Musculoskeletal ultrasound involves the use of high-frequency sound waves to image soft tissues and bony structures in the body for the purposes of diagnosing pathology or guiding real-time interventional procedures Recently, an increasing number of physicians have integrated musculoskeletal ultrasound into their practices to facilitate patient care Technological advancements, improved portability, and reduced costs continue to drive the proliferation of ultrasound in clinical medicine This increased interest creates a need for education pertaining to all aspects of musculoskeletal ultrasound The primary purpose of this article is to review diagnostic ultrasound technology and its potential clinical applications in the evaluation and treatment of patients with neurological and musculoskeletal disorders After reviewing this article, physicians should be able to (1) list the advantages and disadvantages of ultrasound compared to other available imaging modalities; (2) describe how ultrasound machines produce images using sound waves; (3) discuss the steps necessary to acquire and optimize an ultrasound image; (4) understand the difference ultrasound appearances of tendons, nerves, muscles, ligaments, blood vessels, and bones; and (5) identify multiple applications for diagnostic and interventional musculoskeletal ultrasound Part 2 of this 2-part article will focus on the clinical applications of musculoskeletal ultrasound in clinical practice, including the ultrasonographic appearance of normal and abnormal tissues as well as specific diagnostic and interventional applications in major body regions

Diagnostic and interventional musculoskeletal ultrasound: part 2. Clinical applications.

Objective. The purpose of this study was to describe the sonographic appearance of the first annular (A1) pulley–flexor tendon complex in patients with trigger fingers. Methods. Thirty-three trigger fingers in 33 patients were examined with a 7- to 15-MHz probe. A control group consisted of 20 patients without trigger fingers. The study included systematic measurement of the thickness of the A1 pulley and a power Doppler assessment of the pulleys, tendons, and tendon sheaths. Results. Thickening and hypoechogenicity of the A1 pulley were found in all patients with trigger fingers. Measurements of A1 pulley thickness were significantly different (P < .0001) between the groups without trigger fingers (mean, 0.5 mm; range, 0.4–0.6 mm) and with trigger fingers (mean, 1.8 mm; range, 1.1–2.9 mm). Hypervascularization of the A1 pulley on power Doppler imaging was found in 91% of the trigger fingers but was never found in the healthy control group. Flexor tendinosis was found in 48% of the trigger fingers; tenosynovitis was found in 55%; and both were found in 39%. In the control group, tenosynovitis and tendinosis were not found. Conclusions. Thickening and hypervascularization of the A1 pulley are the hallmarks of trigger fingers on sonography. Other frequently observed features include distal flexor tendinosis and tenosynovitis. Key words: finger; power Doppler sonography; sonography.

Sonographic Appearance of Trigger Fingers

OBJECTIVE. The purpose of this study is to illustrate a wide variety of musculoskeletal disorders that can be diagnosed with dynamic sonography.CONCLUSION. Dynamic sonography is a useful tool for the evaluation of a variety of musculoskeletal disorders. Many of these disorders cannot be diagnosed by any other imaging method.

https://www.ajronline.org/doi/pdf/10.2214/AJR.06.0579

Musculoskeletal Sonography: A Dynamic Tool for Usual and Unusual Disorders

The iliotibial tract, also known as Maissiat's band or the iliotibial band, and its associated muscles function to extend, abduct, and laterally rotate the hip, as well as aid in the stabilization of the knee. A select group of associated injuries and pathologies of the iliotibial tract are seen as sequela of repetitive stress and direct trauma. This article intends to educate the radiologist, orthopedist, and other clinicians about iliotibial tract anatomy and function and the clinical presentation, pathophysiology, and imaging findings of associated pathologies. Specifically, this article will review proximal iliotibial band syndrome, Morel-Lavallee lesions, external snapping hip syndrome, iliotibial band syndrome and bursitis, traumatic tears, iliotibial insertional tendinosis and peritendonitis, avulsion fractures at Gerdy's tubercle, and Segond fractures. The clinical management of these pathologies will also be discussed in brief.

The iliotibial tract: imaging, anatomy, injuries, and other pathology.

The aim of the present study was to develop a method for three-dimensional (3D) reconstruction of the brachial plexus to study its morphology and to calculate strain and displacement in relation to changed nerve position. The brachial plexus was finely dissected and injected with contrast medium and leaden markers were implanted into the nerves at predefined places. A reverse shoulder prosthesis was inserted in a cadaveric specimen what induced positional change in the upper limb nerves. Computed tomography (CT) was performed before and after this surgical intervention. The computer assisted image processing package Mimics® was used to reconstruct the pre- and postoperative brachial plexus in 3D. The results show that the current interactive model is a realistic and detailed representation of the specimen used, which allows 3D study of the brachial plexus in different configurations. The model estimated strains up to 15.3% and 19.3% for the lateral and the medial root of the median nerve as a consequence of placing a reverse shoulder prosthesis. Furthermore, the model succeeded in calculating the displacement of the brachial plexus by tracking each implanted lead marker. The presented brachial plexus 3D model currently can be used in vitro for cadaver biomechanical analyses of nerve movement to improve diagnosis and treatment of peripheral neuropathies. The model can also be applied to study the exact location of the plexus in unusual upper limb positions like during axillary radiation therapy and it is a potential tool to optimize the approaches of brachial plexus anesthetic blocks. Anat Rec, 291:1173-1185, 2008. © 2008 Wiley-Liss, Inc.

https://biblio.ugent.be/publication/597247/file/602753.pdf

3D computerized model for measuring strain and displacement of the brachial plexus following placement of reverse shoulder prosthesis.

Objective. The purpose of this study was to determine the ability of high-frequency ultrasonography to provide for direct evaluation of the annular and cruciform finger pulley system. Methods. In the first part of the work, a cadaveric study was performed to outline the normal anatomy of the annular and cruciform finger pulley system. Eighteen cadaveric hands were cut (n = 10) or dissected (n = 8). Two musculoskeletal radiologists retrospectively reviewed in consensus the photographs of anatomic sections and dissections. This cadaveric study gave the 2 readers the opportunity to learn the normal anatomy of the finger pulley system. In the second part of the work, the annular and cruciform finger pulley system of 20 hands of volunteers was evaluated by ultrasonography with a 17-MHz linear transducer. Images were retrospectively analyzed by means of consensus of the 2 radiologists with respect to the visibility of each finger pulley. Results. For annular (A) pulleys, high-frequency ultrasonography showed A1, A2, A3, and A4 in 100%, 100%, 65%, and 100% of cases, respectively. For cruciform (C) pulleys, high-frequency ultrasonography showed only C1 in 45% of cases. Direct visualization of A5, C2, and C3 was not possible. Conclusions. High-frequency ultrasonography allows excellent depiction of finger pulleys except for annular pulley A5 and cruciform pulleys C2 and

High-Frequency Ultrasonographic Examination of the Finger Pulley System

BACKGROUND AND PURPOSE: Lumbar zypapophyseal joints are innervated by the medial branch of the posterior lumbar ramus. The aim of this work was to describe the precise course of the medial ramus on axial CT scans and to define a precise location for its selective infiltration. METHODS: Lumbar spines of two cadavers were first dissected to assess the route of the L1–L5 posterior ramus. Thirty lumbar spinal nerves of three cadavers were injected in the epineural space with a mixture of iodine contrast and stain to perform a correlation between anatomic gross sections and CT sections in the axial plane. A histologic study was also performed to ensure the neurologic nature of the structure identified. RESULTS: The fibroosseous canal located between the mamillary and the accessory processes was a constant pathway for the medial branch of the L1–L4 posterior ramus. This former was always located closer to the accessory process. The L5 posterior ramus and its divisions could also be identified into a groove bounded laterally by the ala of the sacrum and medially by the base of the superior articular process of S1. CONCLUSION: The accessory process and the groove bounded laterally by the ala of the sacrum and medially by the base of the superior articular process of S1 can be easily depicted on CT images and may allow a precise and selective infiltration of the medial branch of the posterior lumbar ramus.

http://www.ajnr.org/content/ajnr/26/4/706.full.pdf

The posterior lumbar ramus: CT-anatomic correlation and propositions of new sites of infiltration.

Segond fracture is an eponym that refers to an avulsion fracture of the anterolateral margin of the proximal tibia, just below the lateral plateau. This fracture was described originally in 1879 by French surgeon Paul Ferdinand Segond (1851-1912) in cadaveric experiments. 1 On the anteroposterior view of the knee, the Segond fracture characteristically appears as a small elliptical bone fragment with its long axis oriented vertically, parallel to the proximal tibia. 2 Recognition of this fracture is important because it has a high association with other knee injuries, including anterior cruciate ligament (ACL) tears (75%-100% of cases) and meniscal tears (53%-75% of cases). 2 - 7 The Segond fracture results from excessive internal rotation and varus stress, which cause abnormal tension on the middle portion of the lateral joint capsule (ie, the lateral capsular ligament [LCL] of the knee) and therefore produce an avulsion fracture of the lateral tibial plateau. 1 - 4 The Segond fracture is usually diagnosed on anteroposterior radiographs of the knee; however, some fractures have subtle findings, and the avulsed cortical fragment may be difficult to detect on routine views. 8 At magnetic resonance (MR) imaging, focal bone marrow edema may be seen at the lateral tibial rim, but the bony fragment itself may be overlooked.4 To our knowledge, there is no report of ultrasonographic findings in Segond fracture. We present a case of Segond fracture diagnosed ultrasonographically and confirmed by radiographs and MR imaging.

Eddy Glaude

Papers

High-Frequency Ultrasonographic Examination of the Finger Pulley System

The posterior lumbar ramus: CT-anatomic correlation and propositions of new sites of infiltration.

Segond fracture revealed by ultrasonography.