Disease
MOVIE LEGENDS
19:
Sonography of the Hip and Thigh
INTRODUCTION
EQUIPMENT AND POSITIONING REQUIREMENTS
SONOGRAPHIC TECHNIQUE AND ANATOMY
Anterior Hip and Groin
Anteromedial Hip
Lateral Hip
Posterior Hip
PATHOLOGY
Hip Pain
Joint Effusion
Synovitis
Hip Bursae
Greater Trochanteric Pain Syndrome
Abscesses, Hematomas, and Seromas
Athletes' Injuries
Groin Pain in Athletes
Athletic Pubalgia
The Prosthetic Hip
Intra- and Extra-articular Fluid
Incisional Drainage in the Postoperative Patient
The Painful and Dysfunctional Joint Arthroplasty
Hip Snaps, Locks, and Clicks
MOVIE LEGENDS
20:
Sonography of the Knee and Lower Limb
INTRODUCTION
EQUIPMENT, POSITIONING REQUIREMENTS, AND SONOGRAPHIC TECHNIQUE
CLINICAL POINTS IN THE EVALUATION OF THE KNEE
Assessing for Joint Swelling
Changes in the Bone
Fluid Within the Joint
Thickening of the Synovial Membrane
Assessing for Instability
Assessing for Locking
PATHOLOGY
Anterior Knee Pain
Chondromalacia Patella
Quadriceps Tendon Tears
Avulsion from the Patella
Disruption Through the Patella (Fractures of the Patella)
Avulsion from the Tibial Tubercle
Patellar Tendon Lesions
Dislocation of the Patella
Bursitis
Irritative Prepatellar Bursitis
Suppurative Prepatellar Bursitis
Uric Acid Induced Prepatellar or Deep Infrapatellar Bursitis
Suprapatellar Bursitis and Synovitis
Meniscal Lesions
Traction Apophysitis
Osgood-Schlatter Disease
Sinding-Larsen-Johansson
Bipartite Patella
Injured Collaterals
Painful Swollen Calf
Baker's Cyst
Synovial Cysts and Ganglia
Plica Syndrome
Osteoarthritis
Osteochondritis Dissecans
Osteochondroma
Myositis Ossificans
Painful Fabella
Osteomyelitis
Knee Swelling
Acute Injury
Chronic Localized Pain
Limited Use in Internal Derangement
Postoperative Knee
MOVIE LEGENDS
21:
Sonography of the Ankle and Foot
INTRODUCTION
EQUIPMENT AND POSITIONING REQUIREMENTS
SONOGRAPHIC TECHNIQUE AND ANATOMY
Anterior Joint
Extensor Tendons and Extensor Retinaculum
Lateral Ankle Tendons and Retinaculum
Medial Ankle Tendons and Retinaculum
Achilles Tendon and Retrocalcaneal Bursa
Plantar Fascia
Interdigital Web Spaces
PATHOLOGY
Acute Injuries of the Ankle
Acute Achilles Tendon Injuries
Acute Ligamentous Injuries
Acute Ankle Joint Pathology
Foreign Bodies
Chronic Ankle Pain
Chronic Lateral Pain
Chronic Medial Pain
Chronic Posterior Pain
Chronic Joint and Anterior Ankle Pain
Soft Tissue Masses
Heel Pain and Plantar Fasciitis
Metatarsalgia
Morton's Neuroma
MOVIE LEGENDS
22:
Sonography of the Abdominal Wall and Chest
INTRODUCTION
ULTRASOUND OF THE ABDOMINAL WALL
Equipment and Positioning Requirements
Sonographic Anatomy: Anterior Abdominal Wall
Anterior Abdominal Wall Muscle Injuries
Internal Oblique Strains
Rectus Abdominis Strains
Rectus Sheath Hematomas
Specialized Ultrasound Examination: Anterior Abdominal Wall Muscle Injuries
Side Strain
Rectus Abdominis
Hernias
Inguinal Region Hernias
Indirect Inguinal Hernia
Direct Inguinal Hernia
Femoral Hernia
Obturator Hernia
Spigelian Hernia
Ventral Hernias
Incisional Hernia
Hernia Repair and Recurrence
Specialized Ultrasound Examination: Hernias
Developing a Routine Protocol to Evaluate Groin and Lower Abdominal Wall Pain
Hip
ULTRASOUND OF THE CHEST WALL
Equipment and Positioning Requirements
Sonographic Anatomy
Pathology
Rib
Sternoclavicular Joint
Pectoralis Major Muscle
Masses
23:
Musculoskeletal Telemedicine
INTRODUCTION
TELEMEDICINE AND TELEULTRASOUND BACKGROUND AND REVIEW OF LITERATURE
FEASIBILITY AND PROMISE OF MUSCULOSKELETAL TELEULTRASOUND
THE USE OF THE INTERNATIONAL SPACE STATION AS A TESTBED FOR REMOTELY GUIDED MUSCULOSKELETAL ULTRASOUND
DEFINITION OF A TELEULTRASOUND SYSTEM
DEVELOPMENT AND ADAPTATION OF THE ISS TELEULTRASOUND SYSTEM FOR MUSCULOSKELETAL ULTRASOUND
RECOMMENDED FEATURES OF A TERRESTRIAL TELEULTRASOUND SYSTEM
Operator Aspects
Communication Aspects
Computer-Based Training
Equipment-Specific Cue Card and Reference Image Sets
Real-Time Remote Guidance Methodology: Spoken Discourse, or Linguistics of Teleultrasound
Guiding Expert Aspects
CONCLUSIONS
ACKNOWLEDGMENTS
INDEX
TOC
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