The most common and most problematic pitfall relates to anisotropy, where the normal hyperechoic tendon appears artifactually hypoechoic when the tendon is not perpendicular to the sound beam. The role of musculoskeletal ultrasound in occupational medicine t. Diagnostic errors in musculoskeletal ultrasound imaging and how to. The higher the echogenicity of tissues, the brighter they appear on us imaging. When practicing musculoskeletal ultrasound, one should be aware of anisotropy. Anisotropy anisotropy us beam did not encounter the structure perpendicular to. Not to teach you msk ultrasound make aware of conditions with symptoms similar to a dvt may encounter during vascular us recommend dedicated msk us avoid unnecessary consults, imaging cover entities that can appear as a dvt on us avoid unnecessary anticoagulant therapy.
Us of the elbow has varied clinical applications, including. Jul 03, 2012 principles of musculoskeletal ultrasound imaging updated 3 july 2012 free download as powerpoint presentation. Anisotropy directionally dependant refraction heeltoe. It is an increasingly useful tool in the assessment of both acute and chronic musculoskeletal injuries. Careful scanning technique to avoid anisotropy and possible misdiagnosis beam steering or compounding can help to overcome anisotropy in linear structures such as tendons. Aium practice parameter for the performance of a musculoskeletal ultrasound examination p a ra me t e r d e ve l o p e d i n co n j u n ct i o n wi t h t h e a me ri ca n co l.
A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Echogenicity refers to the ability of tissue to reflect us waves back toward the transducer and produce an echo. Pdf this is the second of two articles focusing on ultrasound examination of musculoskeletal components of the upper and lower limbs. Page 2 ultrasound beam perpendicular to tendon ultrasound beam oblique to tendon. Ultrasound us use has rapidly entered the field of acute pain medicine and regional anesthesia and interventional pain medicine over the last decade, and it may even become the standard of practice. Musculoskeletal ultrasound for diagnostics and treatment.
Ultra emg 2017 osu center for continuing medical education. Physics, instrumentation and image optimization ultra emg 2017 jeffrey a. Developing your knowledge of the mechanisms by which ultrasound works including sound wave generation, the impact frequency has upon image quality and the effect tissue depth has on image quality are vitally important when using it in clinical practice. Ultrasound would normally be focused on only one or two of these quadrants depending upon the. Pdf introduction to diagnostic musculoskeletal ultrasound. The major soft tissues of the ankle and foot are predominantly superficial and can be assessed with a highfrequency linear transducer. Principles of musculoskeletal ultrasound imaging updated 3. Ultrasound machine knobology probe selection depth gain frequency focus. To avoid anisotropy, the angulation of the transducer must be. This document is endorsed by the american academy of family. Dec 17, 2012 heres a tip on how to recognize and overcome anisotropy, a common imaging artifact associated with msk ultrasound. Knee ian beggs, uk stefano bianchi, switzerland angel bueno, spain michel cohen, france michel courtpayen, denmark andrew grainger, uk franz kainberger, austria andrea klauser, austria carlo martinoli, italy eugene mcnally, uk philip j. Ultrasound guided msk procedures ward mccracken, d.
Musculoskeletal ultrasound acp sports medicine workshop november 6th, 2015 ultrasound david m. The images provided are those most frequently obtained during the sonographic evaluation of each respective joint. Ultrasound is widely available, easytouse and less expensive than most other imaging methods. Recommended curriculum guidelines for family medicine. Advantages disadvantages where to start soft tissue lumps tendon disease joint disease nerve studies soft tissue mass ligament injury tendon disease muscle injury foreign body effusionbursitis. Pdf this is the second of two articles focusing on ultrasound examination of. Anisotropy is an us imaging artifact that appears as decreased. This is a key concept to understand in msk ultrasound. The semimembranosus tendon curves anteriorly to attach to the posterior tibia where anisotropy may make it hypoechoic, simulating a baker cyst. Lecturer of ultrasound uirsmit the university of lahore 3. Select transducer hold transducer between thumb and fingers of dominant hand. Musculoskeletal radiology musculoskeletal ultrasound technical guidelines i. When the ultrasound beam is incident on a fibrillar structure as a tendon or a ligament, the organized fibrils may reflect a majority of the insonating sound beam in.
Most ultrasound scanning is noninvasive no needles or injections. Aium practice parameter for the performance of a musculoskeletal ultrasound examination p a ra me t e r d e ve l o p e d i n co n j u n ct i o n wi t h t h e a me ri ca n co l l e g e o f ra d i o l o g y a cr, t h e s o ci e t y. May 06, 2014 heres a tip on how to recognize and overcome anisotropy, a common imaging artifact associated with msk ultrasound. The appropriate referral of athletes that may benefit from the. Use of a high resolution probe 715mhz is essential when assessing the superficial structures of the shoulder. Over the past 20 years, musculoskeletal ultrasound msk us has. Highfrequency 1017 mhz linear array transducers, with a small footprint provide excellent detail and spatial resolution and are used in musculoskeletal msk ultrasound to assess superficial structures, such as tendons, small joints and muscles. Therefore, great care should be given in imaging a tendon that is not parallel to the skin.
Demystify musculoskeletal msk ultrasound b ll itd ith k d goals ecomewe. Unlike many other structures in the body, the echo received from a compact fibrillar structure such as a tendon or a nerve is highly dependent on the angle of incidence. It is a beginners guide for the most common diagnostic musculoskeletal ultrasound studies. Ultrasound would normally be focused on only one or two of these quadrants depending upon the clinical diagnosis.
Witte, phd1,2 1department of medical imaging, the university of arizona health. A primer for primary care practical pain management echotexture refers to the coarseness or nonhomogeneity of an object. Recommended curriculum guidelines for family medicine residents. Artifacts in musculoskeletal ultrasonography usystem accounts. The musculoskeletal ultrasound pocket guide is a portable and easytouse reference for students, residents and physicians. Shoulder ian beggs, uk stefano bianchi, switzerland angel bueno, spain michel cohen, france michel courtpayen, denmark andrew grainger, uk franz kainberger, austria andrea klauser, austria carlo martinoli, italy eugene mcnally, uk philip j. Occasionally, an ultrasound exam may be temporarily uncomfortable, but it should not be painful. Musculoskeletal ultrasound image interpretation artifacts anisotropy variation of ultrasound interaction with fibrillar tissue sound beam not perpendicular to long axis of a structure small degrees 5 of beam angulation can result in anisotropy tendons and ligaments rutten jc, et al. Principles of musculoskeletal ultrasound heather curtiss, m.
Witte, phd1,2 1department of medical imaging, the university of arizona health network 2department of biomedical engineering, optical sciences, university. Anisotropy is an artefact encountered in ultrasound, notably in muscles and tendons during a musculoskeletal ultrasound. Indications for msk ultrasound include but are not limited to. In musculoskeletal applications, the artefact may prompt an incorrect diagnosis of tendinosis or tendon tear. Lee, md advanced concepts in sports medicine november 2015. Artifacts in musculoskeletal ultrasonography mihra s.
A useful approach to us evaluation of the elbow is to divide it into four compartments. Principles of musculoskeletal ultrasound imaging updated 3 july 2012 free download as powerpoint presentation. Structures evaluated with msk ultrasound and image optimization. This work led to the first description of fibre anisotropy and established the effects of different pathological processes in articular tissues on ultrasound attenuation, laying the foundation of diagnostic musculoskeletal ultrasound. Musculoskeletal ultrasound utilises highfrequency linear transducers to produce highresolution images of soft tissue structures. Ultrasound physics impedance acoustic interface us waves are reflected at the interface of two different tissues, dependent on the properties of each tissue echogenicity ability to reflect sound waves back to transducer if reflects large amount of sound brighter interface composed of very different tissues e. Ultrasound anatomy of the ankle and foot musculoskeletal key. May 28, 2016 ultrasound anatomy of the ankle and foot thomas grant musculoskeletal ultrasound us is a rapidly evolving technique that is gaining popularity for the evaluation and treatment of joint and soft tissue diseases. Demonstrated by lori green, ba, rt, rdms, rdcs, rvt, program director at. Top ten pitfalls to avoid when performing musculoskeletal sonography.
Inherent advantages of sonography include accessibility, quick scan time, low cost, multiplanar capability, and the ability to perform dynamic realtime imaging with contralateral comparison. Because there are advantages and disadvantages to each imaging method. Tilt the transducer gently in the area overlying the tendon insertion to avoid anisotropy. Procedural msk ultrasound meniscal aspiration and injection collegiate soccer athlete. Anisotropy property of all tendons occurs when us beam not 90o can simulate pathology. David baker, extended scope physiotherapist and msk sonographer in order for the ultrasound machine to create an image the systems software must make a number of assumptions. Investigation of anisotropic properties of musculoskeletal. Anisotropy basic overview of a shoulder ultrasound the future of msk ultrasound wednesday, may 1, 20. Knee ian beggs, uk stefano bianchi, switzerland angel bueno, spain michel cohen, france michel courtpayen, denmark. Sonographic artifact associated with linear structures occurs when a linear structure is not 90 degrees to ultrasound beam muscle, tendon, ligament, cortex and nerve tilting the transducer will cause the structure to appear artificially absent.
Brief history 1958 first report of msk us dussick, kt et al. Anisotropy is the sonographic property of linearly organized tissues, such as tendon and ligaments and to a lesser extent nerves in which sonographic. Harsha, md objectives basic ultrasound terminology knowledge of the diagnostic and therapeutic capability of msk skills needed by physicians that perform msk ultrasound. Focused ultrasound foundation summary ultrasound is robust tool, complimentary to mri, in the diagnosis of msk pathology relative low cost, portability, realtime imaging for on the spot clinical decision making and the ability to guide intervention are driving increasing popularity while in its relative infancy, hifu is capable of. Anisotropy structures evaluated with us are shown most distinct when the emitted. David baker, extended scope physiotherapist and msk sonographer in order for the ultrasound machine to create an image the systems software must make a.
Musculoskeletal sonography is a rapidly evolving technique that is gaining popularity for the evaluation and treatment of joint and softtissue diseases. Musculoskeletal sonography of the tendon wiley online library. Introduction to diagnostic musculoskeletal ultrasound. Shoulder ian beggs, uk stefano bianchi, switzerland angel bueno, spain michel cohen, france michel courtpayen, denmark. It allows interventional techniques to be more accurate. Pdf introduction to diagnostic musculoskeletal ultrasound part 2. The role of musculoskeletal ultrasound in occupational. Some applications of bedside ultrasound may be superior to conventional radiographs such as fractures of the ribs and sternum. Musculoskeletal ultrasound ki open archive karolinska institutet. Aium practice parameter for the performance of a musculoskeletal. The advantages of us guidance over conventional techniques.
Do not confuse anisotropy in the proximal tendon with pathologic. The emerging role of musculoskeletal ultrasound in occupational medicine. Heres a tip on how to recognize and overcome anisotropy, a common imaging artifact associated with msk ultrasound. By angling the ultrasound beam along the long axis of the semimembranosus tendon, anisotropy can be visualized confirming that this hypoechoic structure is a tendon. Msk ultrasound is an extension of your physical exam. The common anisotropyrelated artifacts, frequently leading to diagnosis. Assistant professor family and preventative medicine uams nw. Ankle ian beggs, uk stefano bianchi, switzerland angel bueno, spain michel cohen, france michel courtpayen, denmark. Understanding the physics behind diagnostic ultrasound is an absolutely essential foundation when you are starting to learn. An illustrated tutorial of musculoskeletal sonography. Musculoskeletal radiology musculoskeletal ultrasound technical guidelines vi. This has the potential to cause normal structures to appear abnormal. Anisotropy translates to mean directionally dependent and is a result of the fibrillar nature of structures such as tendons and nerves and to a lesser extent muscle.
Ultrasound guided injections foundation for orthopaedic. There are some simple applications of bedside musculoskeletal msk ultrasound that require minimal training and are within the scope of emergency ultrasound. Anatomy may be nonintuitive, as in the elbow and hip, and anisotropy 1, 2 may result in misleading appearances. Remember to scan the lateral pouch of the subacromial subdeltoid bursa along the. Hot tips anisotropy in musculoskeletal msk ultrasound.
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