Sara Riley Consultant Sonographer Leeds Radiology Academy Objectives
Introduction to the upper limb – not including shoulder • Basic msk ultrasound • Images of normal structures • Small amount of pathology
• Practical session – technique – main emphasis Role of ultrasound upper limb
Focussed assessment of: • Muscle, tendon, ligament damage/disease – acute and chronic • Bursitis, joint disease • Vascular pathology • Masses • Post surgical complications • Guidance of injection Important
• Detailed knowledge of anatomy, awareness of normal appearance, artefacts -anisotrophy
• Correct choice, use of equipment – hockey stick helpful
• Knowledge of musculoskeletal pathological processes, mechanisms of injury Elbow
• Anterior • Medial • Lateral • Posterior
• Nerves - Median, ulna and radial (cutaneous and posterior interosseous Anterior
• Distal biceps tendon - ? Rupture ? tendinosis
• Anterior joint recess - ? Joint effusion/ synovitis
6 Distal biceps tendon
• Distal biceps tendon (s) Long/short heads
• Lacertus fibrosus – intact prevents retraction of tendon Technique
• Antecubital fossa directed towards the radial side distally
• Hand supinated
• LS and TS lateral/radial aspect of brachial artery Distal biceps tendon
brachialis
supinator rh capitellum Transverse Pathology – distal BT
• Tendinosis, bicipitoradial bursitis
• Rupture/avulsion, partial/complete – body builders, ‘popeye sign’ Anterior joint recess Lateral – lateral epicondyle common extensor tendon Tendinosis of the common extensor origin Lateral epicondylitis, Tennis elbow Radiocapitellar joint/radial collateral ligament Medial – common flexor origin medial epicondyle
2015 Medial epicondylitis
• ‘Golfers elbow’ • Overuse forearm flexors and pronators
• Aching pain medial elbow
• Grip weakness Ulna nerve –cubital tunnel
? Subluxation during flexion ? Compressing mass Posterior – Triceps insertion, olecranon Triceps tendinosis, rupture, olecranon bursitis Olecranon fossa
• Olecranon fossa – loose bodies, fluid Wrist and hand Important structures
• Synovial Joints – MCP, PIP, DIP, carpometacarpal, midcarpal, radiocarpal, ulnocarpal • Muscles • Tendons – flexor, extensor
• Nerves- carpal tunnel median, radial, ulna Synovial tendon sheaths TS volar wrist/palm – carpal tunnel Flexor digitorum profundus and superficialis
FDS slips insert intermediate phalanx FDP inserts distal phalanx Flexion tip independently
26 Pathology volar hand/wrist
• Tenosynovitis – pain and swelling
• Tendon rupture – limited flexion of finger/thumb – trauma/RA Pulleys Trigger finger/thumb
• Trigger thumb/finger • Restricted and painful flexion • Tenosynovitis and thickening of the pulley often A1 Rupture annular pulleys – A2
• Bowstringing Dorsal wrist Technique
• Start at Listers tubercle distal radius protruberance • EPL (compartment 3) ulna side Pathology dorsal
• Extensor tenosynovitis De Quervain’s ext 1
• 4th compartment Scapholunate ligament Scan distally from Lister’s tubercle
? Integrity, ganglion Ganglion arising from SCL Fingers - Extensor/dorsal hood Dorsal wrist joints midcarpal and radiocarpal