Practice exam Flashcards
Name the origins and insertions of the shoulder girdle muscles
Lhb - glenoid tubercle to the radial tuberosity
Shb - corocoid process
Subscap - subscap fossa to lesser tubercle
Supra - supra fosaa to greater greater tubercle
Infra - infra foss to greater tubercle
Teres min - lat border scap to greater tubercle
Teres major- inferior angle and lower part of the lateral border of scapula to the crest of the lesser tubercle
Deltoid - lateral third clav, acromion, spine of scap to deltoid tubercle
You are performing a dynamic assessment involving abduction of the shoulder. What features would you be looking for
- Pain on abduction
- Bunching of the bursa under the acromion or CA ligament
- Look for upward movement of the humeral head causing supraspinatus tendon bunching
- If bunching occurs in the absence of pain, check the contralateral shoulder
- Lack of movement of the supraspinatus tendon under the C-A lig (that is, blocking) is a sign of capsulitis.
The inserting fibres of the distal biceps tendon may appear hypoechoic. Name and describe the artefact that interferes with visualization in this region
- Anisotropy
- When the fibres of the tendon are not perpendicular to the beam they will appear more hypoechoic than they are in reality giving the false appearance of pathology in a normal tendon or muscle
- To minimise this artifact, the structure to be scanned should be perpendicular to the ultrasound beam (parallel to the transducer face)
In this case use heel toeing
List the important structures to be imaged in the ultrasound examination to assess the lateral elbow
CEO RCL Lateral epicondyle bony surface Lateral synovial fringe Radial nerve and its branches
Define and list the sonographic appearances of: (a) de Quervain’s
• A type of tenosynovitis
• involves the abductor pollicis longus and the extensor pollicis brevis tendons in compartment 1.
• The patient complains of pain specifically over the radial styloid, worse with thumb movements, sometimes with swelling localised to the styloid.
• due to a repetitive overuse injury.
• The tendon itself is usually normal in echotexture.
• It is seen as
o fusiform tendon swelling and thickening of the tendon sheath at the level of the radial styloid
o increased synovium, usually around APL, +/- swelling of tendon.
o In the chronic stage, there is thickening of the tendon and synovial sheaths, with formation of cysts and nodules
Define and list the sonographic appearances of: (b) trigger finger
- Locking of a digit in a flexed position.
- usually caused by a stenosing tenosynovitis at the level of the A1 pulley
- Usually a tendon thickening(nodule) that eventually passes through an annular pulley in flexion or extension.
- Can also be a normal tendon doing the same through a narrowed pulley.
- Can be a combination of both of the above. tendon thickening.
- synovial sheath fluid and thickening.
- small peritendinous cysts.
- The tendon proximal to the restricting lesion may appear to buckle slightly, with flexion.
Define and list the sonographic appearances of: (c) stener lesion
- UCL rupture at the MCPJ of the Thumb. (gamekeepers thumb)
- Distal rupture of the UCL can remain permanently separated by the adductor aponeurosis
- This prevents healing and is an indication for surgical repair.
- Appears as retraction of the ligament fibres which looks like a small mass displaced superficial to the adductor aponeurosis;
- this gives the yo-yo on a string appearance
- passive flexion of the interphalangeal joint of the thumb during dynamic ultrasound imaging of the ulnar collateral ligament (UCL) allows for identification of a non-displaced UCL tear from a Stener lesion
Define and list the sonographic appearances of: (d) cubital tunnel syndrome
- the clinical symptoms that manifest due to ulnar neuropathy.
- this may appear as neural thickening, fascicular oedema of the nerve, there may be perineural echogenic cuffing, increased vascularity.
- On dynamic assessment, the ulnar nerve may be seen to sublux over the medial epicondyle with gentle flexion, or it may only enlocate after flexion.
- At the distal end of the groove the ulnar nerve can become entrapped by the heads of the flexor carpi ulnaris muscle, each head on the ulnar, and the humeral aspect.
- It is important to assess the cubital tunnel for masses that may cause this appearance such as a ganglion or accessory muscle anconeus epitrochlearis
Define and list the sonographic appearances of 3 hernias relating to the anterior abdominal wall.
Umbilical - defect at the umbilicus
Spigelian -This occurs between the layers of internal abdominal oblique and transverse abdominus.
Epigastric - defect in the linea alba between the rectus abdominis muscles
List the anatomical structures of the medial ankle.
Deltoid ligament Spring ligament FDL FHL Posterior tibial tendon Posterior tibial nerve Posterior tibial artery
Briefly describe the normal sonographic appearances of the following conditions: (a) hip joint effusion
- Capsule distension may result from synovitis and/or effusion
- The capsule and iliofemoral ligament will bulge convexly over the neck with an underlying effusion.
- You need to demonstrate a difference of joint distension of greater than or equal to 2 mm between the symptomatic and asymptomatic hips to be considered significant.
- The effusion may be anechoic, hypoechoic, or complex
- You may also see loose bodies or intra-articular osteochondromas.
Briefly describe the normal sonographic appearances of the following conditions: (b) Iliopsoas bursa
- This bursa is not seen well when normal.
- a bursal collection will lie just between the iliopsoas tendon and the joint capsule
- is hourglass or heart shaped when viewed in transverse at the hip joint due to compression by the overlying iliopsoas tendon
Briefly describe the normal sonographic appearances of the following conditions: (c) trochanteric bursa
- large structure located deep to the gluteus maximus muscle as it inserts into the ITB.
- It covers the posterior facet of the greater trochanter as well as the gluteus medius tendinous insertion onto the lateral facet.
- The normal bursa appears a thin, anechoic line anterior to the greater trochanter with echogenic fat on either side.
Bursitis - Well circumscribed fluid collection superficial to the greater trochanter
- Caused by trauma, infection or inflammation due to abnormal gait
- Normally collects just posterior to the trochanter between the muscles deep to the ITB
Describe the sonographic appearance of patellar tendinopathy.
Hypoechoic Heterogeneous Delamination tearing Neovascularity Diffuse or focal thickening usual site for tendinopathy to occur is at the inferior pole of the patella involving the deep fibres of the proximal mid tendon.
Define and list the sonographic appearances of: (a) paratenonopathy
- the paratenon is a fibrous sheath of connective tissue which covers the Achilles tendon.
- It can undergo acute injury during repetitive stress
Appears as - a focal hypoechoic swelling around the Achilles
usually involving the lateral surface. - In the transverse plane a cresenteric thickening will appear at the margin of the Achilles, extending into the deeper fat pad.
- It is painful with compression.
Define and list the sonographic appearances of: (b) plantar fasciitis
- mildly hypoechoic linear band of tissue originating from the undersurface of the calcaneus
- It should generally not exceed 3mm in thickness
- Often associated with a spur that develops on the under surface of the medial calcaneal tubercle
- the fascia can become swollen
- its normally flat superficial surface will become convex.
- Some fasciitis can be focal andmore distal than the calcaneal origin.
- These nodules of fasciitis are usually oval shaped hypoechoic swellings within the fibres of the fascia, known as plantar fibromatosis.
Define and list the sonographic appearances of: (c) haglund’s
- occurs at the tendon-bone interface where the Achilles inserts onto the calcaneus.
- Bony protrusions and spurs develop at the posterosuperior surface of the calcaneus with an associated thickening of the overlying dermis and soft tissues.
- continual dorsi and plantar flexion of the foot during walking will cause a retrocalcaneal bursitis to develop.
- The patient usually presents with symptoms similar to tendinopathy.
What are the anatomical structures of the lateral knee?
LCL Biceps femoris Lateral meniscus ITB Popliteus tendon
Whilst scanning a tendon you are looking for neovascularization. List 4 factors you would consider changing to improve its detection.
Low flow
High gain
Decrease scale
Light transducer pressure
You are scanning a foreign body. Describe all the information required to report its location.
Size
Depth from skin surface at both ends of the foreign body
Location - mark the midpoints of your transducer and draw and x that will be in the middle of the foreign body
With reference to the supraspinatus tendon describe the types of tears possible.
Delamination Rim rent Partial thickness - articular, bursal, insubstance Full thickness Complete
Chronic overuse injuries attribute to the majority of tendon disease. Explain the process of tendinosis.
- fatigued and loses reparative ability
- Repetitive microtrauma results in damage to collagen fibres
- swells due to development of mucoid ground substance
- Focal or diffuse
- Hypoechoic change in echotexture
- Avascular tendon is compromised by micro and macrovasculature resulting in tissue hypoxia
- Leads to linear defects –> intrasubstance degenerative PT tears or splits
- Mucoid degeneration appears as fluid filled cystic mass
- Chronic tendinosis can result in partial or complete rupture when activity is applied
