Ultrasound -WC 2017-KW.pptx [Read-Only]...Bianchi S, Martinoli C. Ultrasound of the Musculoskeletal...
Transcript of Ultrasound -WC 2017-KW.pptx [Read-Only]...Bianchi S, Martinoli C. Ultrasound of the Musculoskeletal...
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MUSCULOSKELETAL ULTRASOUND-
a diagnostic AND therapeutic toolKelly Williams, DO
Northeastern Rehab AssociatesScranton, PA
OBJECTIVES
WHY ultrasound is advantageous as a diagnostic tool
WHAT types of pathologies USD can and cannot be useful in diagnosing
WHAT types of injections USD is used to guide
WHAT types of injections USD is NOT useful for
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INTRO
Linear Transducer (15‐6MHz)Higher ResolutionLower Depth
Curvilinear Transducer (52MHz)Higher DepthLower Resolution
ADVANTAGES OF USD
Nazarian 2008 Increased safety
Decreased discomfort
Increased resolution
Real‐time dynamic imaging
Doppler
Flexible evaluation: symmetry, length of structure
Guided therapeutic interventions
“one‐stop shopping”
Disadvantage: operator dependence! steep learning curve!
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DIAGNOSTIC ULTRASOUND +/‐
POSITIVE:
MUSCLE‐TENDON
EXTRA‐articularLIGAMENTS
NERVE (size‐dependent)
DYNAMIC CONDITIONS
NEGATIVE:
JOINT
INTRA‐articularLIGAMENTS, CARTILAGE
SPINE
*habitus
SHOULDER
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Pathology
Tendon (cuff, bicep)‐ tear, tendinosis
Dinnes et al‐USD (95%) and MRI (89%) highly sensitive for full‐thickness tears, but USD (67%) more sensitive than MRI (44%) for partial thickness tears
Lenza et al (Cochrane)‐MRI, MRA, USD all sensitive for full tears, USD possibly less for partial
Bursitis, tenosynovitis
Glenohumeral Joint effusion, paralabral cyst
AC Joint osteoarthritis, separation
Dynamic impingement
***MRI Needed: labral tear, GHJ
INTERVENTIONS: subacromial, glenohumeral, ACJ injections, calcium barbotage, guide PRP into tear
SupraspinatusTears
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Pathology
Tendon‐ epicondylitis, tendon tear (incl bicep, tricep), wrist tenosynovitis, dynamic (tricep)
Ligament‐ ulnar/radial/annular, +/‐wrist
Joint‐ Elbow effusion, wrist ganglion cyst
Nerve‐Ulnar/Radial/Median
***MRI Needed: intraarticular abnormalities
INTERVENTIONS: elbow joint, tennis elbow (inj, PRP, tenotomy), carpal tunnel, small joint, trigger finger, tendonitis
Lateral Epicondylosis& Partial Tear
0.56cm 0.67cm
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HIP
Pathology
Anterior: effusion, some signs of OA, iliopsoas tendinosis/ bursitis, rectus abnormalities, etc
Medial: Adductor tendinosis/ tear
Lateral: Gluteus Medius/Minimus tendinosis/tear
Posterior: +/‐piriformis thickening, hamstring tendinosis/ tear
Dynamic: snapping hip, femoroacetabular impingement
Limited: Sciatic and femoral nerves
***MRI Needed: intraarticular abnormalities (labrum); X‐Ray for OA
INTERVENTIONS: hip joint, trochanteric (inj, PRP, tenotomy), iliopsoasbursa, piriformis, lateral femoral cutaneous nerve block
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Pathology
EXTRAarticular
Effusion, signs of OA, Baker’s cyst
Patellar and quad tendinitis, ‐osis, tear; retinaculum
MCL, LCL
+/‐Peroneal nerve entrapment
Limited: meniscus (perameniscal cyst)
***MRI Needed: INTRAarticular
meniscus, ACL/PCL; X‐ray for OA
INTERVENTIONS: aspiration
PATELLAR TENDINOSIS
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Pathology
Effusion, signs of OA
Ligaments (ATFL, CFL, PTFL, Detoid, etc)
Tendons (Achilles, peroneal, T‐D‐H), Plantar Fascia
Dynamic: peroneal tendon subluxation, ligament integrity
Morton neuroma
Limited: “tarsal tunnel”
***MRI Needed: intraarticular abnormalities
INTERVENTIONS: joint, tendon (PRP, tenotomy)
MORTON NEUROMA
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SPINE
Uses
LACK OF DIAGNOSTIC VALUE*
Interventional:
SI Joint
Caudal ESI
Cervical facets
Occipital nerve block
Intercostal Nerve Blocks
Advanced‐ epidurals
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SUMMARY
Diagnostic: improved resolution, but limited by depth and limited to extra‐articular pathologies, and learning curve
Therapeutic: improved safety, particularly useful for guiding medications into otherwise non‐visualizablepathology (nerve, tendon), developing use in interventional spine care
QUESTIONS???
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BIBLIOGRAPHY
Bianchi S, Martinoli C. Ultrasound of the Musculoskeletal System, 1st ed. 2007. Springer-VerlagBerlin Heidelburg.
Dinnes et al. The effectiveness of diagnostic tests for the assessment of shoulder pain due to soft tissue disorders: a systematic review. Health Technol Assess 2003; 7(29)
Lenza et al. Magnetic resonance imaging, magnetic resonance artthrography, and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered. The Cochrane Database 24 Sept 2013; Issue 9.
Nazarian LN. The top 10 reasons musculoskeletal sonography is an important complementary or alternative technique to MRI. Amer J Roentgenology 2008;190: 1621-1626.