Pdf introduction to diagnostic musculoskeletal ultrasound. Musculoskeletal ultrasound utilises highfrequency linear transducers to produce highresolution images of soft tissue structures. Ultrasound would normally be focused on only one or two of these quadrants depending upon the. Aium practice parameter for the performance of a musculoskeletal. Focused ultrasound foundation summary ultrasound is robust tool, complimentary to mri, in the diagnosis of msk pathology relative low cost, portability, realtime imaging for on the spot clinical decision making and the ability to guide intervention are driving increasing popularity while in its relative infancy, hifu is capable of.
Ultrasound us use has rapidly entered the field of acute pain medicine and regional anesthesia and interventional pain medicine over the last decade, and it may even become the standard of practice. Anisotropy property of all tendons occurs when us beam not 90o can simulate pathology. The appropriate referral of athletes that may benefit from the. It is an increasingly useful tool in the assessment of both acute and chronic musculoskeletal injuries. Do not confuse anisotropy in the proximal tendon with pathologic.
Ultrasound would normally be focused on only one or two of these quadrants depending upon the clinical diagnosis. Lee, md advanced concepts in sports medicine november 2015. Sonographic artifact associated with linear structures occurs when a linear structure is not 90 degrees to ultrasound beam muscle, tendon, ligament, cortex and nerve tilting the transducer will cause the structure to appear artificially absent. Page 2 ultrasound beam perpendicular to tendon ultrasound beam oblique to tendon. Shoulder ian beggs, uk stefano bianchi, switzerland angel bueno, spain michel cohen, france michel courtpayen, denmark. In musculoskeletal applications, the artefact may prompt an incorrect diagnosis of tendinosis or tendon tear. Anisotropy is an us imaging artifact that appears as decreased. Ultra emg 2017 osu center for continuing medical education. An illustrated tutorial of musculoskeletal sonography. Knee ian beggs, uk stefano bianchi, switzerland angel bueno, spain michel cohen, france michel courtpayen, denmark andrew grainger, uk franz kainberger, austria andrea klauser, austria carlo martinoli, italy eugene mcnally, uk philip j. Heres a tip on how to recognize and overcome anisotropy, a common imaging artifact associated with msk ultrasound. The most common and most problematic pitfall relates to anisotropy, where the normal hyperechoic tendon appears artifactually hypoechoic when the tendon is not perpendicular to the sound beam.
When practicing musculoskeletal ultrasound, one should be aware of anisotropy. Knee ian beggs, uk stefano bianchi, switzerland angel bueno, spain michel cohen, france michel courtpayen, denmark. Musculoskeletal radiology musculoskeletal ultrasound technical guidelines i. Recommended curriculum guidelines for family medicine. Ultrasound guided injections foundation for orthopaedic. Brief history 1958 first report of msk us dussick, kt et al. Highfrequency 1017 mhz linear array transducers, with a small footprint provide excellent detail and spatial resolution and are used in musculoskeletal msk ultrasound to assess superficial structures, such as tendons, small joints and muscles. Us of the elbow has varied clinical applications, including. Structures evaluated with msk ultrasound and image optimization. Harsha, md objectives basic ultrasound terminology knowledge of the diagnostic and therapeutic capability of msk skills needed by physicians that perform msk ultrasound. Musculoskeletal sonography of the tendon wiley online library. The role of musculoskeletal ultrasound in occupational medicine t. Because there are advantages and disadvantages to each imaging method.
Careful scanning technique to avoid anisotropy and possible misdiagnosis beam steering or compounding can help to overcome anisotropy in linear structures such as tendons. The semimembranosus tendon curves anteriorly to attach to the posterior tibia where anisotropy may make it hypoechoic, simulating a baker cyst. Ultrasound guided msk procedures ward mccracken, d. Top ten pitfalls to avoid when performing musculoskeletal sonography. The advantages of us guidance over conventional techniques. This work led to the first description of fibre anisotropy and established the effects of different pathological processes in articular tissues on ultrasound attenuation, laying the foundation of diagnostic musculoskeletal ultrasound. Ideal for visualization of deeper structures receiver detects and amplifies signals. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. When the ultrasound beam is incident on a fibrillar structure as a tendon or a ligament, the organized fibrils may reflect a majority of the insonating sound beam in. It is a beginners guide for the most common diagnostic musculoskeletal ultrasound studies. A primer for primary care practical pain management echotexture refers to the coarseness or nonhomogeneity of an object.
Advantages disadvantages where to start soft tissue lumps tendon disease joint disease nerve studies soft tissue mass ligament injury tendon disease muscle injury foreign body effusionbursitis. Principles of musculoskeletal ultrasound heather curtiss, m. Indications for msk ultrasound include but are not limited to. The higher the echogenicity of tissues, the brighter they appear on us imaging. Therefore, great care should be given in imaging a tendon that is not parallel to the skin. Procedural msk ultrasound meniscal aspiration and injection collegiate soccer athlete. Principles of musculoskeletal ultrasound imaging updated 3. Jul 03, 2012 principles of musculoskeletal ultrasound imaging updated 3 july 2012 free download as powerpoint presentation. Anisotropy translates to mean directionally dependent and is a result of the fibrillar nature of structures such as tendons and nerves and to a lesser extent muscle. Tilt the transducer gently in the area overlying the tendon insertion to avoid anisotropy. Ultrasound is widely available, easytouse and less expensive than most other imaging methods. Physics, instrumentation and image optimization ultra emg 2017 jeffrey a.
Artifacts in musculoskeletal ultrasonography usystem accounts. Select transducer hold transducer between thumb and fingers of dominant hand. The inplane spatial resolution and minimal slice thickness using these probes are superior to those achieved with. Recommended curriculum guidelines for family medicine residents. Musculoskeletal ultrasound image interpretation artifacts anisotropy variation of ultrasound interaction with fibrillar tissue sound beam not perpendicular to long axis of a structure small degrees 5 of beam angulation can result in anisotropy tendons and ligaments rutten jc, et al. Musculoskeletal sonography is a rapidly evolving technique that is gaining popularity for the evaluation and treatment of joint and softtissue diseases. Stabilize transducer on the patient with the small finger of the heel of the imaging hand apply gel to the transducer eliminates air between the probe and skin surface air is the enemy palpate.
Use of a high resolution probe 715mhz is essential when assessing the superficial structures of the shoulder. Dec 17, 2012 heres a tip on how to recognize and overcome anisotropy, a common imaging artifact associated with msk ultrasound. Anisotropy is an artefact encountered in ultrasound, notably in muscles and tendons during a musculoskeletal ultrasound. The emerging role of musculoskeletal ultrasound in occupational medicine. Musculoskeletal radiology musculoskeletal ultrasound technical guidelines vi. By angling the ultrasound beam along the long axis of the semimembranosus tendon, anisotropy can be visualized confirming that this hypoechoic structure is a tendon. Anatomy may be nonintuitive, as in the elbow and hip, and anisotropy 1, 2 may result in misleading appearances. Not to teach you msk ultrasound make aware of conditions with symptoms similar to a dvt may encounter during vascular us recommend dedicated msk us avoid unnecessary consults, imaging cover entities that can appear as a dvt on us avoid unnecessary anticoagulant therapy. There are some simple applications of bedside musculoskeletal msk ultrasound that require minimal training and are within the scope of emergency ultrasound. Anisotropy is the sonographic property of linearly organized tissues, such as tendon and ligaments and to a lesser extent nerves in which sonographic. Director primary care sports medicine fellowship uams nw. This document is endorsed by the american academy of family.
A useful approach to us evaluation of the elbow is to divide it into four compartments. David baker, extended scope physiotherapist and msk sonographer in order for the ultrasound machine to create an image the systems software must make a number of assumptions. Diagnostic errors in musculoskeletal ultrasound imaging and how to. Unlike many other structures in the body, the echo received from a compact fibrillar structure such as a tendon or a nerve is highly dependent on the angle of incidence. Ultrasound machine knobology probe selection depth gain frequency focus. Occasionally, an ultrasound exam may be temporarily uncomfortable, but it should not be painful. Introduction to diagnostic musculoskeletal ultrasound. Echogenicity refers to the ability of tissue to reflect us waves back toward the transducer and produce an echo. Developing your knowledge of the mechanisms by which ultrasound works including sound wave generation, the impact frequency has upon image quality and the effect tissue depth has on image quality are vitally important when using it in clinical practice. Pdf this is the second of two articles focusing on ultrasound examination of musculoskeletal components of the upper and lower limbs. It allows interventional techniques to be more accurate.
Inherent advantages of sonography include accessibility, quick scan time, low cost, multiplanar capability, and the ability to perform dynamic realtime imaging with contralateral comparison. Pdf this is the second of two articles focusing on ultrasound examination of. May 06, 2014 heres a tip on how to recognize and overcome anisotropy, a common imaging artifact associated with msk ultrasound. Anisotropy directionally dependant refraction heeltoe. May 28, 2016 ultrasound anatomy of the ankle and foot thomas grant musculoskeletal ultrasound us is a rapidly evolving technique that is gaining popularity for the evaluation and treatment of joint and soft tissue diseases.
Witte, phd1,2 1department of medical imaging, the university of arizona health network 2department of biomedical engineering, optical sciences, university. Musculoskeletal ultrasound for diagnostics and treatment. Hot tips anisotropy in musculoskeletal msk ultrasound. Principles of musculoskeletal ultrasound imaging updated 3 july 2012 free download as powerpoint presentation. Investigation of anisotropic properties of musculoskeletal. Ultrasound anatomy of the ankle and foot musculoskeletal key. Ankle ian beggs, uk stefano bianchi, switzerland angel bueno, spain michel cohen, france michel courtpayen, denmark. Musculoskeletal ultrasound acp sports medicine workshop november 6th, 2015 ultrasound david m.
This is a key concept to understand in msk ultrasound. Anisotropy anisotropy us beam did not encounter the structure perpendicular to. Anisotropy structures evaluated with us are shown most distinct when the emitted. Msk ultrasound is an extension of your physical exam. The role of musculoskeletal ultrasound in occupational. Anisotropy basic overview of a shoulder ultrasound the future of msk ultrasound wednesday, may 1, 20. Musculoskeletal ultrasound ki open archive karolinska institutet. Lecturer of ultrasound uirsmit the university of lahore 3.
Witte, phd1,2 1department of medical imaging, the university of arizona health. The major soft tissues of the ankle and foot are predominantly superficial and can be assessed with a highfrequency linear transducer. Demonstrated by lori green, ba, rt, rdms, rdcs, rvt, program director at. To avoid anisotropy, the angulation of the transducer must be. Remember to scan the lateral pouch of the subacromial subdeltoid bursa along the. Some applications of bedside ultrasound may be superior to conventional radiographs such as fractures of the ribs and sternum. The musculoskeletal ultrasound pocket guide is a portable and easytouse reference for students, residents and physicians. Understanding the physics behind diagnostic ultrasound is an absolutely essential foundation when you are starting to learn. The common anisotropyrelated artifacts, frequently leading to diagnosis. Pdf introduction to diagnostic musculoskeletal ultrasound part 2.
Over the past 20 years, musculoskeletal ultrasound msk us has. Aium practice parameter for the performance of a musculoskeletal ultrasound examination p a ra me t e r d e ve l o p e d i n co n j u n ct i o n wi t h t h e a me ri ca n co l l e g e o f ra d i o l o g y a cr, t h e s o ci e t y. The images provided are those most frequently obtained during the sonographic evaluation of each respective joint. Demystify musculoskeletal msk ultrasound b ll itd ith k d goals ecomewe. David baker, extended scope physiotherapist and msk sonographer in order for the ultrasound machine to create an image the systems software must make a. Most ultrasound scanning is noninvasive no needles or injections. This has the potential to cause normal structures to appear abnormal. Ultrasound physics impedance acoustic interface us waves are reflected at the interface of two different tissues, dependent on the properties of each tissue echogenicity ability to reflect sound waves back to transducer if reflects large amount of sound brighter interface composed of very different tissues e. Artifacts in musculoskeletal ultrasonography mihra s. Aium practice parameter for the performance of a musculoskeletal ultrasound examination p a ra me t e r d e ve l o p e d i n co n j u n ct i o n wi t h t h e a me ri ca n co l. Shoulder ian beggs, uk stefano bianchi, switzerland angel bueno, spain michel cohen, france michel courtpayen, denmark andrew grainger, uk franz kainberger, austria andrea klauser, austria carlo martinoli, italy eugene mcnally, uk philip j.
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