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abdomen 4 > 3.1 MSK Normal anatomy > Flashcards

3.1 MSK Normal anatomy Flashcards

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1
Q

Why is ultrasounds beneficial for MSK

A

Can see tendons in motion

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2
Q

Is MSK better than MRI and CT?

A

It can be. Very operator dependent, can exceed MRI and CT

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3
Q

What are Tendons? (4)

A
  1. Bundles of collagen fibers
  2. Attach muscle to bone
  3. Facilitate flexion and extension
  4. Poor /Weak blood supply = poor healing. must be surgically repaired.
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4
Q

What is the point of attachments that are raised ridges on the bones?

A

tuberosities

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5
Q

Tendons in Long Axis appearance

A

Fibrillar pattern

hyperechoic strands interspersed with hypoechoic CT

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6
Q

Tendons in Short Axis appearance

A

Hyperechoic finely punctate foci
hypoechoic CT
round, oval or flattened shape.

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7
Q

Tendon echogenicity is highly dependent on?

A

Angle of insonation

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8
Q

Angles >__degrees off perpendicular may demonstrate a loss of ____?

A

> 10; echogenicity

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9
Q

What is the off angle artifact called?

A

ANISOTROPY

Maybe mistaken for pathology or tears

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10
Q

It is vital when scanning a tendon that the beam be?

A

PERPENDICULAR TO TENDON

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11
Q

The tendon has a ____ shape so you may need to change the probe position/or have pt move to straighten tendon to avoid this artifact.

A

Curved

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12
Q

What are 2 types of fibrous sheaths?

A
  1. Synovial

2. Paratenon/Peritenon

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13
Q

What does a Synovial sheath do?

A

wrap around tendon to decrease friction

and secrete fluid for motion

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14
Q

What does Paratenon/Peritenon do?

A

loose CT that surrounds Achilles and patellar tendon

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15
Q

What are flattened synovial lined pouch /sacs called?

A

Bursa

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16
Q

What does the Bursa produce?

A

Synovial fluid

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17
Q

Where are the Bursa located?

A

High friction points

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18
Q

What does the Bursa look like sonographically?

A

Hypoechoic flattened structure
Normal Bursa are Difficult to see on US.

(often only see if inflamed or excess fluid collection)

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19
Q

Nerves in LONG axis have what appearance?

A

“Railroad” hypoechoic nerve fibers divided by hyperechoic CT

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20
Q

Nerves in SHORT axis have what appearance?

A

“Honeycomb” circular nerve fibers (holes) surrounded by hyperechoic CT (web)

many nerves are too small to see. wrist you can see some

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21
Q

What do ligament attach?

A

bone to bone

remember tendons attach Muscle to bone

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22
Q

What is the purpose of ligaments and what are they composed of?

A

Stability and strength of joints

Collagen

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23
Q

What is the sonographic appearance of ligamnets?

A

similar to tendon but HARDER to visualize due to smaller size and location

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24
Q

What does bone look like sonographically?

A

Hyperechoic line with alot of shadowing

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25
Q

US is not good to assess bone we see more of the ______ of the bone

A

Cortical (superficial) surface

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26
Q

Cartilage is a____ ____ in the body?

A

Shock absorber

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27
Q

____Cartilage lies at the terminal ends of bones

A

Hyaline

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28
Q

On US the Cartilage appears as (4)

A

Hypoechoic
well defined
smooth
Non-compressible (with Transducer pressure)

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29
Q

The muscle we see when performing MSK US is ?

A

Skeletal striated muscle

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30
Q

Skeletal striated muscle can?

A

Extract and extend

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31
Q

Skeletal striated muscle sonographically

A

Hypoechoic tissue (muscle) with hyperechoic fibers (striations)

32
Q

what is the most common joint evaluated by US?

A

The shoulder joint

33
Q

The shoulder is scanned with a??? and how is pt positioned?

A

high resolution linear array transducer

pt sitting on rotating stool

34
Q

What is the upper arm bone in the shoulder?

A

Humerus

35
Q

The shoulder blade is called the?

A

Scapula

36
Q

The 2 shoulder extension off of the scapula are called?

A

the coracoid process

and the Acromion

37
Q

The rotator cuff is what we visualize with US and has 4 tendons, which are?

A
  1. Subscapularis
  2. Supraspinatus
  3. Infraspinatus
  4. Teres minor
38
Q

The Biceps tendon is a ?

A

Flexor and Extendor

39
Q

where does the biceps tendon sit and location?

A

In the bicipital groove between the greater and lesser tuberosity
located anterior to humerus

40
Q

Patient position of biceps tendon

A

Arm nutral, eblow bent 90 degree

41
Q

The biceps tendon in SAX protocol?

A

Document proximal tendon, check position in bicipital groove
(we are checking to R/O subluxation (if tendon is displaced outside of groove. medial or laterally, medial being more common)

42
Q

The biceps tendon in LAX protocol?

A

Document proximally and more distally

43
Q

The subscapularis originates from?

A

the underside of scapula

attached to the lesser tuberosity of the humeral head.

44
Q

The subscapularis is scanned with the arm in a ______ rotation

A

external

rotate in towards abdomen and then back out watching if the tendon will “catch” if impingement.. should be smooth

45
Q

When scanning the subscapularis the probe will be _____ on pt but _____ on tendon

A

Transvere; LAX

46
Q

What 2 pictures are taken of the subscapularis ?

A

1 at the Coracoid process (more medial)
1 at the insertion on the lesser tuberosity. (more lateral)
Performing a dynamic assessment to R/O impingement

47
Q

What does the SUPRASPINATUS assist in?

A

abduction of humerus and stabilizes the humerus head

48
Q

SUPRASPINATUS postion?

A

superior to the humeral head and attaches to the greater tuberosity

49
Q

WHAT IS THE MOST COMMON TORN TENDON OF THE ROTATOR CUFF

A

SUPRASPINATUS tendon

50
Q

How do you scan the SUPRASPINATUS?

A

Arm Hyperextended and internally rotated
Image the LAX (sharp beak like appearance)and SAX (symmetrical arch or “rainbow”)

(arm behind back and palm outwards, if sore, then “slip hand into back pocket”

51
Q

The INFRASPINATUS is?

A

The External rotator of the humeral head.

It is the abductor of the humerus

52
Q

The INFRASPINATUS postiion

A

lateral and posterior to shoulder and extends from the scapula to the greater tuberosity.

53
Q

what is related closely to the The INFRASPINATUS?

A

Teres minor (below) white line separating the 2

54
Q

Patient position of the The INFRASPINATUS and TERES MINOR

A

arm across chest (pledge position, hand over heart)

55
Q

what is the only axis the The INFRASPINATUS and TERES MINOR taken in?

A

LAX ( INFRASPINATUS has beak like appearance)

56
Q

The INFRASPINATUS is the abductor of the humerus. What is the ADDuctor of the humerus?

A

Teres minor

57
Q

what 2 tendons does US examine with The knee?

A

Quadricep and patellar tendon

58
Q

The quadriceps tendon is formed by __ quad muscles

A

4

59
Q

The tendon is _____ when leg is extended so patient needs to flex leg to scan (over coming anisotropy)

A

Concave

60
Q

quadriceps tendon inserts on to the base of the ?

A

patella

(inverted pyramid shaped bone, so base of patella is the more superior aspect of bone)

61
Q

quadriceps tendon is scanned in both planes and appears as what shape in SAX?

A

oval

62
Q

The patellar tendon extends from?

A

apex of patella (inferior pointed aspect) to tibial tuberosity (raised ridge of bone anterior prox portion on tiba)

63
Q

The patellar tendon Length, width, AP?

scanned in both LAX and SAX

A

5-6cm L
2-2.5 cm W
4-5 mm AP (note mm)

64
Q

The petellar tendon is technically a ligament why?

A

because it connects bone to bone.

65
Q

The most COMMONLY imaged tendon of the ankle?

A

Achilles Tendon

66
Q

The achilles tendon is the fusion of what 2 muscles?

A

Aponeuroses of the soleus and the gastronemius

67
Q

The achilles tendon inserts on the posterior surface of the

A

calcaneus (heel)

68
Q

The achilles tendon is examined this way…

A

pt in prone, foot hanging off table and dorsiflexed (toe towards shin) to straighten tendon (as it is concaved, over come anisotropy)

69
Q

The achilles tendon is this wide and AP is?

A
  1. 2-1.5 cm wide

0. 5-0.7 cm AP

70
Q

What is the area of variable echogenictiy anterior to distal half of tendon?

A

Kager’s fatty triangle

71
Q

Besides trauma what is the most common cause of pathology in the hand and wrist?

A

Overuse/compression

72
Q

What is the most common Hand/wrist entrapment syndrome involving the median nerve?

A

CARPAL Tunnel syndrome

73
Q

What is the carpal tunnel?

A

Space between carpal bones (tiny bones of wrist) and the ligament (flexor retinaculum)

74
Q

Tendons, the median nerve, muscles, vessels ….

A

all must pass through this tunnel any pathological process that decreases the size of this tunnel can result in an entrapment syndrome

75
Q

The median nervecourses ____ to the flexor tendon of the _____ finger

A

Anterior; second

76
Q

How is the median nerve scanned? and what is used as a landmark?

A

TRV; forearm resting on flat surface, wrist up (supination)

and ulnar artery used as a medial landmark (pulsing)

77
Q

The sonographic appearance of the median nerve TRV?

A

Nerve Hypoechoic
Tendons echogenic
“honeycomb appearance”

abdomen 4 (10 decks)

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