Musculoskeletal Ultrasound ApplicationsResearch Park US Phillips HDI 5000 unit Specially trained...
Transcript of Musculoskeletal Ultrasound ApplicationsResearch Park US Phillips HDI 5000 unit Specially trained...
![Page 1: Musculoskeletal Ultrasound ApplicationsResearch Park US Phillips HDI 5000 unit Specially trained sonographers: Amy Huari and Rhonda Arbogast Weekdays: 8:30am – 5:00pm Daily add-ons](https://reader030.fdocuments.us/reader030/viewer/2022040607/5ebeff2be575630c1745ad39/html5/thumbnails/1.jpg)
Musculoskeletal Musculoskeletal Ultrasound ApplicationsUltrasound Applications
Division of Musculoskeletal RadiologyDivision of Musculoskeletal Radiology University of Wisconsin School of Medicine & Public HealthUniversity of Wisconsin School of Medicine & Public Health
University of Wisconsin Hospital & ClinicsUniversity of Wisconsin Hospital & Clinics
![Page 2: Musculoskeletal Ultrasound ApplicationsResearch Park US Phillips HDI 5000 unit Specially trained sonographers: Amy Huari and Rhonda Arbogast Weekdays: 8:30am – 5:00pm Daily add-ons](https://reader030.fdocuments.us/reader030/viewer/2022040607/5ebeff2be575630c1745ad39/html5/thumbnails/2.jpg)
Research Park US
Phillips HDI 5000 unitPhillips HDI 5000 unitSpecially trained Specially trained sonographers: Amy Huari sonographers: Amy Huari and Rhonda Arbogastand Rhonda ArbogastWeekdays: 8:30am Weekdays: 8:30am ––5:00pm5:00pmDaily addDaily add--onsons
![Page 3: Musculoskeletal Ultrasound ApplicationsResearch Park US Phillips HDI 5000 unit Specially trained sonographers: Amy Huari and Rhonda Arbogast Weekdays: 8:30am – 5:00pm Daily add-ons](https://reader030.fdocuments.us/reader030/viewer/2022040607/5ebeff2be575630c1745ad39/html5/thumbnails/3.jpg)
Why Ultrasound ?Why Ultrasound ?
Quick Quick
EasyEasy
AccessibleAccessible
Patient satisfactionPatient satisfaction
![Page 4: Musculoskeletal Ultrasound ApplicationsResearch Park US Phillips HDI 5000 unit Specially trained sonographers: Amy Huari and Rhonda Arbogast Weekdays: 8:30am – 5:00pm Daily add-ons](https://reader030.fdocuments.us/reader030/viewer/2022040607/5ebeff2be575630c1745ad39/html5/thumbnails/4.jpg)
Advantages of UltrasoundAdvantages of UltrasoundNo RadiationNo RadiationDirected, real time Directed, real time examinationsexaminations–– Patient feedback is helpfulPatient feedback is helpful
DynamicDynamic–– Multiplanar capabilityMultiplanar capability–– Dynamic motion Dynamic motion
assessmentassessment–– Tendon subluxationTendon subluxation–– Guided needle aspiration, Guided needle aspiration,
injectioninjection
Contralateral comparisonContralateral comparison
Not affected by implanted Not affected by implanted devices / metaldevices / metalNo claustrophobiaNo claustrophobiaCostCost--effectiveeffectiveColor / Power Doppler Color / Power Doppler sonography for vascularitysonography for vascularityNonNon--radiopaque FBradiopaque FB
![Page 5: Musculoskeletal Ultrasound ApplicationsResearch Park US Phillips HDI 5000 unit Specially trained sonographers: Amy Huari and Rhonda Arbogast Weekdays: 8:30am – 5:00pm Daily add-ons](https://reader030.fdocuments.us/reader030/viewer/2022040607/5ebeff2be575630c1745ad39/html5/thumbnails/5.jpg)
LimitationsLimitations
OperatorOperator--dependentdependent–– extensive training requiredextensive training required
Limited field of viewLimited field of viewRequires patient Requires patient cooperationcooperationBody habitus dependentBody habitus dependent–– > 5 cm deep hard to > 5 cm deep hard to
evaluateevaluate
![Page 6: Musculoskeletal Ultrasound ApplicationsResearch Park US Phillips HDI 5000 unit Specially trained sonographers: Amy Huari and Rhonda Arbogast Weekdays: 8:30am – 5:00pm Daily add-ons](https://reader030.fdocuments.us/reader030/viewer/2022040607/5ebeff2be575630c1745ad39/html5/thumbnails/6.jpg)
Technical Advances in UltrasoundTechnical Advances in Ultrasound 10 yrs ago vs. present10 yrs ago vs. present
Supraspinatus
Flexor pollicis longus
![Page 7: Musculoskeletal Ultrasound ApplicationsResearch Park US Phillips HDI 5000 unit Specially trained sonographers: Amy Huari and Rhonda Arbogast Weekdays: 8:30am – 5:00pm Daily add-ons](https://reader030.fdocuments.us/reader030/viewer/2022040607/5ebeff2be575630c1745ad39/html5/thumbnails/7.jpg)
When to evaluate with ultrasound??
ShoulderShoulderElbowElbowHand/WristHand/WristHip Knee Hip Knee Ankle/Foot Ankle/Foot NervesNerves
![Page 8: Musculoskeletal Ultrasound ApplicationsResearch Park US Phillips HDI 5000 unit Specially trained sonographers: Amy Huari and Rhonda Arbogast Weekdays: 8:30am – 5:00pm Daily add-ons](https://reader030.fdocuments.us/reader030/viewer/2022040607/5ebeff2be575630c1745ad39/html5/thumbnails/8.jpg)
Shoulder IndicationsShoulder IndicationsRotator cuff tearsRotator cuff tears
Calcified tendinitis of the cuffCalcified tendinitis of the cuff
SubdeltoidSubdeltoid--subacromial bursitissubacromial bursitis
Biceps tendinitis / tenosynovitis Biceps tendinitis / tenosynovitis
Glenohumeral effusionGlenohumeral effusion
Impingement syndromeImpingement syndrome
Acromioclavicular jointAcromioclavicular joint
Suprascapular Ganglion CystSuprascapular Ganglion Cyst
![Page 9: Musculoskeletal Ultrasound ApplicationsResearch Park US Phillips HDI 5000 unit Specially trained sonographers: Amy Huari and Rhonda Arbogast Weekdays: 8:30am – 5:00pm Daily add-ons](https://reader030.fdocuments.us/reader030/viewer/2022040607/5ebeff2be575630c1745ad39/html5/thumbnails/9.jpg)
ElbowElbow
Ulnar collateral ligament evaluationUlnar collateral ligament evaluation–– Unknown accuracy vs. MRIUnknown accuracy vs. MRI
Triceps / biceps tendonsTriceps / biceps tendons–– Unknown accuracy vs. MRIUnknown accuracy vs. MRI
EpicondylosisEpicondylosisOlecranon bursaOlecranon bursaEffusionEffusionUSUS-- guided aspiration/injectionguided aspiration/injection
![Page 10: Musculoskeletal Ultrasound ApplicationsResearch Park US Phillips HDI 5000 unit Specially trained sonographers: Amy Huari and Rhonda Arbogast Weekdays: 8:30am – 5:00pm Daily add-ons](https://reader030.fdocuments.us/reader030/viewer/2022040607/5ebeff2be575630c1745ad39/html5/thumbnails/10.jpg)
Wrist / Hand EvaluationWrist / Hand EvaluationGanglion cystsGanglion cystsTenosynovitisTenosynovitis–– DeQuervainDeQuervain’’ss
Carpal Tunnel SyndromeCarpal Tunnel SyndromeForeign Bodies (esp. radiolucent)Foreign Bodies (esp. radiolucent)Tendon Tears (Flexor & Extensor)Tendon Tears (Flexor & Extensor)Gamekeeper Thumb (UCL)– Stener Lesion
Extensor Hood InjuryPulley Tears
![Page 11: Musculoskeletal Ultrasound ApplicationsResearch Park US Phillips HDI 5000 unit Specially trained sonographers: Amy Huari and Rhonda Arbogast Weekdays: 8:30am – 5:00pm Daily add-ons](https://reader030.fdocuments.us/reader030/viewer/2022040607/5ebeff2be575630c1745ad39/html5/thumbnails/11.jpg)
Foot / AnkleFoot / Ankle
Joint effusionJoint effusionAchilles TendonAchilles TendonPosterior Tibialis TendonPosterior Tibialis TendonPeroneal TendonPeroneal TendonJoint / Tarsal Tunnel InjectionJoint / Tarsal Tunnel InjectionPlantar FasciitisPlantar FasciitisMortonMorton’’s Neuromas Neuroma–– Steroid or 20% ethanol injectionsSteroid or 20% ethanol injections
![Page 12: Musculoskeletal Ultrasound ApplicationsResearch Park US Phillips HDI 5000 unit Specially trained sonographers: Amy Huari and Rhonda Arbogast Weekdays: 8:30am – 5:00pm Daily add-ons](https://reader030.fdocuments.us/reader030/viewer/2022040607/5ebeff2be575630c1745ad39/html5/thumbnails/12.jpg)
KneeKneeQuad / Patellar tendon injuriesQuad / Patellar tendon injuriesEffusion Effusion –– ArthrocentesisArthrocentesisBakerBaker’’s Cysts CystBursitisBursitis
![Page 13: Musculoskeletal Ultrasound ApplicationsResearch Park US Phillips HDI 5000 unit Specially trained sonographers: Amy Huari and Rhonda Arbogast Weekdays: 8:30am – 5:00pm Daily add-ons](https://reader030.fdocuments.us/reader030/viewer/2022040607/5ebeff2be575630c1745ad39/html5/thumbnails/13.jpg)
HipHip
BursitisBursitis–– Greater TrochanterGreater Trochanter–– IliopsoasIliopsoas
Joint effusionJoint effusionUSUS--guided aspiration/injectionguided aspiration/injection
![Page 14: Musculoskeletal Ultrasound ApplicationsResearch Park US Phillips HDI 5000 unit Specially trained sonographers: Amy Huari and Rhonda Arbogast Weekdays: 8:30am – 5:00pm Daily add-ons](https://reader030.fdocuments.us/reader030/viewer/2022040607/5ebeff2be575630c1745ad39/html5/thumbnails/14.jpg)
Sonographic Evaluation of MassesSonographic Evaluation of Masses
LipomasLipomasHematomasHematomasNerve Sheath TumorsNerve Sheath TumorsHemangiomasHemangiomasCystsCystsGangliaGangliaForeign body not apparent on xrayForeign body not apparent on xray–– Glass, wood, plasticGlass, wood, plastic
![Page 15: Musculoskeletal Ultrasound ApplicationsResearch Park US Phillips HDI 5000 unit Specially trained sonographers: Amy Huari and Rhonda Arbogast Weekdays: 8:30am – 5:00pm Daily add-ons](https://reader030.fdocuments.us/reader030/viewer/2022040607/5ebeff2be575630c1745ad39/html5/thumbnails/15.jpg)
Shoulder SonographyShoulder SonographyNormal Rotator Cuff
supraspinatus
Greatertuberosity
Humeral head
![Page 16: Musculoskeletal Ultrasound ApplicationsResearch Park US Phillips HDI 5000 unit Specially trained sonographers: Amy Huari and Rhonda Arbogast Weekdays: 8:30am – 5:00pm Daily add-ons](https://reader030.fdocuments.us/reader030/viewer/2022040607/5ebeff2be575630c1745ad39/html5/thumbnails/16.jpg)
Ultrasound AccuracyUltrasound Accuracy for Rotator Cuff Imagingfor Rotator Cuff Imaging
Difficult to differentiate:Difficult to differentiate:–– PartialPartial--thickness articular vs. tendinopathythickness articular vs. tendinopathy–– HighHigh--grade partial vs fullgrade partial vs full--thicknessthickness
With Modern EquipmentWith Modern Equipment–– FullFull--thickness: thickness:
Sensitivity: 95Sensitivity: 95--100 %100 %Specificity: 94 %Specificity: 94 %
–– PartialPartial--thickness:thickness:Sensitivity: 93 %Sensitivity: 93 %Specificity: 87 %Specificity: 87 %
Van Holsbeeck et al. Radiology 1995;197:443-446Teefey et al. JBJS 2000; 82:498
![Page 17: Musculoskeletal Ultrasound ApplicationsResearch Park US Phillips HDI 5000 unit Specially trained sonographers: Amy Huari and Rhonda Arbogast Weekdays: 8:30am – 5:00pm Daily add-ons](https://reader030.fdocuments.us/reader030/viewer/2022040607/5ebeff2be575630c1745ad39/html5/thumbnails/17.jpg)
Tendinosis of the Supraspinatus
Utility of Power Doppler flow
![Page 18: Musculoskeletal Ultrasound ApplicationsResearch Park US Phillips HDI 5000 unit Specially trained sonographers: Amy Huari and Rhonda Arbogast Weekdays: 8:30am – 5:00pm Daily add-ons](https://reader030.fdocuments.us/reader030/viewer/2022040607/5ebeff2be575630c1745ad39/html5/thumbnails/18.jpg)
Color Doppler
Tennis Elbow
Hypoechoic common extensor tendon with hyperemia
![Page 19: Musculoskeletal Ultrasound ApplicationsResearch Park US Phillips HDI 5000 unit Specially trained sonographers: Amy Huari and Rhonda Arbogast Weekdays: 8:30am – 5:00pm Daily add-ons](https://reader030.fdocuments.us/reader030/viewer/2022040607/5ebeff2be575630c1745ad39/html5/thumbnails/19.jpg)
Muscle Strain
GCMGCM
SoleusSoleus
Grade II
![Page 20: Musculoskeletal Ultrasound ApplicationsResearch Park US Phillips HDI 5000 unit Specially trained sonographers: Amy Huari and Rhonda Arbogast Weekdays: 8:30am – 5:00pm Daily add-ons](https://reader030.fdocuments.us/reader030/viewer/2022040607/5ebeff2be575630c1745ad39/html5/thumbnails/20.jpg)
Extended Field-of-View
Extensor Mechanism
![Page 21: Musculoskeletal Ultrasound ApplicationsResearch Park US Phillips HDI 5000 unit Specially trained sonographers: Amy Huari and Rhonda Arbogast Weekdays: 8:30am – 5:00pm Daily add-ons](https://reader030.fdocuments.us/reader030/viewer/2022040607/5ebeff2be575630c1745ad39/html5/thumbnails/21.jpg)
Distal Patellar Tendinosis
Short axis
Osgood-Schlatter
patellatibia
![Page 22: Musculoskeletal Ultrasound ApplicationsResearch Park US Phillips HDI 5000 unit Specially trained sonographers: Amy Huari and Rhonda Arbogast Weekdays: 8:30am – 5:00pm Daily add-ons](https://reader030.fdocuments.us/reader030/viewer/2022040607/5ebeff2be575630c1745ad39/html5/thumbnails/22.jpg)
Foot / AnkleJoint effusionJoint effusionAchilles TendonAchilles TendonPosterior Tibial TendonPosterior Tibial TendonPeroneal TendonPeroneal TendonJoint / Tarsal Tunnel InjectionJoint / Tarsal Tunnel InjectionAnkle sprainsAnkle sprainsPlantar FasciitisPlantar FasciitisMortonMorton’’s Neuromas Neuroma–– Ethanol injectionsEthanol injections
![Page 23: Musculoskeletal Ultrasound ApplicationsResearch Park US Phillips HDI 5000 unit Specially trained sonographers: Amy Huari and Rhonda Arbogast Weekdays: 8:30am – 5:00pm Daily add-ons](https://reader030.fdocuments.us/reader030/viewer/2022040607/5ebeff2be575630c1745ad39/html5/thumbnails/23.jpg)
Achilles Tendon: Anatomy
cal
sol
mall
Long Axis
Short Axis
LONG AXIS
SHORT AXIS
![Page 24: Musculoskeletal Ultrasound ApplicationsResearch Park US Phillips HDI 5000 unit Specially trained sonographers: Amy Huari and Rhonda Arbogast Weekdays: 8:30am – 5:00pm Daily add-ons](https://reader030.fdocuments.us/reader030/viewer/2022040607/5ebeff2be575630c1745ad39/html5/thumbnails/24.jpg)
Plantar Fasciitis
Long Axis
Long Axis
Short AxisLong Axis
![Page 25: Musculoskeletal Ultrasound ApplicationsResearch Park US Phillips HDI 5000 unit Specially trained sonographers: Amy Huari and Rhonda Arbogast Weekdays: 8:30am – 5:00pm Daily add-ons](https://reader030.fdocuments.us/reader030/viewer/2022040607/5ebeff2be575630c1745ad39/html5/thumbnails/25.jpg)
US-guided Interventions
Very useful techniqueVery useful technique–– Multiplanar imaging of targetMultiplanar imaging of target–– Information about surrounding tissuesInformation about surrounding tissues
Nerves, vesselsNerves, vessels
![Page 26: Musculoskeletal Ultrasound ApplicationsResearch Park US Phillips HDI 5000 unit Specially trained sonographers: Amy Huari and Rhonda Arbogast Weekdays: 8:30am – 5:00pm Daily add-ons](https://reader030.fdocuments.us/reader030/viewer/2022040607/5ebeff2be575630c1745ad39/html5/thumbnails/26.jpg)
Summary
Ultrasound is very useful for performing a Ultrasound is very useful for performing a focused exam for a specific questionfocused exam for a specific questionUltrasound technology has improvedUltrasound technology has improvedUltrasound can be used in conjunction Ultrasound can be used in conjunction with MRIwith MRIExcellent for dynamic evaluation and Excellent for dynamic evaluation and guided proceduresguided proceduresSafe, inexpensive, accessible, portableSafe, inexpensive, accessible, portable
![Page 27: Musculoskeletal Ultrasound ApplicationsResearch Park US Phillips HDI 5000 unit Specially trained sonographers: Amy Huari and Rhonda Arbogast Weekdays: 8:30am – 5:00pm Daily add-ons](https://reader030.fdocuments.us/reader030/viewer/2022040607/5ebeff2be575630c1745ad39/html5/thumbnails/27.jpg)
Acknowledgments
John Wilson, MD John Wilson, MD –– Department of Family Medicine/Sports Department of Family Medicine/Sports
Medicine, UWSMPHMedicine, UWSMPHArthur De Arthur De SmetSmet, MD, MD–– Department of Radiology, UWSMPHDepartment of Radiology, UWSMPH
Michael J. Michael J. TuiteTuite, MD, MD–– Department of Radiology, UWSMPHDepartment of Radiology, UWSMPH
Tony Bouffard, MDTony Bouffard, MD–– Department of Radiology, Henry Ford Department of Radiology, Henry Ford
HospitalHospital