Pathology Concepts for MSK sonography

Question 1

why is ultrasound at a disadvantage to MRI

Answer 1

• operator dependent
• FOV (limited)
• limited for bone assessment
• Limited for intraarticular assessment & structures deep to bone

Question 2

what does MRI offer

Answer 2

More global assessment

Question 3

what are the types of tears

Answer 3

• intrasubstance
• partial thickness
• full thickness
• complete rupture or tear

Question 4

Intrasubstance tear

Answer 4

does not contact the articular

or bursal side of the supraspinatus is

Question 5

Sonographic appearance of intrasubstance tear

Answer 5

anechoic or hypoechoic, located within the
tendon substance or in contact with the greater
tuberosity surface

Question 6

what is often seen with intrasubstance tear

Answer 6

Cortical irregularity

Question 7

what may extensive intrasubstance tears represent

Answer 7

May either represent or be precursors of a more extensive delamination tear

Question 8

well-defined anechoic cyst within the rotator cuff

Answer 8

Usually associated with supraspinatus articular-side tear

Question 9

Full thickness tear

Answer 9

A full-thickness supraspinatus tendon tear is
characterized by a well-defined hypoechoic or
anechoic defect that disrupts the hyperechoic
tendon fibers and extends from the articular to
bursal surfaces of the tendon

Question 10

Reasons for MSL ultrasound

Answer 10

 Trauma chronic/acute
 Inflammation chronic/acute
 Collections
 Lumps & bumps
 Foreign bodies
 The unexpected

Question 11

Common MSK injuries

Answer 11

Tears
 Abscesses or collections
 Hematomas

Question 12

what are the causes of acute muscle injuries

Answer 12

Direct impact
 Stretch injury
 Penetrating injury

Question 13

chronic muscle injuries

Answer 13

Happens over time

 Last for extended period

Question 14

Acute muscle injury grade 1

Answer 14

No fiber disruption

 More difficult to pick out, but can be seen w/ a trained eye

Question 15

Acute muscle injury grade 2

Answer 15

Partial tear or moderate fiber disruption

 Decreased strength

Question 16

Acute muscle injury grade 3

Answer 16

Complete fiber disruption, no continuity

Question 17

is intrasubstance tear common

Answer 17

No

Question 18

where is the defect in an intrasubstance tear

Answer 18

within the tendon entirely
do not see an abnormality on the surface of this
tendon

Question 19

Partial thickness tear

Answer 19

affect one surface, they don’t affect the whole
amount of fiber, only affects a percentage of
the tendon

Question 20

Full thickness tear

Answer 20

Disruption of the fiber, through & through, from one surface to the other, can still have intact fiber
Have a hole in the tendon

Question 21

an acute full thickness tear will have have

Answer 21

Hyperemia

Question 22

why should PRF scale be turned down when imaging a full thickness tear

Answer 22

tendons are relatively avascular, this will

help to appreciate the vascularity