The Distal Limb

Question 1

What are some key examination techniques to ultrasound the distal limb?

Answer 1

• Quiet, dark environment with suitable facilities
• Allow sufficient time for an examination
• Sedation/analgesics for painful lesions
• Clip and scrub affected area
• Use plenty of coupling gel
• Move limb during musculoskeletal examination (dynamic studies)
• Good knowledge of normal anatomy
• Image any lesions in 2 planes to ensure they are not an artefact
• Use comparisons of the normal
• Image contralateral limb
• Have normal values available
• Label all images
• Record findings and store images

Question 2

How do you grade tendon injuries?

Answer 2

Grading for changes in echogenicity:
Type 1: slightly less echogenic than normal
Type 2: half echogenic and half anechoic
Type 3: mostly anechoic
Type 4: completely anechoic

Question 3

Define:

1) Keratinisation
2) Cornification
3) Horn

Answer 3

1. Keratinisation- process of differentiation of living epidermal cells characterised by high cellular metabolic activity.
2. Cornification- programmed death of living epidermal cells at the end of their differentiation. Dead epidermal cells become horn cells.
3. Horn- final product of keratinisation and cornification
   build up by dead cells and intercellular material.