Ultrasound

Question 1

Tendons can resist traction up to ______ per ____

They can only tolerate _____ elongation before being damaged

Answer 1

1000kg per 10mm^2

Elongation of 6%

Question 2

Tendons have ____ metabolism. Increased by ____ and ____

Answer 2

slow metabolism even during activity.

Can be increased significantly by inflammation and trauma.

Question 3

The _____ is a thin connective strip surrounding the primary, secondary and tertiary bundles of a tendon, as well as separates them.

Answer 3

Endotenon

Question 4

The _____ is a thin band of stronger connective tissue that envelops the whole tendon

Answer 4

Epitenon

Question 5

Tendons can be divided into two types:
1.
2.

Answer 5

1. Supporting (or anchor)

2. Sliding tendons

Question 6

Anchor tendons:

1. two examples
2. Size in relation to sliding tendons:
3. Lack _____

Answer 6

Achilles, patellar
bigger and stronger
synovial sheath

Question 7

_____ is a connective lamina external to the epitenon on anchor tendons providing stability

Answer 7

Peritenon

Question 8

Sliding tendons are wrapped in ________.

Function:

Answer 8

a covering sheath (teno-synovial sheath)
guarantee better sliding and protection to the tendons when they run adjacent to irregular osseous surfaces, sites of potential friction.

Question 9

The sites of union between tendon and muscle or tendon and bone are named _____ or _____ respectively

Answer 9

myotendinous or osteotendinous junctions

latter is also called enthesis.

myotendinous is usually more easily discernable
osteotendinous can be fibrous or fibrocartilaginous according to the tendon mobility, the angle formed between the tendon fibers and the bone. Also due to presence of a retinaculum underneath.

Question 10

______ scans are optimal to measure tendon thickness, as it can be overestimated when measured on other axis

Answer 10

transverse view (short axis)

Question 11

Ultrasound evaluation can be affected by ______ artifacts. Describe?

Answer 11

anisotropy - when the US beam is not orthogonal to the course of the tendon fibers, both a decrease of reflected and an increase of the diffracted echoes occur, thus resulting in a significant or partial reduction of tendon echotexture.

Question 12

Ligaments are ____, ____ and have higher amount of ____ with comparison to tendons

Answer 12

Thinner, shorter, higher amount of elastin

Question 13

Ligaments can be subdivided into ____ and ____ ligaments. Describe

Answer 13

1. intrinsic - capsular thickening than true ligaments and are designed to provide capsular strengthening.
2. extrinsic - independent from the fibrous capsule and can be further classified as extracapsular and intracapsular.

Question 14

On ultrasound, ligaments are most often assessed by ____ view.

Answer 14

long axis - no diagnostic value in short axis due to less homogeneity and thinner, shorter tendons.

Question 15

On US, ligaments appear as _______ bands, _____ thick, lying close to ____. Usually appear _____ -echoic, although echogenicity may vary according to ligament course.

Answer 15

Homogeneous bands, 2-3mm thick, close to bone, hyperechoic

Question 16

______ is the connective tissue interspersed between the outer nerve sheath and the fascicles.

Answer 16

inter-fascicular epineurium. - houses the nerve vasculature.

Question 17

Systematic scanning on ____ axis planes is preferred to follow the nerves contiguously throughout the limbs. Once detected, nerve is kept in the center of the US image in its ____ axis and then followed proximally and distally shifting the transducer up or down according to its course.

Called the ____ technique.

Answer 17

short axis

lift technique - examiner is able to explore long segments of a nerve in a few seconds throughout the limbs and extremities.

Question 18

Cartilage is a greatly specialized type of connective tissue, mainly composed of _____.
It is _____ and ____.
The solid component of cartilage is formed of _____ that are scattered in a firm gel-like substance, ______, consisting of collagen and proteoglycans.

Answer 18

water (70-80% by wet weight)
avascular, aneural
cells (chondrocytes)
(extracellular matrix - collagen and proteoglycans)

Question 19

Collagen forms a network of ____ which resists the swelling pressure generated by the proteoglycans

Answer 19

fibrils.

Question 20

In the MSK system, cartilage is classified as either ____ or ____.
1. Which type containes more collagen and is more resistant to tensile strength?

Answer 20

hyaline, fibrous

fibrocartilage.

Question 21

fibrocartilage (as opposed to hyaline cartilage) has a higher amount of collage and is found in what 6 locations in the body?

Answer 21

1. Intervertebral disks
2. symphyses
3. glenoid labra
4. menisci
5. Round ligament of the femur
6. at sites connecting tendons or ligaments to bones

Question 22

Which type of cartilage is most common variety of cartilage?
Where is it found? (3)

Answer 22

Hyaline cartilage

1. costal cartilage
2. epiphyseal plates
3. covering bones in joints (articular cartilage)

Question 23

The free surfaces of most hyaline cartilage (no articular cartilage) are covered by a layer of fibrouse connective tissue called _____.

Answer 23

perichondrium

Question 24

Hyaline cartilage is stratified and divided into four zones

Answer 24

1. superficial
2. middle
3. deep
   4 calcified (hardly detectably by US)

Question 25

Orientation of collagen fibers varies through the _______ of articular cartilage in order to give better tensile strength. The fibrillar framework seems to have an _____ arrangement

Answer 25

``` 4 zones (superficial, middle, deep, calcified) arcade-like arrangement ```

Question 26

_____ is easily detectible by US as a homogeneously hypoanechoic layer delimited by thin, sharp and hyperechoic margins

Answer 26

hyaline cartilige

Question 27

Normal articular cartilage appears as a well-defined layer with these three distinguishing features:

Answer 27

1. high degree of homogeneous transparencey due to its high water content. 2. sharp and continuous synovial space-cartilage interface (superficial margin) 3. Sharp hyperechoic profile of the bone-cartilage interface (deep margin)

Question 28

The synovial space-cartilage interface is ____ than the bone-cartilage interface. Both margins are best visualized when the direction of the US beam is _____ to the cartilage surface

Answer 28

thinner; perpendicular

Question 29

______ is essential for measuring thickness of cartilage

Answer 29

visualization of the cartilage margins (deep and superficial margins)

Question 30

Cartilage thickness ranges from ____ on the articular surface of the head of the proximal phalanx to ____ on the lateral femoral condyle of theknee joint

Answer 30

0.1mm; 2.6mm

Question 31

_____ and ____ are hallmarks of normal cartilage

Answer 31

sharp margins, homogeneous echotexture

Question 32

Muscle is externally surrounded by a thick connective sheath called the ______. From the internal aspect of this sheath, several septa depart to constitute the _____, which surrounds several bundles of muscular fibers, named _____.

Answer 32

epimysium | perimysium - fascicles

Question 33

Very light and thin septa arising from the perimysium spread into the fascicles to surround every single muscular fiber and thus form the _____

Answer 33

endomysium

Question 34

The extremity of a muscle may continue as a tendon or insert onto the ____, ____ or the ____.

Answer 34

periosteum, aponeurosis, dermis

Question 35

Each muscle presents at lease one _____ and two _____.

Answer 35

muscular belly | tendons - one at the origin and the other at the insertion.

Question 36

Muscles with fibers parallel to the longitudinal axis (abdomen, head and neck) are made for ____. Conversily, the uni-, bi-, and circum- pennate structures (muscles of the limbs) can bear _____

Answer 36

bearing reasonable weights for long distance activities. | greater weight for a shorter period of time.

Question 37

The epimysium appears as a hyperechoic external band _____ thick, continuing without interruption along the corresponding tendon profile on longitudinal US scans

Answer 37

2-3mm

Question 38

The ____ can be appreciated as a hyperechoic lines separating the contiguous hypoechoic muscular fascicles from one another.

Answer 38

perimysium.

Question 39

____ is the angle measured between the muscular fibers' direction and the central aponeurosis axis (usually corresponding to the longitudinal muscular axis). The value of the angle varies depending on ____ of the muscle and, within the same muscle, on the ____ state

Answer 39

pennation angle function of the muscle, functional state (contraction/relaxation)

Question 40

In ultrasound transverse views, the muscle is sectioned according to a plane that is ______ to the muscular longitudinal axis. The 1st and 2nd order fascicles present an ______, defined by thin, elongated, hyperechoic septa, corresponding to the perimysial fibro-adipose septa

Answer 40

orthogonal, irregular polygonal shape