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Manual De Ecografía Musculoesqueletica

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Manual De Ecografía Musculoesqueletica Manual de ecografía musculoesquelética Dr Lucio Ventura Ríos Médico Internista y Reumatólogo Hospital Central Sur de Alta especialidad PEMEX Hospital General de Zona 194 IMSS BUENOS AIRES • BOGOTÁ • CARACAS • MADRID • MÉXICO • PORTO ALEGRE www.medicapanamericana.com Indice ecografiaR6.indd 3 2/11/10 4:55:56 PM C Colaboradores Dr. Lucio Ventura Ríos Dr. Mario Alfredo Chávez López Médico Internista y Reumatólogo Médico Internista y Reumatólogo Hospital central Sur de Alta Especialidad PEMEX Centenario Hospital Miguel Hidalgo, Hospital General de Zona 194. IMSS Aguascalientes, Ags. Profesor de Propedéutica y Fisiopatología UNAM. Profesor Escuela de Ecografía del Profesor Escuela de Ecografía del Colegio Colegio Mexicano de Reumatología Mexicano de Reumatología Dr. Carlos Moya McClaugherty Dra. Cristina Hernández Díaz Reumatólogo Reumatóloga Práctica Privada, México D. F. Jefa del Servicio de Ultrasonido Profesor Escuela de Ecografía del Músculo-esquelético Colegio Mexicano de Reumatología Instituto Nacional de Rehabilitación Profesor Escuela de Ecografía del Colegio Dra. Esperanza Naredo Sánchez. Mexicano de Reumatología Reumatóloga Hospital Universitario Severo Ochoa, Dr. Carlos Pineda Villaseñor Madrid España Médico Internista y Reumatólogo Escuela de Ecografía de la Subdirector de Investigación Biomédica Sociedad Española de Reumatología Instituto Nacional de Rehabilitación. Profesor Cursos EULAR Profesor titular Diplomado en Ecografía musculoesquelética y articular avalado por UNAM. Dra. Ingrid Möller Investigador Titular “C” de los Reumatóloga Institutos Nacionales de Salud desde 1992 Instituto Poal. Barcelona España. Investigador Nivel II del Sistema Nacional Profesor Escuela de Ecografía de la de Investigadores desde 1994. Sociedad Española de Reumatología Profesor Escuela de Ecografía del Profesor Cursos EULAR Colegio Mexicano de Reumatología Indice ecografiaR6.indd 5 2/11/10 4:55:57 PM Dr. Juan Carlos Acebes Cachafeiro Dr. Juan Jorge Mendoza Ruiz Reumatólogo Jefe del Servicio de Ultrasonido y Fundación Jiménez Díaz, Madrid, España Tomografía Computada. Profesor Escuela de Ecografía de la Unidad de Patología Clínica. Sociedad Española de Reumatología Guadalajara, Jalisco. Dr. Eugenio de Miguel Mendieta Dr. Juan Pablo Ornelas Reumatólogo Radiólogo Hospital Universitario, Madrid, España Encargado del Departamento de Profesor Escuela de Ecografía de la Imagenología Diagnóstica Dres. Ornelas Sociedad Española de Reumatología Centro de Rehabilitación, Medicina Deportiva y Artroscopía “MEDYARTHROS”. Dr. Emilio Filippucci Guadalajara Jalisco. Reumatólogo Catttedra Di Reumatologia Dra. Norma Marín Ospedale “A. Murri” Radióloga Universitá Poltecnica delle Marche, Ancona. Instituto Nacional de Rehabilitación Profesor cursos EULAR Dra. Carla Beatriz Solano Avila Dr. José Antonio Bouffard. Reumatóloga Radiólogo. Diplomado en Ecografía Musculoesquelética Senior Staff, Department of diagnostic Radiology, y Articular. UNAM Section Musculo-Skeletal Ultrasound Henry ford Hospital & Medical Centers, Dr. Pedro José Alberto Rodríguez Enriquez Detroit, Michigan, USA. Reumatólogo Diplomado en ecografía Musculoesquelética Dr. Victor H. Flores y Articular. UNAM Physical Medicine Associates Fort Worth, Tx. 76104 USA. Dr. Fritz Hofmann González. Médico en Servicio Social Dr. Marwin Gutierrez Riveros Subdirección de Investigación Biomédica. Reumatólogo Instituto Nacional de Rehabilitación. Cátedra Di Reumatologia Hospédale “A. Murri” Lic en Enf. Araceli Bernal González Universitá Politecnica delle Marche, Ancona, Italia. Enf. Especialista Quirúrgica y Entrenamiento en Ultrasonido Musculoesquelético Dr. Santiago Oscar Ruta Instituto Nacional de Rehabilitación. Reumatólogo Servicio de Reumatología Hospital Gral. San Martín de La Plata, Argentina. Indice ecografiaR6.indd 6 2/11/10 4:55:57 PM Prólogo Prólogo Desde hace poco más de una década, el Reumató- La ecografía ha demostrado ser más sensible y logo cuenta con el ultrasonido musculoesquelético, específica que la exploración física en la detección una técnica de imagen de fácil acceso, rápida, ino- de derrame y sinovitis intraarticular. También permi- cua y de bajo costo comparada con otras técnicas te diferenciar la afección inflamatoria periarticular que además permite la exploración dinámica y en como bursitis, tenosinovitis, celulitis, etc. de la infla- tiempo real de múltiples áreas anatómicas; carece mación articular. de efectos adversos y prácticamente no tiene con- traindicaciones. El Doppler de color como el de Poder se em- plean para detectar flujo sinovial e, indirectamente Es una herramienta idónea para aplicarla des- así, vascularización sinovial. El Doppler ayuda a pués de la exploración física en el consultorio. No distinguir sinovitis activa de engrosamiento intraarti- sustituye a la exploración física, sino que la com- cular inactivo. Varias publicaciones han demostrado plementa. la utilidad del ultrasonido en valorar sinovitis y cam- bios estructurales, favoreciendo su aplicación para Aunque el ultrasonido es una técnica que na- investigar la actividad de la enfermedad y el monito- turalmente realiza el Radiólogo, es el Reumatólogo reo de una respuesta terapéutica en pacientes con quien puede hacer una mejor correlación clínica y artritis inflamatoria. funcional con los hallazgos sonográficos. Al contar con un equipo de Ultrasonido en el consultorio se Sin lugar a dudas el ultrasonido es una herra- pueden establecer diagnósticos de certeza y tomar mienta fundamental en los procedimientos de pun- decisiones terapéuticas específicas. ción-aspiración o infiltración, ya sea con fines de diagnóstico y/o terapéuticos. Articulaciones como el Esta técnica se basa en la emisión y recepción hombro, la cadera o el tobillo pueden ser difíciles de ultrasonidos que son emitidos por cristales con- de abordar clínicamente, pero el ultrasonido facilita tenidos en el transductor o sonda. El desarrollo de un abordaje seguro y certero del objetivo anatómi- sondas de alta frecuencia y alta resolución ofrece co. En cualquier articulación esta técnica resulta de imágenes con alta definición de las estructuras su- gran utilidad en los procedimientos al mostrar las es- perficiales y posibilita la evaluación de tendones, tructuras con aumento de líquido para su aspiración músculos, ligamentos, bursas, nervios periféricos y y/o infiltración. articulaciones. De tal forma que la ultrasonografía está indicada en la valoración de patología articular Una de las desventajas del ultrasonido es que y de partes blandas. es operador-dependiente, situación que puede ser II Indice ecografiaR6.indd 7 2/11/10 4:55:57 PM Manual de ecografía musculoesquelética modificada con un entrenamiento apropiado (a tra- to para mejorar la calidad asistencial del Reumató- vés de un conocimiento profundo de la anatomía, logo, a través de una atención con “ecografía al pie principios físicos y tecnológicos del ultrasonido, de la camilla”. Este manual tiene el objetivo de servir dominio de la técnica estandarizada de explora- como guía para los Reumatólogos que se entrenan ción de las regiones anatómicas, conocimiento del en ultrasonido musculoesquelético y escrito en len- patrón normal y patológico de los tejidos muscu- gua española, cubre aspectos fundamentales como loesqueléticos, criterios diagnósticos, artefactos, los principios físicos de la ecografía, el conocimiento conocimiento de la técnica del Doppler, además de de los elementos de un ecógrafo para obtener imá- asistencia a cursos téoricos y prácticos de ultraso- genes óptimas, la revisión de las estructuras arti- nido, así como revisión de libros de texto, DVDs o culares y periarticulares, la revisión sistemática de sitios relacionados en internet), que demuestre el las regiones anatómicas, la utilidad del Doppler de uso seguro de la técnica por Reumatólogos. Esta poder, los hallazgos sonográficos en las diferentes situación motivó que Reumatólogos y Radiólogos patologías en las que el ultrasonido ha demostra- con experiencia en ultrasonido musculoesquelé- do su utilidad tanto para el diagnóstico como para tico, profesores de cursos de EULAR (European seguimiento, además del papel del ultrasonido en League Againts Rheumatism) hayan emitido guías patologías menos frecuentes como vasculitis, afec- sobre el contenido y la forma de impartir cursos ción de glándulas salivales, lesiones traumáticas de ultrasonido en forma estandarizada, que no sólo y, por último pero no menos importante, el uso del son válidos en Europa, sino que se pueden aplicar ultrasonido como guía para punciones-infiltraciones. en todo el mundo. Cuenta con la participación de renombrados Reu- matólogos con gran experiencia en la técnica, que Estamos convencidos que el ultrasonido es la apoyan a ECOMER (Escuela de Ecografía del Co- técnica de imagen de más fácil acceso y menor cos- legio Mexicano de Reumatología). Dr. Lucio Ventura Ríos Dra. Esperanza Naredo Sánchez III Indice ecografiaR6.indd 8 2/11/10 4:55:57 PM ÍNDICE Í Manual de ecografía musculoesquelética Capítulo 1. Capítulo 4. Principios físicos del ultrasonido | 1 Revision sistemática de las diferentes regiones anatómicas | 41 Capítulo 2. 4.1 Hombro: explicación Conocimiento y uso del equipo del sonográfica | 41 ultrasonido (botonologia) | 9 4.2 Codo | 47 Capítulo 3. 4.3 Mano y muñeca | 56 Revisión de estructuras | 17 4.4 Cadera | 66 3.1 Tendones | 17 4.5 Rodilla | 74 3.2 Sinovitis en artropatías inflamatorias | 22 4.6 Tobillo y pie | 84 3.3 Sonoanatomía de los ligamentos | 29 3.4 Evaluación sonográfica de Capítulo 5. músculos | 29 Principios
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