7 - muscles And Skeletins

Question 1

Besides all the normal US uses ED peeps can also use it for?

Answer 1

Fractures
SubQ FOB
Joint effusion and tendon inj
Soft tissue abscesses vs cellulitis

Question 2

Rib fractures?

Answer 2

US is more sensitive than CXR for rib fractures

Time for sternal/rib fractures is better for POCUS vs CXR

Question 3

What probe do you use for MSK stuff?

Answer 3

Linear probe

Question 4

What does a rib fracture look like on US?

Answer 4

Short axis:
Dense posterior acoustic shadowing
- pleural line is seen as a horizontal echogenic line in

Long axis:
Rib has a Horizontal line just beneath the skin and sub q tissue
- may see step-off

Pic on 7, 8, 9, 10

Question 5

Besides just a broken hyperechoic area of a fracture on long axes you may also see?

Answer 5

A hematoma (hypoechoic) above the fx

Question 6

Femur fracture?

Answer 6

Slide 12 shows shadowing that is caused by the dislocated bone

Question 7

Clinical indications for US w FOB?

Answer 7

Eval for FOB

• detection and localization
• removal of FOB

Question 8

How do FOBs present on US?

Answer 8

Most are hyperechoic w posterior acoustic shadowing

Wood: hyperechoic posterior acoustic shadow

Linear metalic FOB: reverberation artifact - regular lines distal to the actual object

Question 9

Small rounded metal objects will appear?

Answer 9

Comet tail artifact

Question 10

FOB retained >24hrs often?

Answer 10

Have a hyperechoic “halo” resulting from edema, pus or granulation

Question 11

Pics of FOB?

Answer 11

18-22

Give them a look

Question 12

Musculotendinous injuriries that US is good for?

Answer 12

1. Complete tendon tear
2. Suspected muscle tears
3. Ganglion cysts
4. Flexor tendons of hand
5. Selected nerves that are entrapped or compressed

Pics on 24 - 35

Question 13

US and soft tissue infections?

Answer 13

Detect occult subq abscess

Localization of optimal site for incision and drainage

Assessment of soft tissue inflammatory process - arthritis, tendonitis vs cellulitis

Pics on 37-47

Question 14

MSK and soft tissue summary

Answer 14

Linear transducer
Scan in 2 orthoganoal planes
- long axis view and short axis view
- point probe marker to pts R and Head
Color dopler for abscess and lymph
Water bath- standoff for hand/foot
Be aware of anistropy

Question 15

What is anistropy?

Answer 15

If you arent at 90* on the tendon it may look like a partial tear, adjust your probe and it’ll get better

Question 16

Dont trust atoms

Answer 16

They make up everything