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Advanced Musculoskeletal > RTUS > Flashcards

RTUS Flashcards

1
Q

MSK ultrasound characteristics

A
  • MSK US high-frequency sound waves (1-17 MHz)
  • Amplitude < 0.1 W/cm2
  • Image soft tissues and bone * Identify pathology
  • Guide real-time procedures
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2
Q

what can MSK ultrasound identify

A
  • Tendons * Nerves * Ligaments * Joint capsules * Muscles * Bone
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3
Q

Common uses for MSK ultrasound by PT’s

A
  • To help guide clinical decision making
  • Documenting changes in clinical conditions
  • Dynamic tissue differentiation
  • Identification of when to progress exercises or
    activity
  • Localization of specific targets for manual
    interventions or physical agents
  • To guide needle placement
  • Blood flow or inflammatory changes
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4
Q

Point of care ultrasound imaging by PTs can identify pathology and/or be procedural:

A
  • Neuromuscular reeducation
  • Obtaining real-time information about the activation of specific muscles
  • Patient biofeedback
  • Monitoring real-time changes in morphology and movement
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5
Q

can you bill for imagining?

A
  • not as imaging CPT code
  • can use biofeedback code
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6
Q

benefits of MSK US

A
  • Ability to image in real-time = hands-on, dynamic,
    fast
  • Interactive – allows feedback from patient
  • Generally unaffected by metal artifacts
  • No radiation to patient or provider
  • Exam of contralateral limb for comparison
  • High resolution
  • Real-time guidance for interventional procedures
  • Sono palpation
  • Portable
  • (Relatively) inexpensive
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7
Q

echo

A

an ultrasound beam returning to its source

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8
Q

what produces the sound wave

A

Traditional diagnostic ultrasound beam generated within the US probe by the piezoelectric effect:
* the production of a pressure wave when an
applied voltage deforms
a crystal element

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9
Q

array

A

refers to the alignment of the crystals
(linear vs curvilinear)

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10
Q

what transducer shows deeper images?

A

curvilinear

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11
Q

How do you get an image from a newer portable US

A
  • they are digitally produced by a silicon chip containing a 2S array of capacitive micro machined US transducers
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12
Q

reflection at an interface …..

A

increases when the density difference between two tissues at an interface increases

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13
Q

echogenicity

A

Echogenicity of the tissue refers to the ability to reflect or transmit US waves in the context of surrounding tissues and shows up as the
amplitude / brightness of the image

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14
Q

hyperechoic

A

more echoic than surrounding tissue (white)

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15
Q

anechoic

A

absence of echoes
black

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16
Q

hypoechoic

A

less echogenic than surrounding tissue
gray

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17
Q

homogenous tissues…

A
  • have fewer interfaces and so less reflection occurs
  • they will appear as hypoechoic structures on the screen
    (bladder full of homogenous fluid)
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18
Q

bone

A
  • appears black or anechoic on an ultrasound image with a bright hyperechoic rim
  • It is black because the US beam cannot penetrate bone and casts an acoustic shadow
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19
Q

blood vessels

A
  • appear black
  • have a distinct appearance on color Doppler mode
    (red/blue color indicates direction of flow not arterial/venous)
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20
Q

Ansiotrophy

A

irregularity you see because of the way you hold the transducer (artifact)

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21
Q

when is the reflected sound energy at its greatest as it is returned to the transducer

A

at an angle of isolation directly perpendicular to the tendon

22
Q

optimal image when transducer is…

A
  • 90 degrees from target
  • Each degree from perpendicular will cause image to drop out
  • Anisotropy appears black on screen
  • Toggling and rocking transducer will fill in image
23
Q

B Mode

A
  • most commonly used to
    visualize morphology and the position of structures and dynamic events through a snapshot in time
24
Q

M Mode

A

movement, motion

25
Q

doppler mode

A
  • Velocity information is presented as a colored overlay on a B- mode image * Detects direction (blue is motion away from transducer, red towards)
  • Velocity – high vs. low
26
Q

orientation marker

A
  • when the screen marker is on the left of the screen, the probe marker should be directed to the patients head or pt’s right side
27
Q

2 different probe orientations

A
  • short axis/transverse/cross sectional
  • long axis/longitudinal/ same plane as target
28
Q

tendons in long axis

A

have characteristic pattern of fine parallel lines, fibrillar appearance
- more hyper echoic and densely striated than muscle or ligaments

29
Q

tendons in short axis

A
  • appear round or flattened ovals with a punctate interior
  • consider artifact
30
Q

transverse view of muscle

A

starry night

31
Q

ligaments in long axis

A
  • fibrillar appearance
32
Q

how can ligaments be differentiated from tendons

A
  • Ligaments can be differentiated from tendons by noting their more compact fibrillar pattern;
  • they are less regularly hyperechoic than tendons due to higher collagen density in tendons
  • Bone to bone
33
Q

Nerves

A
  • Nerves are visible running
    along fascial planes, paired with blood vessels, and sometimes within muscles
  • Longitudinally, they appear as hyperechoic fibrillar cords, they may look similar to tendons but are more hyperechoic with loosely packed fibers
  • In transverse view, the nerve fascicles give a “honeycomb” appearance and are less densely fibrillar than tendons
34
Q

Hyperechoic Characteristics

A
  • High tissue density
  • high amount of reflective echoes
  • bright
  • surface of bone, normal tendon, calcific deposits
35
Q

Hypoechoic Characteristics

A
  • Moderate tissue density
  • Moderate amount of reflective echoes
  • gray
  • normal muscle, disease tendons, normal fat pad, normal synovium, normal ligs, certain soft tissue masses, complex fluid collections
36
Q

Anechoic Characteristic

A
  • minimal tissue density
  • min amount of reflective echoes
  • black
  • hyaline cartilage, fluid collections, cysts, normal burial spaces, tendon tear
37
Q

gain

A

controls overall amplification of returning signal (think volume knob)

38
Q

time gain compensation

A

to control for signal attenuation

39
Q

depth (field of view)

A

goal is to target all pertinent anatomy; make
image as big as possible but still see bone

40
Q

learn about all sorts of imaging on slide 63

A

p 29 and slide 64 too

41
Q

advantages of MSK US

A
  • hands on dynamic examination
  • together with information gained from the hx, PE, and available dx testing, can help to define the clinical question
  • US generally unaffected by metallic artifacts
  • comparative exams of the contralateral extremity
42
Q

Disadvantages of MSK US

A
  • limited field of view
  • incomplete evaluation of bones and joints
  • limited penetration
  • operator dependent
  • lack of formal education
  • cost and availability to PTs
  • variable image quality
43
Q

considerations as you begin to scan

A
  • Set up the exam beforehand so as to be comfortable for both patient
    and PT
  • Perform the exam based on the focal complaint
  • Compare to normal contralateral anatomy
  • Obverse structures throughout their dynamic range when possible
  • Always account for anisotropy in the study of tendons and nerves
  • Develop good recognition of normal structures
  • Use copious gel, water or stand-off pad over painful or
    topographically convoluted surfaces
  • Scan all structures in two planes, i.e. longitudinal and transverse
  • Always know one’s limits and that of the tools being used
44
Q

Steps for RTUS success

A
  • Know your anatomy
  • Capture a good image
  • Recognize structures
  • Analyze the image
  • Compare to opposite side
  • Correlate to clinical findings
  • ?add dynamic component to imaging
45
Q

Multifidus Dysfunction

A
  • Decreased lumbar multifidus cross-sectional area in LBP
  • Evidence of asymmetrical atrophy of lumbar multifidus in acute unilateral
    LBP, ipsilateral to side of symptoms and present with chronic LBP
  • Presence of fatty infiltrate in lumbar multifidus in those with LBP and with
    aging
46
Q

Multifidus Cues

A
  • Prone over pillow
  • “Swell” or “contract” without moving spine
  • Utilize manual cues or RTUS biofeedback
  • Contralateral Arm Lifting Task (CALT)
  • Isometric training has suggested
  • Slow sustained contraction, 10x10sec.
  • Several studies include visual aids (models, anatomy, etc)
47
Q

General considerations for smaller areas

A
  • Use smaller transducer, if possible, with generous use of gel or gel pad
  • Consider transducer pressure
48
Q

Achilles Tendon Exam

A
  • Paratenon, not a synovial sheath
  • Elliptical shape on transverse images
  • Normal AP thickness ~5mm
  • Tears of the Achilles tendon most commonly
    occur ~2–6 cm proximal to the calcaneal insertion site
49
Q

MSK RTUS and Elastography

A
  • Elastography maps the elastic properties and stiffness of soft tissue.
  • “Sonoelastography” has been used to examine tendon stiffness or changes
    within muscle
50
Q

Marathon runners and elastography

A
  • Marathon runners demonstrate a higher prevalence of morphological
    alterations mid-Achilles compared to non-runners (AP thickness, hypoechogenicity, & neovascularization)
  • Reduced tendon stiffness at baseline associated with post-marathon Achilles tendon pain
51
Q

Plantar fascia thickness and plantar fasciitis

A

> 4 mm consistent with plantar fasciitis

Advanced Musculoskeletal (21 decks)

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