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DMST 295 Abdomen 2 > MSK Ultrasound > Flashcards

MSK Ultrasound Flashcards

(144 cards)

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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
What does these images demonstrate?
Pre-patellar bursas
26
What does this image demonstrate?
Patellar Synovial sheaths in long and short axis
27
What does these images demonstrate?
Achilles synovial sheath in long and short axis
28
What is the sonographic appearance of nerves in long axis?
1. Railroad appearance 2. Hypoechoic nerve fibres divided by hyperechoic connective tissue
29
What does nerves look like in short axis?
1. Honeycomb pattern 2. Circular nerve fibres surrounded by hypoechoic connective tissue
30
What do Ligaments attach?
Bone to bone
31
What does ligaments help us do?
Stability and strength
32
What is the composition of ligaments?
Collagen
33
What is the sonographic appearance of ligaments?
Similar to tendon but more difficult to visualize
34
What does this image demonstrate?
Nerve fibres in short and long axis *honeycomb pattern and railroad pattern*
35
Can we assess bone?
Limited
36
The bone has what type of surface?
Cortical (superficial)
37
What does this image demonstrate?
ligaments, note how similar to tendons they look like.
38
What does bone look like sonographically?
Hyperechoic line with strong posterior shadowing
39
What is cartilage?
Shocker absorbers
40
Where does hyaline cartilage lie?
Terminal ends of bonds
41
What does cartilage look like on U/S?
1. Hypoechoic 2. Well defined 3. Smooth 4. Non-compressible
42
What does this image demonstrate?
Cartilage in the knee
43
What does muscles look like u/s?
1. Skeletal striated muscle 2. Hypoechoic tissue with hyperechoic fibres
44
What can muscles do?
Contract and extend
45
What does this image demonstrate?
Muscles
46
What type of resolution do we need for the shoulder?
High resolution linear array
47
How should the patient sit for shoulder examination?
Patient sitting on a rotating stool
48
The rotator cuff has 4 tendons, what are they?
1. Subscapularis 2. Supraspinatus 3. Infraspinatus 4. Teres minor
49
Label the image
50
What kind of movement does bicep tendons do?
Flexor and extenders
51
Where is the bicep tendon located?
1. Bicipital groove between the greater and lessor tuberosity 2. Anterior to humerus
52
What is the technique for scanning the biceps tendon? *SAX and LAX*
1. Arm neutral elbow bent at 90 degrees 2. SAX: document proximal tendon, check position in groove 3. LAX: Document proximally and more distally
53
Label the image
54
Label the image
55
Where does the subscapularis attach?
1. From underside of scapula 2. Attaches to the lesser tuberosity
56
How do we scan a subscapularis tendon?
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
57
Label the image
58
What type of movement can the supraspinatus do?
Abduction of humerus/ stabilizer
59
Where is the supraspinatus located?
1. Superior to humeral head 2. Attaches to greater tuberosity
60
What incident do we usually see at the supraspinatus?
Torn tendon of the rotator cuff
61
What kind of technique can we use to scan the supraspinatus?
1. Arm hyperextended and internally rotated 2. Image in LAX and SAX
62
Label the image
63
What does the infraspinatus do?
1. External rotator of HH 2. Abductor of humerus
64
Where does the infraspinatus sit?
1. Lateral and posterior to shoulder 2. Extends from Scapula to GT
65
What is the technique for imaging of the infrapinatous?
1. Patient places area across chest 2. Imaged in LAX only
66
Where does the teres minor attach?
Inserts on GT
67
What does the teres minor move?
Adductor of the humerus
68
Label the image
69
Label the image
70
What forms the Quadriceps tendon?
Tendons from all four quads join to form
71
When the quadriceps tendon look like when the leg is extended?
Tendon concave
72
How should the leg present for scanning?
The leg needs to be scanned
73
What planes do we scan the quad tendon?
LAX and SAX
74
How does the quad tendon look like in SAX?
Oval
75
Label the image
76
Where does the patellar tendon extend from?
Apex of patella to tibial tuberosity
77
What is the measurements of the patellar tendon?
1. 5-6 cm length 2. 2- 2.5 cm wide 3. 4-5 mm AP
78
What planes can we scan the patellar tendon?
LAX and SAX
79
What is the most commonly imaged tendon of the ankle?
Achilles tendon
80
What is the Achilles tendon a fusion of?
Of the aponeuroses of the sole us and gastrocnemius muscles
81
What does the Achilles tendon insert into?
The posterior surface of the calcaneus
82
How do we scan the Achilles tendon?
1. Prone position 2. Foot hands off the end of the table 3. Patient can dorsiflex to straighten tendon
83
What is the typical measurement of the Achilles?
1. 1.2 - 1.5 cm wide 2. 0.5 - 0.7 cm AP
84
What is kager’s fatty triangle?
Area of variable echogenicity anterior to distal half of tendon
85
In terms of the hands and wrist what is the most common pathology?
Outside trauma, overuse/ compression
86
What is the most common entrapment syndrome of the wrist and hand?
Carpal tunnel
87
What is the carpal tunnel?
Space between the carpal bones and ligament
88
What is included inside the carpal tunnel joint?
1. Tendons 2. Median nerve 3. Muscles 4. Vessels
89
Where does the median nerve pass through?
The carpal tunnel
90
How does the median nerve course?
Anterior to the flexor tendon of the second finger
91
What is the scanning technique for the median nerve?
1. Scanned in transverse 2. Forearm resting on a flat surface 3. Wrist in supination
92
What is the landmarks of the median nerve?
Ulnar artery- medial landmark
93
What does this image demonstrate?
The Achilles tendon scanned in long axis then proximal, medial and distal in short axis
94
What is the sonographic appearance of the median nerve?
1. Median nerve hypoechoic 2. Tendons are echogenic 3. Honeycomb appearance
95
Label the image of the wrist
96
What are some pathology that we may see in the wrist?
1. Tears 2. Inflammation 3. Ganglion cysts 4. Popliteal/ bakers cysts 5. Carpal tunnel syndrome 6. Tumours 7. Foreign bodies
97
What are factors that contribute to a tendon tear?
1. Age 2. Calcification 3. Corticosteroids 4. Systemic diseases
98
What are the two types of tears?
Complete and incomplete
99
What does tears look like sonographically?
1. Hypoechoic defects 2. Focal thinning 3. Architectural distortion 4. Fluid filled defects 5. Echogenic deposits if chronic 6. Possible non visualization
100
What kind of tears will we see with rotator cuffs?
1. Complete 2. Small incomplete 3. Associated
101
What does a complete rotator cuff tear look like?
Cartilage interface sign *thin hyperechoic line at interface between normally hypoechoic cartilage and abnormally hypoechoic tendon*
102
Where does a the rotator cuff sit with a complete rotator cuff tear?
Deltoid sits directly on the humeral head
103
What does a small incomplete rotator cuff look like?
Rim tent
104
What is a associated tear look like?
1. Joint effusion 2. Irregularity of bony surface
105
What sign is associated with the rotator cuff?
Geyser sign
106
What does these images demonstrate?
Rotator cuff tears
107
What causes inflammation?
1. Tendonitis 2. Sport or work related 3. Diffuse or focal involvement 4. Edema 5. Possible calcifications
108
What should we do to confirm tendon thickening?
Compare to the contralateral side if possible
109
What does tendon thickening look like sonographically?
1. Decreased echogenicity (watch technique) 2. III margins 3. Hyperemia 4. Possible calcifications
110
What does this image demonstrate?
Tendinitis
111
What is peritendinitis?
1. Inflammation to peritendon 2. Achilles
112
What is tenosynovitis?
Inflammation of tendon sheath
113
What is bursitis?
Sonolucent collection with ill-defined walls
114
What causes bursitis?
Due to trauma or microtrauma
115
What is this an example of?
Bursitis
116
What are ganglion cysts?
Benign soft tissue tumors
117
Where are ganglion cysts usually found?
1. Hand/ wrist 2. Typically in the hand/wrist 3. In any joint or tendon sheath
118
What does ganglion cysts present as?
1. Palpable mass 2. focal pain
119
What is the sonographic appearance of ganglion cysts?
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
What does this image demonstrate?
Ganglion cyst
121
What is another name for a popliteal cyst?
Baker's cyst
122
Where is a popliteal cyst?
1. Synovial cyst of the knee 2. dilated gastrocnemiosemimembranous bursa
123
Where is popliteal cyst located?
Posteromedial
124
What is popliteal cysts associated with?
Rheumatoid arthritis
125
Are popliteal cysts asymptomatic?
They are asymptomatic and symptomatic
126
What can popliteal cysts mimic?
Can mimic Thrombophlebitis or DVT
127
Can the popliteal cyst rupture?
Potential to
128
What does this image demonstrate?
Baker's cyst
129
What is carpel tunnel syndrome?
1. Encroachment of median nerve 2. Decrease in size of tunnel 3. Increase in volume within the space
130
What do patients with carpel tunnel syndrome feel?
Pins and needles
131
What is not generally a imaging diagnosis for carpel tunnel?
CTS
132
What are some imaging signs for carpel tunnel?
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
What does this image demonstrate?
Carpal tunnel syndrome (comparison of the circumference of one carpal tunnel to the other)
134
What are giant cell tumors?
Benign tumor of the tendon sheath
135
What does giant cell tumors look like sonographically?
1. Hypoechoic masses 2. Lobulated contours
136
What are osteochondromas?
Benign cartilaginous tumor
137
How can osteochondromas develop?
Can develop in a popliteal cyst
138
What does osteochondroma's look like sonographically?
Hyperechoic area with posterior shadow
139
What are lipomas?
1. Adipose tissue 2. Compressible, mobile, painless
140
What does lipomas look like sonographically?
Often hypoechoic by depends on surrounding tissue
141
What are foreign bodies?
ID nonradio-opaque FB's or localization of radio-opaque FB's
142
How can foreign bodies be examined?
Soft tissue can be examined for secondary inflammatory changes
143
What does the metal of foreign bodies look like?
1. Hyperechoic 2. Comet tail
144
What does this image demonstrate?
A foreign object (IUD?)

DMST 295 Abdomen 2 (8 decks)

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