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Abd / SS 3 > Module 5 : MSK > Flashcards

Module 5 : MSK Flashcards

1
Q

what are tendons and what do they attach

A
  • bundles of collagen fibers

- attach muscle to bone

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2
Q

what movements do tendons facilitate

A
  • flexion and extension
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3
Q

do tendons have good or poor blood supply

A
  • poor blood supply
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4
Q

what is the sonographic appearance of tendons in LAX

A
  • tightly bound linear band of hyperechoic strands

- fibrillar pattern (hyperechoci strands interspersed with relatively hypoechoci connective tissue)

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5
Q

what is the sonographic appearance of tendons in SAX

A
  • hyperechoic
  • finely punctate foci (collagen fibers) interspersed with hypoechoci connective tissue
  • round, oval or flattened shape
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6
Q

what important technical factor must be considered when scanning tendons

A
  • tendon echogenicity is highly dependant on angle of insonation
  • > 10 degrees off perpendicular may demonstrate a low of returning signal
  • ANISOTROPY
  • beam must be perpendicular to the tendon
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7
Q

what are the 2 fibrous sheaths

A
  • synovial

- paratenon/peritenon

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8
Q

what is the synovial sheath

A
  • wrap around tendon to decrease friction
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9
Q

what is the paratenon/peritenon sheath

A
  • loose connective tissue

- achilles and patellar tendon

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10
Q

what is the sonographic appearance of a fibrous sheath

A
  • thin

- hypoechoci area around tendon

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11
Q

what is the bursa

A
  • flattened synovial lined pouches
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12
Q

what does the bursa do

A
  • produce fluid (synovial)
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13
Q

where is bursa located

A
  • located at the high friction points

- where muscle and tendons are required to slip through/around opposing structures

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14
Q

what is the sonographic appearance of bursa

A
  • hypoehoic
  • flattened structure
  • difficult to identify on ultrasound
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15
Q

what is the purpose of nerves

A
  • sensory and motor function
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16
Q

what is the sonographic appearance of nerves in LAX

A
  • railroad/fascicular appearance

- hypoechoic nerve fibers divided by hyperechoic perineuron

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17
Q

what is the sonographic appearance of nerves in SAX

A
  • honeycomb pattern

- circular nerve fibers surrounded by hyperechoic connective tissue

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18
Q

what do ligaments connects and what is their purpose

A
  • bone to bone

- provide stability and strength

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19
Q

what are ligaments made of

A
  • composed of collagen
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20
Q

what is the sonographic appearance of ligaments

A
  • similar to a tendon but more difficult to visualize due to position and overlying bony structures
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21
Q

characteristics of bone on ultrasound

A
  • only superficial surface identified

- hyerechoic line with strong posterior shadowing

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22
Q

what is the function of cartilage

A
  • shock absorber
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23
Q

where is cartilage located

A
  • hyaline cartilage lies at the terminal ends of bones and joints
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24
Q

ultrasound appearance of cartilage

A
  • hypoechoic
  • well defined
  • smooth
  • non compressible
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25
what is muscle
- skeletal striated muscle | - ability to contract and extend
26
ultrasound appearance of muscle
- hypoechoic tissue with hyperechoic fibers
27
what is the major bone anatomy of the shoulder
- humerus - scapula - coracoid process - acromion process
28
what are the 5 tendons evaluated in the shoulder
- biceps - subscapularis - supraspinatus - infraspinatous - teres minor
29
what is the biceps
- strong flexor and extender of the arm and elbow
30
where is the biceps located
- sits in bicipital groove between the greater and lesser tuberosity - anterior to humerus
31
what is the scanning technique of the biceps
- arm in neutral position elbow bent at 90º - SAX = document prox tendon and check position in groove - LAX = document prox foot print and distal muscle insertion
32
where is the subscapularis located
- arise form the underside of scapula | - attaches to lesser tuberosity
33
what is the scanning technique of the subs cap
- arm in external rotation - probe trans on patient long on tendon - one image taken at coracoid, one image taken at insertion - perform dynamic assessment with internal and external rotation of arm
34
what is the purpose of the supraspinatous
- assists in abduction of humerus | - stabilizes numeral head in glenohumeral joint
35
what is the location of the supra
- superior to humeral head | - attaches to greater tuberosity
36
what is the most commonly torn tendon of the rotator cuff
- supra
37
what is the scanning technique of the supra
- arm behind back | - image in LAX and SAX
38
what is the purpose of the infraspinatus
- external rotator of the humeral head | - abductor of the humerus
39
what is the location of the infraspinatus
- sits lateral and posterior to the shoulder | - extends from scapula to greater tuberosity
40
scanning technique of the infra
- patient places arm across chest | - only in LAX
41
what is the purpose of the teres minor
- adductor fo humerus | - provides stability to the glenohumeral joint
42
what does the teres minor insert
- inserts on greater tuberosity
43
what is the scanning technique of the teres
- same arm placement as infra | - imaged in LAX
44
what are the two tendons scanned in the knee
- quadriceps | - patellar tendon
45
what is the quadriceps tendon
- tendons from all 2 quadriceps muscles join together to form the quadriceps tendon
46
what is the position of the leg to scan the quad
- flexed
47
where does the quad tendon insert
- base of patella
48
what is the appearance of the quad tendon in SAX
- oval
49
what is the location of the patellar tendon
- apex of petal to tibial tuberosity
50
what are the dimensions of the patellar tendons
- 5-6cm length - 2-2.5cm wide - 0.4-0.5cm AP
51
what is the appearance of the patellar tendon in SAX
- tendon convex anteriorly and flattened posteriorly
52
what is the most commonly imaged tendon in the ankle
- the achilles tendon
53
what is the achilles tendon
- formed by the fusion of the aponeuroses of the soleus and gastrocnemius muscle
54
what is the location of the achilles tendon
- inserts on the posterior surface of the calcaneus
55
what is the patient position for scanning the achilles tendon
- patient in prone with foot hanging of bed in dorsiflexed position
56
what is the normal measurement of the achilles
- 1.2-1.5cm wide | - 0.5-0.7cm AP
57
what is Kagers fatty triangle
- an area of variable echogenicity identified anterior to the distal half of the tendon
58
what is the most common hand and wrist pathology
- result of overuse and or compression aetiologies
59
what is the most common entrapment syndrome of the upper extremity
- carpel tunnel
60
what is the carpel tunnel
- space between the carpel bones and ligament
61
what structures run through the carpal tunnel
- tendons - median nerve - muscles - vessels
62
what is the pathway of the median nerve
- courses anterior to the flexor tendon of the second tendon
63
what is the scanning technique of the median nerve
- scanned in transverse - forearm resting on flat surface - wrist in supination - ulnar artery is medial landmark
64
what is the ultrasound appearance of median nerve
- hypoechoic - less echogenic than tendons - honeycomb
65
what are the 7 pathologies of MSK
- tears - inflammation - ganglion cyst - popliteal cyst - carpel tunnel syndrome - tumors - foreign bodies
66
when do tears occur
- when tendons become weak
67
what are 4 contributing factors to tendon weakening
- age - calcifications - corticosteroid treatment - systemic diseases
68
what are the 2 categories of tears
- complete tears | - incomplete tears
69
characteristics of complete tears
- diagnosed clinically - complete disruption of tendon - gaps/defects can be variable in length
70
characteristics of incomplete tears
- can present with tendonitis symptoms | - can appear as focal hypoechoic defects in tendon or at attachment
71
what is the sonographic appearance of tendon tears
- hypoechoic defect - focal thinning - architectural distortion - fluid filled defects - echogenic deposits - possible non visualization of tendon
72
characteristics of a complete tear with retraction (SHOULDER ONLY)
- deltoid muscles sits directly on top of humeral head - cartilage interface sign + thin hypoechoci line at interface between the normally hypoechoci cartilage and abnormally hypoechoic tendon
73
characteristics of small partial tears (SHOUDLER ONLY)
- rim rent sign = comma shaped focal abnormal echogenicity within tendon
74
what are three associated findings with shoulder tears
- joint effusion - irregularity of bone surface - geyser sign - fluid collection superior to AC joint
75
what is inflammation related to
- sport or work
76
can tendonitis be focal or diffuse
- both
77
what is inflammation
- edema of tissue | - possible calc if chronic
78
ultrasound appearance of tendonitis
- thickening of tendon - decreased echogenicity - ill defined margins - hyperaemia - possible calcifications
79
what are three other types of inflammation
- peritendonitis - tenosynovitis - bursitis
80
what is peritendinitis
- inflammation fo peritenon - usually achilles - hypoechoci thickening of connective tissue around tendon
81
what is tenosynovitis
- inflammation of tendon sheath - usually hand wrist or ankle - fluid in sheath identified
82
what is bursitis
- trauma or repeated micro trauma - sub deltoid, olecranal, radiohumeral, patellar and calcanea bursa - sonolucent collection with ill defined margins - hyper vascular thickened bursa walls
83
what is a ganglion cyst
- benign soft tissue tumor typically in the hand or wrist | - can develop in any joint or tendon sheath
84
what doe ganglion cysts clinically present as
- palpable mass with focal pain
85
ultrasound appearance of ganglion cyst
- cystic mass attached to tendon sheath - oval fluid filled collection with posterior enhancement - may contain debris - chronic cysts will have hypoechoic solid tumor appearance
86
what is a popliteal cyst
- synovial cyst of the knee | - dilated gastrocnemiosemimbranous bursa
87
what do popliteal cysts usually occur with
- rheumatoid arthritis
88
what is the location of a pop cyst
- communicates with knee joint at the posterior medial aspect of the capsule
89
are pop cyst asymptomatic or symptomatic
- both | - if symptomatic resemble thrombophlebitis or DVT
90
ultrasound appearance of pop cyst
- fluid collection in the pop fossa with possible internal echoes
91
what is carpel tunnel syndrome
- encroachment of the median nerve from a decrease in size of tunnel or increase volume of nerve
92
what is the clinical presentation of carpel tunnel syndrome
- tingling or pins and needles sensation
93
ultrasound appearance of carpel tunnel
- nerve 3x greater in one axis than another at 90º - loss of honeycomb appearance in SAX - sudden increase or decrease in contour in LAX - increase in cross sectional area when compared to the unaffected side
94
what are three different types of MSK tumros
- giant cell tumor - osteochondroma - lipoma
95
what is a giant cell tumor
- benign tumor of the tendon sheath | - hypoechoic mass with a lobulated contour
96
what is a osteochondroma
- bengin cartilaginous tumor - can develop in pop cyst - hyperechoic area with posterior shadowing
97
what is a lipoma
- bengin tumor composed of adipose tissue - compressible somewhat mobile generally painless - usually hyperechoic but can be isoechoic or hypoechoic depending on surrounding issue
98
how does ultrasound aid in the finding of foreign bodies
- if they're non radio opaque or radiopaque soft tissue surrounding the area can be examined for secondary inflammatory changes
99
what is the ultrasound appearance of metal
- hyperechoci | - comet tail artifact

Abd / SS 3 (6 decks)

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