Thigh and Knee Ultrasound
Transcript of Thigh and Knee Ultrasound
![Page 1: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/1.jpg)
Stephen Bird
Thigh and Knee Ultrasound
![Page 2: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/2.jpg)
Quadriceps Insertion
![Page 3: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/3.jpg)
3 Layers• Superficial: (Rectus Femoris)• Middle: (Vastus Medialis / Vastus Lateralis)• Deep: (Vastus Intermedius)
• Partial tears commonly involve superficial layer only • Axial scans required to independently assess VM
and VL involvement
Quadriceps Insertion
![Page 4: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/4.jpg)
Quadriceps Tendon Layers
![Page 5: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/5.jpg)
Rectus Femoris Anatomy
![Page 6: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/6.jpg)
Rectus Femoris Anatomy
![Page 7: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/7.jpg)
Rectus Femoris Central Tendon Rupture
![Page 8: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/8.jpg)
Rectus Femoris Central Tendon Rupture
![Page 9: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/9.jpg)
Rectus Femoris Central Tendon Rupture
![Page 10: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/10.jpg)
Stephen Bird
Hamstring Ultrasound
![Page 11: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/11.jpg)
Hamstring
Origin : Enthesis / Tendon
Belly : MTJ x 2 / Myo-fascial Boundary
Insertion : Enthesis / Tendon
Bursae : Ischial, Semimemb, Pes Anserine
Adjacent Structures : Sciatic Nerve ,
Sacrotuberous Lig
![Page 12: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/12.jpg)
Hamstring Muscle and Tendon Units
LateralMedial
Ischial Tub
Knee
SM
ST
BFL/H
BFS/H
![Page 13: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/13.jpg)
Hamstring Muscle and Tendon Units
LateralMedial
Ischial Tub
Knee
SM
BFL/H
BFS/H
SN
ST
![Page 14: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/14.jpg)
Hamstring Navigation Rules
• In the standard Bakers cyst plane the Semitendinosus tendon lies stacked on top of the Semimembranosus tendon
• The distal Semimembranosus tendon is short while the proximal tendon is long
• The distal Semitendinosus tendon is long while the proximal tendon is short
• Semitendinosus has the “inscription”
![Page 15: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/15.jpg)
Hamstring Navigation Rules
• Sciatic Nerve always sits deep to the long head of Biceps Femoris
• In the proximal hamstring the Semimembranoustendon (pseudo-sciatic nerve) always sits deep to the Semitendinous muscle belly
• In the distal hamstring the Long Head of Biceps Femoris tendon sits superficial to the short head muscle
• Adductor Magnus forms the floor
![Page 16: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/16.jpg)
Hamstring Navigation Rules• The first muscle to form as you head distal from
the iscial tuberosity is semitendinosus• The biceps femoris long head and
semitendinosus unite proximally to form the conjoint tendon
• The conjoint tendon occupies the medial 2/3 of the ischial tuberosity
• The proximal semimembranosus tendon occupies the lateral 1/3 of the iscial tuberosity
• The common peroneal nerve sits against the medial edge of the short head of biceps femoris
![Page 17: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/17.jpg)
Origins
![Page 18: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/18.jpg)
What do we see Sonographically ?At the Ischial TuberosityNote : C.T. = Conjoint Tendon (Semitend and Biceps Fem Long Head)
LateralMedial
SN
S.M.
ST
BFC.T.
![Page 19: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/19.jpg)
What do we see Sonographically ?
1cm Below the Ischial Tuberosity
LateralMedial
SN
C.T.
S.M.
![Page 20: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/20.jpg)
What do we see Sonographically ?
2cm Below the Ischial Tuberosity
LateralMedial
SN
C.T.
S.M.
ST
![Page 21: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/21.jpg)
What do we see Sonographically ?
3cm Below the Ischial Tuberosity
LateralMedialST
SM
BF(L/H)
SN
Common MTJ Injury Site
![Page 22: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/22.jpg)
What do we see Sonographically ?
3cm Below the Ischial Tuberosity
LateralMedial ST
SM
BF
(L/H)
SN
Common MTJ Injury Site
![Page 23: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/23.jpg)
What do we see Sonographically ?
• 1/3 of the way from Ischial Tuberosity to Knee
LateralMedial ST
SM
BF
(L/H)
SN
Adductor Magnus
![Page 24: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/24.jpg)
What do we see Sonographically ?
• 2/3 of the way from Ischial Tuberosity to Knee
LateralMedial ST
SM
BF
(L/H)BF
(S/H)
SN
![Page 25: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/25.jpg)
What do we see Sonographically ?
• Just above the Knee
LateralMedial
ST
SM
BF (L/H)
BF
(S/H)
![Page 26: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/26.jpg)
What do we see Sonographically ?
• At the Knee
LateralMedialST
SMBF
![Page 27: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/27.jpg)
Hamstring Origin Pathology• Tendinosis• Enthesopathy• Avulsion with preservation of the sacrotub ligament• Complete avulsion with rupture of sacroptub ligament• Proximal MTJ tear• Proximal central tendon rupture
• Piriformis / Lateral Rotators• Sciatic Nerve• Ischial Bursa• Sacrotuberous Ligament
![Page 28: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/28.jpg)
Myofacial Vs MTJ Vs Central Tendon
![Page 29: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/29.jpg)
The MTJ Hot Spot
![Page 30: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/30.jpg)
Cohens Triangle
![Page 31: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/31.jpg)
Insertions
Pes Anserine
Sartorius
Gracilis
Semitendinosus
SG T
![Page 32: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/32.jpg)
Pes Anserine Navigation Rules
• Follow the MCL to its distal insertion (6-7cm below medial joint line)
• Observe the 3 small tendons passing superficial to the MCL in short axis
• Rotate almost 90 degrees with the posterior end of the transducer a little proximal relative to the distal end
• Locate one of the tendons in LAX
![Page 33: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/33.jpg)
Pes Anserine Navigation Rules
• Scan inferiorly until the tendons disappear
• Slowly scan proximally identifying the 3 tendons individually
• The order from proximal to distal is ST, Gr, Sart
• The Pes Anserine bursa lies between the 3 tendons and the underlying MCL
![Page 34: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/34.jpg)
Biceps Femoris InsertionIntimate with FCL
![Page 35: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/35.jpg)
Semimembranosus Insertion
![Page 36: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/36.jpg)
Semimembranosus Insertion
![Page 37: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/37.jpg)
Knee
Stephen Bird : © 2014
![Page 38: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/38.jpg)
Knee Pathology, Joint Effusion / Synovial Hypertrophy
80% of patients with effusions >10mm have internal derangement.
14% of patients with effusions <10mm had derangement.
![Page 39: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/39.jpg)
Haemarthrosis
Stephen Bird : © 2014
![Page 40: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/40.jpg)
Synovitis
![Page 41: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/41.jpg)
Trochlear Cartilage
![Page 42: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/42.jpg)
Patellar Tendon
![Page 43: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/43.jpg)
Usual Tendinosis Distribution
![Page 44: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/44.jpg)
Patellar Tendinosis
![Page 45: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/45.jpg)
Patellar Tendon Vessel Ingrowth
![Page 46: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/46.jpg)
Hoffa’s Fat Pad Inflammation
![Page 47: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/47.jpg)
MCL3 Layers
•Superficial Layer
Deep Fascia
•Middle Layer
Tibial Collateral Lig
•Deep Layer
Capsular Lig
![Page 48: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/48.jpg)
MCL Tear
![Page 49: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/49.jpg)
Pellegrini Stieda
![Page 50: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/50.jpg)
Meniscus
Stephen Bird : © 2014
![Page 51: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/51.jpg)
![Page 52: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/52.jpg)
FCL Anatomy
![Page 53: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/53.jpg)
Bakers Cyst Anatomy
Stephen Bird : © 2014
![Page 54: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/54.jpg)
Bakers Cyst Anatomy
Stephen Bird : © 2014
![Page 55: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/55.jpg)
Bakers Cyst
Stephen Bird : © 2014
![Page 56: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/56.jpg)
Bakers Cyst Haemarthrosis
Stephen Bird : © 2014
![Page 57: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/57.jpg)
Ilio-Tibial Band
![Page 58: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/58.jpg)
Iliotibial Band Friction Syndrome
![Page 59: Thigh and Knee Ultrasound](https://reader030.fdocuments.in/reader030/viewer/2022012511/6188dad966d33c5c6b1752a5/html5/thumbnails/59.jpg)
Iliotibial Band Friction Syndrome