Diagnostic Sonography for the Musculoskeletal System

Question 1

Common Uses of Sonography in the Musculoskeletal System? (8)

Answer 1

 Tendon tears or tendinitis of rotator cuff
 Muscle tears
 Ligament sprains or tears
 Inflammation or effusions within the bursae
 Early changes of rheumatoid arthritis
 Nerve entrapments - carpal tunnel syndrome
 Benign and malignant soft tissue tumors
 Dislocations of the hip in infants

Question 2

What is sound? It requires?

Answer 2

Sound is a mechanical, longitudinal wave that travels in a straight line
Sound requires a medium through which to travel

Question 3

What is US?

Answer 3

Ultrasound is a mechanical, longitudinal wave with a frequency exceeding the upper limit of human hearing, which is 20,000 Hz or 20 kHz.

Question 4

Therapeutic US has what frequency? Thermal effect is? Medium used?

Answer 4

• 0.7 to 3.3 MHz
• Present
• Gel

Question 5

Diagnostic US has what frequency? Thermal effect is? Medium used?

Answer 5

• 7 – 15 MHz
• absent
• gel

Question 6

Basic Scanning Techniques - prereqs? Know? (2) What kind of axis does each have?

Answer 6

 Prerequisite: know the anatomy 
 Positioning of patient and practitioner 
 Planes 
>>> Transverse plane - short axis 
>>> Longitudinal plane - long axis

Question 7

How does bone appear in US? It is? What’s visualized?

Answer 7

• bright
• hyperechoic (echogenic)
• only the surface

Question 8

How does subcutaneous fat appear in US? It is? What’s visualized?

Answer 8

 Relatively hypoechoic (low level echoes)

 Has thin septations of connective tissue

Question 9

How does muscle appear in US? When scanned transversely, it appears? Longitudinally?

Answer 9

• Hypoechoic
   When scanned transversely, muscle striations or septa appear dotted or form short lines.
   When scanned longitudinally, appears as slabs of irregularly striated tissue.

Question 10

How does tendon appear in US? (2) When scanned transversely, it appears? Longitudinally?

Answer 10

 Hyperechoic to nerve and muscle
 Hypoechoic to bone
 When scanned transversely, appears as a round or flattened oval.
 When scanned longitudinally, appears as narrow densely striped and fibrillar parallel lines.

Question 11

Nerve is visible when? Paired with? It’s hyperechoic to? Hypo? When scanned transversely, it appears? Longitudinally?

Answer 11

 Visible running along fascial planes
 Paired with blood vessels, and sometimes with muscles
 Hyperechoic to muscle
 Hypoechoic to tendon
 When scanned transversely, the nerve fascicles give a “honeycomb” appearance
 When scanned longitudinally, appears as a fibrillar cord

Question 12

Synovial bursa - is it visualized? When?

Answer 12

• not often

- More visible if inflamed or infected

Question 13

Ligament appears? More? What’s its size?

Answer 13

Appears similar to tendon
More compact and irregular
Small in size; difficult to discern, especially in transverse view

Question 14

Hyaline articular cartilage appears as?

Answer 14

Appears as a thin hypoechoic rim over a hyperechoic bony cortex