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SON5024 MSK > Topic 1 MSK > Flashcards

Topic 1 MSK Flashcards

1
Q

What are 4 uses for ultrasound in the setting of MSK trauma?

A

o 1. Detect muscle tears
o 2. Assess the extent of muscle tears
o 3. Evaluate the healing process
o 4. Assist in the aspiration of hematoma when indicated

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2
Q

What is a muscle strain?

A

• When pain is acute and persistent, beginning during exercise, and not related to muscle rupture, it is referred to as muscle strain

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3
Q

What is DOMS?

A

• When pain starts hours to days after exercise, it is called delayed onset muscle soreness (DOMS)

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4
Q

How does an ultrasound appear in the setting of DOMs?

A

• Ultrasound is often normal but helps in excluding muscle tear or intramuscular hematoma, which may clinically mimic DOMS

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5
Q

What is ultrasound used for when a mass is clinically palpable or is suspected?

A
  • confirm a muscular mass
  • exclude causes of pseudomuscular mass of the extremities, such as accessory muscle, muscle herniation, or subcutaneous edema.
  • locate and delineate the mass by determining its exact location in the muscle
  • To characterize the mass.
  • distinguishing cystic from solid muscular masses, presence of calcifications or ossifications in the mass
  • guiding a biopsy
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6
Q

What are the ultrasound features of a partial muscle tear?

A
  • Discontinuity in the muscle fibers and the fibrous septa
  • Hematoma appearing as a hypoechoic fluid filling the gap in the torn muscle
  • Echoic debris in the hematoma, representing muscle fragments or blood clot
  • Shaggy margins of the torn muscle
  • Interfascial fluid collection is a sign of fascial tear
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7
Q

What are the ultrasound features of a complete muscle tear?

A
  • A retracted and hyperechoic muscle
  • Surrounded by a large hematoma (“bell clapper” appearance)
  • Fascial tear may be demonstrated by US
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8
Q

What constitutes a grade 1 partial tear?

A

May be normal
Focal fibre discontinuity
Small haematoma <1cm

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9
Q

What constitutes a grade 2cpartial tear?

A

Fibres rupture involving <1/3 or the of the muscle surface
Moderate haematoma <3cm
Small interfascial haematoma

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10
Q

What constitutes a grade 3 partial tear?

A

Fibres rupture involving >/3 of the muscle surface
Large haematoma >3cm
Large interfascial haematoma

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11
Q

What is shadowing?

A

occurs posterior to a highly reflective interface, where most of the incident sound beam is reflected, producing a signal void or shadow posterior to that structure.

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12
Q

What is posterior enhancement?

A
  • sound travels through an anechoic structure it is not attenuated as much as the surrounding tissue, and more sound is available to image the deeper tissues
  • The echoes returning are of greater amplitude, further amplified by the time gain compensation.
  • The result is a false impression of increased echogenicity from deeper structures.
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13
Q

What is the comet tail artefact?

A
  • Reverberation occurs within a glass or metallic object when the sound beam is repeatedly reflected between the highly reflective anterior and posterior walls.
  • The resultant artifact is echogenic bands placed at equal depth from each other, with the periodicity of the bands equal to the thickness of the object.
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14
Q

What is refraction artefact?

A
  • bending of the beam when travelling from one material and into another of differing acoustic impedance
  • can result in a real lesion being depicted at an incorrect location
  • minimised by having the angle of incidence as close to 90 degrees as possible.
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15
Q

What is the speed of sound artefact?

A
  • Ultrasound equipment calculates distance based on the time a sound pulse takes to return as an echo, and on the assumption that there is a constant speed of sound
  • within the human body there are slight variations in the speeds that sound can travel at through differing tissues.
  • The artefact produced may be an object shown at an incorrect depth.
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16
Q

What is beam width artefact?

A

When an object is smaller than the beam width, echoes depicted at that location are a combination of the echoes from that object and the surrounding tissues. It is the same as ‘volume averaging’ in CT and MRI.

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17
Q

What is anisotropy?

A

• Anisotropy is a false hypoechogenicity of a structure due to the obliquity of the ultrasound beam

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18
Q

Why is recognising anisotropy important?

A

• can mimic abnormal hypoechoic pathology in a normal tendon or muscle

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19
Q

How can anisotropy ne eliminated?

A
  • the structure to be scanned should be perpendicular to the ultrasound beam (parallel to the transducer face)
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20
Q

What are some ways to bring a structure perpendicular to the transducer face when attempting to limit anisotropy?

A

• positioning the limb to align the tendon or muscle in a more linear approach
- angling the transducer to bring the ultrasound beam perpendicular to the structure (‘heel-toeing’)
• The use of a stand-off pad to facilitate heel-toeing, or the use of an angled stand-off on the transducer face will help achieve the desired result.

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21
Q

What structure is most effected by anisotropy?

A

Tendons

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22
Q

When can anisotropy be useful?

A

To differentiate tendons from surrounding structures

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23
Q

What are muscle fibres surrounded by?

A

endomysium (extensive network of capillaries and nerves)

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24
Q

What are groups of fibres referred to as?

A

Bundles

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25
Q

What are bundles surrounded by?

A

perimysium (connective tissue, blood vessels, nerves, and adipose tissue) also called the fibroadipose septa

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26
Q

What do bundles form?

A

The muscle

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27
Q

What is the muscle covered by?

A

epimysium.

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28
Q

What may separate single muscles or groups of muscle?

A

A fascial layer

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29
Q

What are the three parts of a skeletal muscle?

A

Tendinous origin, Muscle belly, tendinous insertion

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30
Q

Briefly describe the ultrasound appearance of muscle

A
  • Bundles of fibres appear as homogeneous and hypoechoic striated bundles.
  • The perimysium surrounds the bundles is a thin echogenic linear septations arranged longitudinally within the muscle substance, dispersed throughout the bundles
  • epimysium appears as a thin echogenic layer surrounding the periphery of the muscle.
  • Adjoining muscles are separated by a slightly thicker echogenic fascial layer.
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31
Q

What are tendons made up of?

A

tightly packed collagen fibres arranged in parallel bundles. These fibres are relatively avascular.

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32
Q

What is the peritenon?

A

• a layer of connective tissue that wraps around the tendon and sends intratendinous septae between the bundles of fibres.

33
Q

Why is the musculotendinous juntion important to examin closely?

A

prone to tear during stresses.

34
Q

Where do tendons usually attach?

A

usually attach to bone at sites of tuberosities, ridges, or spinae

35
Q

What are retinacula?

A

fibrous sheaths that cover parts of tendons to provide stability and to keep certain tendons close to the bone

36
Q

What is a synovial sheath?

A

a double layered sheath containing a thin layer of synovial fluid that allows the tendon to glide smoothly

37
Q

What are synovial bursae?

A

small fluid filled pouches that act as bolsters to facilitate the dynamics of associated tendons and muscles, reducing friction between two structures.

38
Q

What is the ultrasound appearance of tendons?

A

• The bundles of fibres appear as echogenic linear structures in their longitudinal orientation, and as a bundle of finely punctated echogenic foci when viewed transversely.

39
Q

What is the ultrasound appearance of the peritenon?

A

a thin echogenic layer around the tendon, often indiscernible from the tendon itself.

40
Q

What is the ultrasound appearance of the synovial sheath?

A

it appears as two thin echogenic layers around the tendon, with a very thin (< 1 mm) layer of anechoic synovial fluid within the layers.

41
Q

What is the ultrasound appearance of nerves?

A
  • Peripheral nerves typically appear as linear bundles of multiple hyper and hypoechoic fascicles, with a ‘honeycomb-like’ appearance when viewed in transverse.
  • The nerves are usually small in diameter (3 mm to 5-6 mm).
  • The overall nerve shape is rounded or slightly ellipsoid in cross-section, and evenly linear in a longitudinal plane.
  • Nerve fibres have a similar echotexture to tendons, but are slightly less echogenic than tendon fibres.
42
Q

How does size affect the ultrasound appearance of a nerve?

A

Larger nerves like the median nerve take on the honeycomb appearance
Smaller nerves tend to appear as tri-laminar structures as seen in the included image of the radial nerve.

43
Q

What are the muscles of the anterior thigh?

A 
Pectineus
Iliopsoas
Tensor fascia lata
Sartorius
Rectus femoris
Vastus lateralis
Vastus medialis
Vastus intermedius
44
Q

What is the pectineus origin and insertion?

A

Superior pubic ramus

Pectineal line of femur

45
Q

What is the iliopsoas origin and insertion?

A

Transverse processes of lumbar spine, iliac crest, iliac fossa
Lesser trochanter

46
Q

What is the TFL origin and insertion?

A

ASIS anteriorly

ITB attachment at lateral tibial condyle

47
Q

What is the Sartorius origin and insertion?

A

ASIS

Pes anserinus

48
Q

What is the rectus femoris origin and insertion?

A

AIIS Patella

49
Q

What is the vastus lateralis origin and insertion?

A

Greater trochanter

Patella

50
Q

What is the vastus medialis origin and insertion?

A

Intertrochanteric line

Patella

51
Q

What is the vastus intermedius origin and insertion?

A

Anterior and lateral surface of body of femur

Patella

52
Q

What are the muscles of the medial thigh?

A 
Adductor longus
Adductor brevis
Adductor magnus
Gracilis
Obturator externus
53
Q

What is the adductor longus origin and insertion?

A

Inferior pubic ramus

Middle 1/3 linea aspera

54
Q

What is the adductor brevis origin and insertion?

A

Inferior pubic ramus

Pectineal line and prox linea aspera

55
Q

What is the adductor magnus origin and insertion?

A

Inferior pubic ramus and ischial tuberosity

Linea aspera, medial supracondylar line and adductor tubercle of femur

56
Q

What is the gracilis origin and insertion?

A

Medial inferior pubic ramus

Pes anserinus

57
Q

What is the obturator externus origin and insertion?

A

Margins of obturator foramen

Trochanteric fossa of femur

58
Q

What are the muscles of the posterior thigh?

A

Semitendinosus
Semimembranosus
Biceps femoris

59
Q

What is the semitendinosus origin and insertion?

A

Ischial tuberosity

Pes anserinus

60
Q

What is the semimembranosus origin and insertion?

A

Ischial tuberosity

Posterior medial condyle of tibia

61
Q

What is the biceps femoris origin and insertion?

A

Long head- Ischial tuberosity
Short head - Linea aspera
Insertion - Lateral head fibula

62
Q

What are the anterior muscles of the calf?

A

Tibialis anterior
Extensor digitorum longus
Extensor hallucis longus
Peroneus tertius

63
Q

What is the tibialis anterior origin and insertion?

A

Antero-lateral tibial Condyle

Medial cuneiform and base first metatarsal

64
Q

What is the EDL origin and insertion?

A

Antero-lateral tibial Condyle

Middle and distal phalanges of four digits

65
Q

What is the EHL origin and insertion?

A

Middle anterior fibula

Base of distal phalanx, dorsum great toe

66
Q

What is the peroneus tertius origin and insertion?

A

Inferior 1/3 of anterior fibula and interosseous membrane

Dorsum base fifth MT

67
Q

What are the lateral muscles of the calf?

A

Peroneus longus

Peroneus brevis

68
Q

What is the peroneus longus origin and insertion?

A

Head lateral fibula

Base first metatarsal and medial cuneiform

69
Q

What is the peroneus brevis origin and insertion?

A

Inferior 2/3 lateral fibula

Base fifth metatarsal

70
Q

What are the superficial muscles of the posterior calf?

A

Lateral gastrocs
Medial gastrocs
Soleus
Plantaris

71
Q

What is the lateral gastrocs origin and insertion?

A

Lateral femoral condyle

Posterior calcaneus

72
Q

What is the medial gastrocs origin and insertion?

A

Medial femoral condyle

Posterior calcaneus

73
Q

What is the soleus origin and insertion?

A

Posterior prox. fibula and prox medial border of tibia Posterior calcaneus

74
Q

What is the plantaris origin and insertion?

A

Lateral supracondylar line of femur

Posterior calcaneus

75
Q

What are the deep muscles of the posterior calf?

A

Popliteus
Flexor hallucis longus
Flexor digitorum longus
Tibialis posterior

76
Q

What is the popliteus origin and insertion?

A

Lateral surface of lateral Condyle of femur

Posterior prox tibia

77
Q

What is the FHL origin and insertion?

A

Inferior 2/3 posterior fibula

Base of distal phalanx of great toe

78
Q

What is the FDL origin and insertion?

A

Postero-medial tibia

Bases of distal phalanges of four digits

79
Q

What is the tibialis posterior origin and insertion?

A

Interosseous membrane and posterior tibia and fibula Navicular, cuneiform, bases 2nd and 3rd bones

SON5024 MSK (15 decks)

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