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Differential Diagnosis & Med Screening > STAATS- US Imaging in the PT Practice > Flashcards

STAATS- US Imaging in the PT Practice Flashcards

1
Q

Ultrasound Imagining aka

A

Ultrasonography, Medical Ultrasound, Diagnostic Ultrasound imagining, Real Time Ultrasound Imagining (RUSI), Rehabilitative Ultrasound Imaging (RUSI)

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2
Q

Use of sound waves to generate an image done thru echo interpretation

A

US imaging

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3
Q

US Imagining

what is it?

A

Use of sound waves to gen. image done thru echo interpretation

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4
Q

US imagining predominantly used to what?

A
  1. R/O blood clots (doppler)
  2. ID organs
  3. Sonograms to monitor fetal dev.
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5
Q

Sonar/Echolocation

A

Dolphins, bats, submarines

  • To detect objs in distance
  • Returning echoes give fb on size, structure and distance
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6
Q

How US works

A

Time elapsed bw sound waves sent and echo returned AND the freq of waves returning to the sound head is interpreted and a grey scale img produced

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7
Q

US Image ex.

A

NOTE: patella, patellar tendon, tibia

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8
Q

US Terminology:

ALL First

A
  • HypERechoic/echogenic=> LOTS of echoes, BRIGHT
    • Ex’s: MOST bright: bone, calcific deposits, fascia, tendon, lig: LEAST bright
  • HypOechoic= LOW echogenicity, fewer echoes, DARK
    • Ex’s: Muscle, fat, cartilage, organs, nerve (honey comb, starry night, little bright specks)
  • Anechoic (think TEARS)= means devoid of echoes, BLACK
    • Ex. Fluid/gas
  • Isoechoic= used when two structures look similar due to similar echoes
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9
Q

Objects INFERIOR to BRIGHT hypERechoic objs will appear

A

DARK or ANechoic

makes assess. of these structures diff. ***

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10
Q

US Terminology

HypERechoic/echogenic==>

A

BRIGHT

  • LOTS of echoes
  • Exs from MOST bright to LEAST bright:
    • bone, calcific deposits, fascia, tendon, ligament
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11
Q

US Terminology

HypOechoic==

A

DARK

  • LOW echogenicity, fewer echoes
  • EX’s:
    • Muscle, fat, cartilage, organs, Nerve (honeycomb/starry night/little white specks)
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12
Q

US Terminology

Anechoic==

A

THINK “TEARS”

BLACK

  • Devoid of echoes
  • Ex: Fluid/Gas
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13
Q

US physics

ALL FIRST

A
  • HIGHER Freq==> CLEARER, but only Superficial***
  • LOWER Freq==> LESS clear, penetrates Deeper***
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14
Q

US Physics

HIGHER FREQ==>

A

CLEARER PIC but penetrate superficially

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15
Q

US Physics

LOWER FREQ==>

A

LESS clear pic, but penetrates Deeper*

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16
Q

Types of Probes for MSK purposes

A
  1. Linear
  2. Curvilinear

*NOTE: SMALLER footprint== higher freq==more superf penetration==clearer pic

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17
Q

Probes

SMALLER footprint== higher freq==more superf penetration==clearer pic

A

Linear

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18
Q

Probes

Curvilinear

A

LOWER freq, wider, curved footprint

Penetrate deeper==LESS clear img

*piriformis, TrA, Multifidi

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19
Q

MSK RUSI in PT Practice

USES:

A

See List

Be familiar!!!

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20
Q

RUSI for Shoulder Exam

A
  • Structures ID’d:
    • LHB→ SAX (Short axis horizontal) and LAX (Long axis vertical) (in relation to body)
    • Suprasp, Subscap, SubAC bursa, Infrasp, Articular cart. below SSP
    • AHI→ Acromio-Humeral Interval
    • Labrum→ diff to img
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21
Q

SAX view ex

A

Short-Axis, Horizontal

see pics

22
Q

US Imaginng:

RTC Tear Validity

23
Q

Left Oblique SAX

RTC Bird Beak

24
Q

RTC Tear Ex.

25
Q

Tear Ex.

26
Q

Large Calcific Deposit ex.

27
Q

Ex. Measuring calcific deposit

28
Q

Measuring AHI and note sound head angle***

29
Q

R. Bicep LAX view for LHB tendon

30
Q

R. Bicep Calcific deposit in LAX view (LONG-AXIS, VERTICAL)

31
Q

Ulna view

32
Q

Fx of Ulna

A

see pics (same view to view Ulna as previously seen) ***

33
Q

LAX view medial aspect of knee

MCL Tear

34
Q

LAX View medial aspect of knee

Medial meniscus

35
Q

Displaced meniscus

NOTE: Femur, tibia and how displaced Medial Meniscus displays along MCL

36
Q

Posterior aspect of knee (SAX, HORIZONTAL)

NOTE: Baker’s Cyst,

37
Q

Left Long Bakers

Most likely from Posterior aspect of knee (SAX, Horizontal)

38
Q

Anterior aspect of distal wrist (SAX, HORIZ)

Looking into Carpal Tunnel

NOTE: Median N.

39
Q

More on Median N. @ Carpal Tunnel w/ SAX, HORIZ.

Measured out here

40
Q

>___________ CSA (Cross-sectional Area) @ wrist crease indicates_________

A

>10mm CSA indicates CTS

41
Q

WFR (Wrist:Forearm Ratio) to Dx CTS

Median N. progression pics to check for CTS

NOTE: FDP, FDS

A
  • >1.4 Wrist measurement to Forearm measurement is indicative of CTS*
  • NOTE IN PICTURES:
    • Distal R. wrist crease measurement==> 18mm2
    • R. Median N. 4in. PROX==> 6mm2
    • THEREFORE→ 18mm2/6mm2==> 3!
      • So…YES CTS!!!
42
Q

Posterior aspect of Gastroc (LAX, VERT.)

Gastroc tear

43
Q

Post-Gastroc tear

2wks later

~4wks later

44
Q

Lateral aspect of R. ankle (SAX, Horizontal)

NOTE: ATFL ligament the partial tear

45
Q

Achilles Tendon view (LAX, Vertical) L think Longways think VERTICAL***

A

NOTE: Partial Tear vs. Tendinosis*

46
Q

Lateral portion of abdomen (SAX, HORIZ) SAX think “short view, hOrizontal rhymes w/ shOrt***

A

NOTE: TrA and then “shortened” TrA and see it visibly shortens!!!!

47
Q

Dry needling can be done under RUSI***

48
Q

Beneftis of RUSI

A
  • Painless, NO iodizing radiation*, LESS expensive, Accessible, *Efficient (included in PT exam), Improved quality of care
49
Q

Limitations of RUSI

A
  • Cannot see deep structures well or those deep to hypERechoic structures
  • *Operator dependent
50
Q

Reimbursement for RUSI

In general…

A
  • Ongoing battle in state of NJ
  • Aetna and Meritian reimburse RUSI done by a PT
51
Q

Some states (Mass, NY, Oklahoma, Washington)→ RUSI by a PT is reimbursed

How?

A
  • Have to educate third party payers
  • AIUM and APCA physician alignment should help
  • PT’s have directed 6 webinars on RMSK on the AIUM website
  • May 2016 Hazle, Kirsch, White and Keil clearly states APTA support of imagining privileges***

Differential Diagnosis & Med Screening (12 decks)

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