Musculoskeletal and Soft Tissues SA

Question 1

The sonogram of the glenohumeral joint starts by scanning the:

Answer 1

infra and supraspinatus mm down to their attachment sites on the greater tubercle.

Question 2

Shoulder scan evaluates what structures:

Answer 2

infraspinatus

supraspinatus

bicep tendon and bicipital groove

deltoid

teres major

joint capsule

Question 3

Origin and insertion of:

supraspinatus

infraspinatus

biceps brachii

deltoid

teres major

Answer 3

o: supraspinatus fossa i: cranial aspect of geater tubercle of humerus
o: infraspinatus fossa i: caudal aspect of greater tubercle of humerus
o: supraglenoid tubercle i: medial tuberosity of the proximal humerus
o: acromion i: deltoid tuberosity of humerus
o: dorsal part of caudal scapula i: teres tuberosity

Question 4

True or False: The bicep tendon at the level of the bicipital groove is surrounded by a small amount of hypoechoic fluid within the tendon sheath.

Answer 4

True

Question 5

Sonographic appearance of supraspinatus tendinopathy

Answer 5

thickened (normal measurement ~ 0.6 cm cm2)

heterogeneous

may see mineralization. Mineralization is associated with lameness if its affects the supraspinatus tendon near the bursa resulting in synovitis.

Question 6

Calcifying tendinopathy is common in what breed?

Answer 6

Rottweilers

Question 7

ultrasonographic appearance of contracrture of the infraspinatus muscle

Answer 7

enlargement (thickening)

hetergeneous or hyperechoic

Question 8

Sonographic appearance of bicipital tenosynovitis

Answer 8

thickening of tendon sheath

becomes rounded

hypoechoic areas (could be hemorrhage or partial tears)

inhomogeneous

effusion

osteophytes within bicipital groove (chronic)

mineralization of bicipital tendon sheath

Question 9

Sonographic appearance of acute vs chronic strain injuries

Answer 9

acute: hypoechoic or anechoic and muscle swelling
chronic: heperechoic and inhomogeneous

Question 10

definition of enthesophyte

Answer 10

abnormal bony projections at the attachment of a tendon or ligament.

Question 11

True or False: Non visualization of the tendon bicips tendon indicates a complete tear or medial luxation associated with rupture of the transverse intertubercular ligament (transeverse humeral ligament)

Answer 11

true

Question 12

Sonographic appearance of partial or complete tendon rupture

Answer 12

complete: fibrillar structure is disrupted, anechoic gap between retracted tendon stumps, severe tendon sheath effusion
partial: inhomogeneous, hyperechoic bone fragments, hypoechoic tendon, core lesions

Question 13

most partial tendon ruptures occur in the area of _____________

Answer 13

supraglenoid tubercle

Question 14

Sonographic appearance of supraglenoid tubercle

Answer 14

hyperechoic fragments at the proximal aspect of the biceps tendon

irregular surface at supraglenoid tubercle

Question 15

Sonographic appearance of OCD glenohumeral joint

Answer 15

irregular borders of humeral head

the defect appears hypoechoic (due to disturbed endochondral ossification)

may see migrating calcified bodies or joint mice (hyperechoic foci)

Question 16

The stifle can be divided into 5 regions:

Answer 16

suprapatellar

infrapatellar

lateral

medial

caudal

Question 17

What composes the suprapatellar region of the stifle?

Answer 17

quadriceps tendon

femoral trochlea

proximal joint recess

Question 18

In a normal stifle the suprapatellar recess measures approx

Answer 18

1-2 mm thick

it is anechoic

Question 19

What composes the infrapatellar region?

Answer 19

patella, patellar ligament, femoral condyles, infrapatellar fat body, cruciate ligaments

Question 20

What composes the medial and lateral regions of the stifle?

Answer 20

Collateral ligaments

menisci

joint capsule

synovium

Question 21

The stifle is flexed approx ______ degrees to examine the suprapatellar region and ______ degrees to examine the infrapatellar region.

Answer 21

45 degrees

90 degrees

Question 22

Sonographic appearance of cranial cruciate ligament rupture

Answer 22

sensitivity is low ~15%

may see irregularly demarcated hyperechoic stumps near its insertion site (tibial plateau)

Question 23

Approximately how long does tendon healing takes?

Answer 23

~ 10-12 weeks

Question 24

Sensitivity and Specificity for detecting meniscal lesions accompanying CCLR on U/S

Answer 24

82% sens

93% spec

Question 25

True or false: Bulging or abaxial displacement of the meniscus may infdicate rupture

Answer 25

true

Question 26

Patellar fxs are commonly associated with damge to the ________ and \_\_\_\_\_\_\_\_\_\_.

Answer 26

quadriceps tendon (proximally) patellar ligment (distally)

Question 27

origina and insertion of iliopsoas muscles

Answer 27

psoas major originates from the transverse process of L3 then extends caudally through L4-L7 and then joining the iliacus the iliopsoas insterts on the lesser trochanter

Question 28

Sonographic appearance of iliopsoas myopathies

Answer 28

muscle swelling with hypoechoic areas (acute face)

Question 29

Calcanean tendon is made up of 3 structures. What are they?

Answer 29

Gastrocnemius tendon (medial and lateral aspects fuse and form the tendon) Superficial digital flexor tendon commo calcanean tendon - tendons of the biceps femoris, semitendenosus and gracilis

Question 30

True or false: common calcaneal tendon is the deepest structure of calcanean tendon

Answer 30

true it has a characteristic hyperechoic linear echotexture when scanned longitudinally

Question 31

What muscles are predisposed to strain injuries?

Answer 31

iliopsoas hip adductor pectineus

Question 32

Sonographic appearance of fascial tears

Answer 32

appears as an interruption of the hyperechoic line enrobing the muscle belly with protrusion of the muscle through the defect

Question 33

What muscles are commonly affected by fibrosing and calcifying myopathies? In what breed this problem is overrepresented

Answer 33

supraspinatus, iliopsoas, gluteal, biceps brachii, gracilis and semitendinous German Shepherds

Question 34

Sonographic appearance of cellulitis

Answer 34

alternating anechoic and hyperechoic bands in the SQ

Question 35

Sonographic appearance seen with phlegmon

Answer 35

accumulation of hypoechoic fluid pockets in the SQ. This appears to be similar in appearance with necrotizing fasciitis.

Question 36

True or false: Most FB appear hyperechoic to normal tissue

Answer 36

true

Question 37

Sonographic appearance of: Wooden FBs BB pellets Glass Porcupine quills Grass awns

Answer 37

wood: hyperechoic and cast a shadow (acute) can see an inflammatory cast or fistular tract- seen as a hypoechoic rim BB: cause reverberation artifact (may be confused with air) glass: hyperechoic, can be seen on rads porcupine quills: double banded fusiform hyperechoic structures. not typically seen on rads Grass awns: double/ triple spindle shaped echogenic interface often with acoustic shadowing

Question 38

sonographic appearance of lipomas

Answer 38

echogenic masses with diffuse hyperechoic dots and striations

Question 39

Sonographic appearance of joint soft- tissue tumors

Answer 39

Synovial cell sarcoma or histiocytic sarcoma irregular soft tissue thickening that crosses the joint space, invades the osteochondral junctions and protrudes into the synovial space

Question 40

Typically joint effusions in OCD of OA are _____ vs septic effusions that are \_\_\_\_\_\_\_\_\_ (talking about the echogenicity of fluid)

Answer 40

anechoic echogenic

Question 41

Sonographic appearance of osteomyelitis

Answer 41

hypoechoic ill defined irregular interfces may see soft tissue swelling

Question 42

Sonographic appearance of areteriovenous fistulas

Answer 42

result in limb soft tissue swelling tortuous network of vessels are identified to a dilated vein