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DMST 295 Abdomen 2 > MSK Ultrasound > Flashcards

MSK Ultrasound Flashcards

1
Q

What doe MSK ultrasound evaluate?

A

Dynamic evaluation of tendons

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2
Q

Is MSK ultrasound more accurate from MRI and CT?

A

In some cases

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3
Q

What are the composition of tendons?

A

Bundles of collagen fibres

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4
Q

What does Tendons attach?

A

Muscle to bone (tuberosities)

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5
Q

What does the tendons facilitate in terms of motion?

A

Flexion and extension

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6
Q

How is experience is for MSK?

A

Very

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7
Q

How is the blood supply for tendons?

A

Poor

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8
Q

What does tendons look like in long axis?

A
  1. Linear band of hyperechoic strands
  2. Fibrillar pattern: interspersed with hypoechoic connective tissue
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9
Q

What does tendons looks like in short axis?

A
  1. Hyperechoic finely punctuate foci
  2. Hypoechoic connective tissue
  3. Round, oval or flattened shape
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10
Q

Tendon echogenicity is highly dependent on what?

A

Angle of insonation

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11
Q

What is anisotrophy?

A

Angles greater than 10 degrees off perpendicular may demonstrate a loss of echogenicity

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12
Q

Anisotropy may be mistaken for what sometimes?

A

Pathology

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13
Q

In terms MSK the beam must like how in relation to tendons?

A

Perpendicular

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14
Q

What happens if we have a curved shape of tendon?

A

Change probe position/ straighten tendon

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15
Q

What does a and be demonstrate?

A

Patellar tendon in long axis and short axis

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16
Q

What does these two images demonstrate?

A

Achilles tendon in long axis and short axis

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17
Q

What does synovial sheaths do?

A
  1. Wraps around tendon to decrease friction
  2. Secretes fluid
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18
Q

What is the paratenon/ peritenon sheaths?

A

Loose connective tissue

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19
Q

What are examples of Paratenon/ peritenon?

A

Achilles and patellar tendon

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20
Q

What are bursas?

A

Flattened synovial lined pouch/sac

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21
Q

What does bursas produce?

A

Synovial fluid

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22
Q

Where are bursas located?

A

High friction points

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23
Q

What does Bursas look like on u/s?

A

Hypoechoic flattened structure

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24
Q

How easy is it to identify bursas on U/S?

A

Difficult

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25
Q

What does these images demonstrate?

A

Pre-patellar bursas

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26
Q

What does this image demonstrate?

A

Patellar Synovial sheaths in long and short axis

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27
Q

What does these images demonstrate?

A

Achilles synovial sheath in long and short axis

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28
Q

What is the sonographic appearance of nerves in long axis?

A
  1. Railroad appearance
  2. Hypoechoic nerve fibres divided by hyperechoic connective tissue
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29
Q

What does nerves look like in short axis?

A
  1. Honeycomb pattern
  2. Circular nerve fibres surrounded by hypoechoic connective tissue
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30
Q

What do Ligaments attach?

A

Bone to bone

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31
Q

What does ligaments help us do?

A

Stability and strength

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32
Q

What is the composition of ligaments?

A

Collagen

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33
Q

What is the sonographic appearance of ligaments?

A

Similar to tendon but more difficult to visualize

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34
Q

What does this image demonstrate?

A

Nerve fibres in short and long axis

honeycomb pattern and railroad pattern

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35
Q

Can we assess bone?

A

Limited

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36
Q

The bone has what type of surface?

A

Cortical (superficial)

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37
Q

What does this image demonstrate?

A

ligaments, note how similar to tendons they look like.

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38
Q

What does bone look like sonographically?

A

Hyperechoic line with strong posterior shadowing

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39
Q

What is cartilage?

A

Shocker absorbers

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40
Q

Where does hyaline cartilage lie?

A

Terminal ends of bonds

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41
Q

What does cartilage look like on U/S?

A
  1. Hypoechoic
  2. Well defined
  3. Smooth
  4. Non-compressible
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42
Q

What does this image demonstrate?

A

Cartilage in the knee

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43
Q

What does muscles look like u/s?

A
  1. Skeletal striated muscle
  2. Hypoechoic tissue with hyperechoic fibres
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44
Q

What can muscles do?

A

Contract and extend

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45
Q

What does this image demonstrate?

A

Muscles

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46
Q

What type of resolution do we need for the shoulder?

A

High resolution linear array

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47
Q

How should the patient sit for shoulder examination?

A

Patient sitting on a rotating stool

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48
Q

The rotator cuff has 4 tendons, what are they?

A
  1. Subscapularis
  2. Supraspinatus
  3. Infraspinatus
  4. Teres minor
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49
Q

Label the image

A
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50
Q

What kind of movement does bicep tendons do?

A

Flexor and extenders

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51
Q

Where is the bicep tendon located?

A
  1. Bicipital groove between the greater and lessor tuberosity
  2. Anterior to humerus
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52
Q

What is the technique for scanning the biceps tendon? SAX and LAX

A
  1. Arm neutral elbow bent at 90 degrees
  2. SAX: document proximal tendon, check position in groove
  3. LAX: Document proximally and more distally
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53
Q

Label the image

A
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54
Q

Label the image

A
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55
Q

Where does the subscapularis attach?

A
  1. From underside of scapula
  2. Attaches to the lesser tuberosity
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56
Q

How do we scan a subscapularis tendon?

A
  1. Arm in a external rotation
  2. Probe will be transverse on patient, LAX on tendon
  3. One image at caracoid, one at insertion
  4. Perform a dynamic assessment
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57
Q

Label the image

A
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58
Q

What type of movement can the supraspinatus do?

A

Abduction of humerus/ stabilizer

59
Q

Where is the supraspinatus located?

A
  1. Superior to humeral head
  2. Attaches to greater tuberosity
60
Q

What incident do we usually see at the supraspinatus?

A

Torn tendon of the rotator cuff

61
Q

What kind of technique can we use to scan the supraspinatus?

A
  1. Arm hyperextended and internally rotated
  2. Image in LAX and SAX
62
Q

Label the image

A
63
Q

What does the infraspinatus do?

A
  1. External rotator of HH
  2. Abductor of humerus
64
Q

Where does the infraspinatus sit?

A
  1. Lateral and posterior to shoulder
  2. Extends from Scapula to GT
65
Q

What is the technique for imaging of the infrapinatous?

A
  1. Patient places area across chest
  2. Imaged in LAX only
66
Q

Where does the teres minor attach?

A

Inserts on GT

67
Q

What does the teres minor move?

A

Adductor of the humerus

68
Q

Label the image

A
69
Q

Label the image

A
70
Q

What forms the Quadriceps tendon?

A

Tendons from all four quads join to form

71
Q

When the quadriceps tendon look like when the leg is extended?

A

Tendon concave

72
Q

How should the leg present for scanning?

A

The leg needs to be scanned

73
Q

What planes do we scan the quad tendon?

A

LAX and SAX

74
Q

How does the quad tendon look like in SAX?

A

Oval

75
Q

Label the image

A
76
Q

Where does the patellar tendon extend from?

A

Apex of patella to tibial tuberosity

77
Q

What is the measurements of the patellar tendon?

A
  1. 5-6 cm length
  2. 2- 2.5 cm wide
  3. 4-5 mm AP
78
Q

What planes can we scan the patellar tendon?

A

LAX and SAX

79
Q

What is the most commonly imaged tendon of the ankle?

A

Achilles tendon

80
Q

What is the Achilles tendon a fusion of?

A

Of the aponeuroses of the sole us and gastrocnemius muscles

81
Q

What does the Achilles tendon insert into?

A

The posterior surface of the calcaneus

82
Q

How do we scan the Achilles tendon?

A
  1. Prone position
  2. Foot hands off the end of the table
  3. Patient can dorsiflex to straighten tendon
83
Q

What is the typical measurement of the Achilles?

A
  1. 1.2 - 1.5 cm wide
  2. 0.5 - 0.7 cm AP
84
Q

What is kager’s fatty triangle?

A

Area of variable echogenicity anterior to distal half of tendon

85
Q

In terms of the hands and wrist what is the most common pathology?

A

Outside trauma, overuse/ compression

86
Q

What is the most common entrapment syndrome of the wrist and hand?

A

Carpal tunnel

87
Q

What is the carpal tunnel?

A

Space between the carpal bones and ligament

88
Q

What is included inside the carpal tunnel joint?

A
  1. Tendons
  2. Median nerve
  3. Muscles
  4. Vessels
89
Q

Where does the median nerve pass through?

A

The carpal tunnel

90
Q

How does the median nerve course?

A

Anterior to the flexor tendon of the second finger

91
Q

What is the scanning technique for the median nerve?

A
  1. Scanned in transverse
  2. Forearm resting on a flat surface
  3. Wrist in supination
92
Q

What is the landmarks of the median nerve?

A

Ulnar artery- medial landmark

93
Q

What does this image demonstrate?

A

The Achilles tendon scanned in long axis then proximal, medial and distal in short axis

94
Q

What is the sonographic appearance of the median nerve?

A
  1. Median nerve hypoechoic
  2. Tendons are echogenic
  3. Honeycomb appearance
95
Q

Label the image of the wrist

A
96
Q

What are some pathology that we may see in the wrist?

A
  1. Tears
  2. Inflammation
  3. Ganglion cysts
  4. Popliteal/ bakers cysts
  5. Carpal tunnel syndrome
  6. Tumours
  7. Foreign bodies
97
Q

What are factors that contribute to a tendon tear?

A
  1. Age
  2. Calcification
  3. Corticosteroids
  4. Systemic diseases
98
Q

What are the two types of tears?

A

Complete and incomplete

99
Q

What does tears look like sonographically?

A
  1. Hypoechoic defects
  2. Focal thinning
  3. Architectural distortion
  4. Fluid filled defects
  5. Echogenic deposits if chronic
  6. Possible non visualization
100
Q

What kind of tears will we see with rotator cuffs?

A
  1. Complete
  2. Small incomplete
  3. Associated
101
Q

What does a complete rotator cuff tear look like?

A

Cartilage interface sign
thin hyperechoic line at interface between normally hypoechoic cartilage and abnormally hypoechoic tendon

102
Q

Where does a the rotator cuff sit with a complete rotator cuff tear?

A

Deltoid sits directly on the humeral head

103
Q

What does a small incomplete rotator cuff look like?

A

Rim tent

104
Q

What is a associated tear look like?

A
  1. Joint effusion
  2. Irregularity of bony surface
105
Q

What sign is associated with the rotator cuff?

A

Geyser sign

106
Q

What does these images demonstrate?

A

Rotator cuff tears

107
Q

What causes inflammation?

A
  1. Tendonitis
  2. Sport or work related
  3. Diffuse or focal involvement
  4. Edema
  5. Possible calcifications
108
Q

What should we do to confirm tendon thickening?

A

Compare to the contralateral side if possible

109
Q

What does tendon thickening look like sonographically?

A
  1. Decreased echogenicity (watch technique)
  2. III margins
  3. Hyperemia
  4. Possible calcifications
110
Q

What does this image demonstrate?

A

Tendinitis

111
Q

What is peritendinitis?

A
  1. Inflammation to peritendon
  2. Achilles
112
Q

What is tenosynovitis?

A

Inflammation of tendon sheath

113
Q

What is bursitis?

A

Sonolucent collection with ill-defined walls

114
Q

What causes bursitis?

A

Due to trauma or microtrauma

115
Q

What is this an example of?

A

Bursitis

116
Q

What are ganglion cysts?

A

Benign soft tissue tumors

117
Q

Where are ganglion cysts usually found?

A
  1. Hand/ wrist
  2. Typically in the hand/wrist
  3. In any joint or tendon sheath
118
Q

What does ganglion cysts present as?

A
  1. Palpable mass
  2. focal pain
119
Q

What is the sonographic appearance of ganglion cysts?

A
  1. Cystic mass attached to tendon sheath
  2. Oval fluid collection with enhancement
  3. May contain debris
  4. Chronic cysts may have a hypoechoic, solid appearance
120
Q

What does this image demonstrate?

A

Ganglion cyst

121
Q

What is another name for a popliteal cyst?

A

Baker’s cyst

122
Q

Where is a popliteal cyst?

A
  1. Synovial cyst of the knee
  2. dilated gastrocnemiosemimembranous bursa
123
Q

Where is popliteal cyst located?

A

Posteromedial

124
Q

What is popliteal cysts associated with?

A

Rheumatoid arthritis

125
Q

Are popliteal cysts asymptomatic?

A

They are asymptomatic and symptomatic

126
Q

What can popliteal cysts mimic?

A

Can mimic Thrombophlebitis or DVT

127
Q

Can the popliteal cyst rupture?

A

Potential to

128
Q

What does this image demonstrate?

A

Baker’s cyst

129
Q

What is carpel tunnel syndrome?

A
  1. Encroachment of median nerve
  2. Decrease in size of tunnel
  3. Increase in volume within the space
130
Q

What do patients with carpel tunnel syndrome feel?

A

Pins and needles

131
Q

What is not generally a imaging diagnosis for carpel tunnel?

A

CTS

132
Q

What are some imaging signs for carpel tunnel?

A
  1. A nerve that is 3x greater in one axis than another axis at 90 degrees
  2. Loss of honeycomb appearance
  3. Sudden increase or decrease in contour
  4. Increase in cross sectional area when compared to unaffected side
133
Q

What does this image demonstrate?

A

Carpal tunnel syndrome
(comparison of the circumference of one carpal tunnel to the other)

134
Q

What are giant cell tumors?

A

Benign tumor of the tendon sheath

135
Q

What does giant cell tumors look like sonographically?

A
  1. Hypoechoic masses
  2. Lobulated contours
136
Q

What are osteochondromas?

A

Benign cartilaginous tumor

137
Q

How can osteochondromas develop?

A

Can develop in a popliteal cyst

138
Q

What does osteochondroma’s look like sonographically?

A

Hyperechoic area with posterior shadow

139
Q

What are lipomas?

A
  1. Adipose tissue
  2. Compressible, mobile, painless
140
Q

What does lipomas look like sonographically?

A

Often hypoechoic by depends on surrounding tissue

141
Q

What are foreign bodies?

A

ID nonradio-opaque FB’s or localization of radio-opaque FB’s

142
Q

How can foreign bodies be examined?

A

Soft tissue can be examined for secondary inflammatory changes

143
Q

What does the metal of foreign bodies look like?

A
  1. Hyperechoic
  2. Comet tail
144
Q

What does this image demonstrate?

A

A foreign object (IUD?)

DMST 295 Abdomen 2 (8 decks)

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