Appendix Musculoskeletal Ultrasound Imaging Protocols Shoulder Date: History: Biceps—long head ___________________________________ Subscapularis _______________________________________ Infraspinatus ________________________________________ Supraspinatus _______________________________________ Posterior Labrum ____________________________________ Spinoglenoid Notch __________________________________ ACL Joint & Acromion _______________________________ Fluid: SASD1 Joint ____________________________ Bicipital Sheath ___________________ Other ___________________________ Cortical Margin2 ________________________________________________ Impingement: Supraspinatus _______________________________________ Subcoracoid ________________________________________ Other: Additional comments: Sonographer Note: Tendon tears should be measured in orthogonal planes, distance from key landmarks, e.g., rotator cuff interval for supraspinatus tears, involvement of musculo- tendinous junction, muscle belly atrophy/fat infiltration, description tear, e.g., partial, delaminating, etc. 1Subacromial-subdeltoid bursa. 2Greater and lesser tuberosities. 329 330 Appendix Elbow Date: History: Joints Space: Effusion Synovial Proliferation Cartilage Cortex Coronoid fossa Radial fossa Radial neck recess1 Olecranon fossa Anterior Biceps Tendon Brachialis Median Nerve Radial Nerve Medial Common Flexor Tendon Ulnar Collateral Ligament Medial Epicondyle Lateral Common Extensor Tendon Radial Collateral Ligament Lateral Epicondyle Posterior Triceps Tendon Olecranon/Fossa Ulnar Nerve Additional comments: Sonographer Note: Usually a dedicated study performed as per clinical request and/or symptoms. 1Includes the proximal radioulnar joint. Musculoskeletal Ultrasound Imaging Protocols 331 Wrist Date: History: Wrist Volar Flexor Tendons: FDS/FDP/FPL FCR/FCU Flexor Retinaculum Nerves: Median N Ulnar N Dorsal Compartments: 1 2 3 4 5 6 Scapholunate Ligament Lunotriquetral Ligament Triangular Fibrocartilage Complex TFC Ulnar Collateral Ligament Tendon Sheath Extensor Carpi Ulnaris Joint Effusion Synovial Proliferation Cartilage Cortex DRUJ Radiocarpal joint Additional comments: Sonographer Note: Usually a dedicated study performed as per clinical request and/or symptoms. 332 Appendix Hip Date: History: Joint: Effusion Synovial Proliferation Cartilage Cortex Anterior Labrum Anterior Femoral Triangle Iliopsoas Tendon and Bursa Sartorius Rectus Femoris Medial Pectineus Adductor Longus Adductor Brevis Adductor Magnus Gracilis Lateral Bursae around the Greater Trochanter Gluteus Maximus Gluteus Medius Gluteus Minimus Tensor Fascia Lata Iliotibial Band Posterior Gluteus Maximus Gluteus Medius Gluteus Minimus Hamstrings: Semimembranosus Conjoint Tendon Semitendinosus/Biceps Femoris Sciatic Nerve Additional comments: Sonographer Note: Usually a dedicated study performed as per clinical request and/or symptoms. Musculoskeletal Ultrasound Imaging Protocols 333 Knee Date: History: Anterior Quadriceps Tendon Patellar Tendon Patella Patellar Retinaculum ACL1 Superior Joint Recess Bursae Medial Semitendinous Gracilis Sartorius Medial Collateral Ligament Medial Meniscus (Anterior Horn and Body) Lateral Iliotibial Band Fibular Collateral Ligament Biceps Femoris Lateral Meniscus (Anterior Horn and Body) Common Peroneal Nerve Posterior Semimembranosus Gastrocnemius: Medial Head Lateral Head PCL ACL Bursae Posterior Horns Menisci: Medial Lateral Popliteal Fossa Vessels Tibial Nerve Joint: Effusion Synovial Proliferation Cartilage Cortex Additional comments: Sonographer Note: Usually a dedicated study performed as per clinical request and/or symptoms. 1ACL: may not be identifiable in all patients. 334 Appendix Ankle and Foot Date: History: Joint: Effusion Synovial Proliferation Cartilage Cortex Anterior Tibialis Anterior Extensor Hallucis Longus Extensor Digitorum Longus Peroneus Tertius Posteromedial Tibialis Posterior Flexor Digitorum Longus Flexor Hallucis Longus Flexor Retinaculum Posterolateral Peroneus Brevis Peroneus Longus Extensor Retinaculum Posterior Achilles Retrocalcaneal Bursa Retroachillean Bursa Kagar’s Fat Pad Ligaments Anterior Tibiofibular Distal Interosseous Membrane Lateral: Anterior Talofibular Calcaneofibular Posterior Talofibular1 Medial: Deltoid Additional comments: Sonographer Note: Usually a dedicated study performed as per clinical request and/or symptoms. 1May not be identifiable in all patients. Musculoskeletal Ultrasound Imaging Protocols 335 Soft Tissue Mass: Upper/Lower Limb Date: History: Site1 Overlying Skin Size AP Longitudinal Transverse Shape Contour2 Internal Echotexture3 Compressible4 Posterior Acoustic Enhancement Doppler Extension5 Surrounding Fluid Surrounding Tissues (Displacement/Invasion) Examine adjacent joint if in close proximity Additional comments: Sonographer Notes 1. Plane, e.g., subcutaneous, intramuscular, intermuscular. 2. Contour, e.g., smooth, lobulated, ill-defined, etc. 3. In/homogeneous, hyper/hypo/anechoic, calcification, air, vascularity. 4. Compressibility: also assess with Doppler. 5. Extension, e.g., along nerve or fascial plane. 336 Appendix Synovitis Protocol: Wrist and Hand Date: History: Distal Radioulnar Joint. 1 2 3 4 5 MCPJ PIPJ DIPJ Radiocarpal Joint Space Midcarpal Joint Space Carpometacarpal Joints Additional comments: Sonographer Notes 1. Usually a dedicated examination limited to the symptomatic joints is performed and agreed upon with referring clinicians. 2. Assess joints in longitudinal and transverse planes, volar and dorsal aspects, and, where accessible, the lateral joint recesses. 3. Assess the following: (a) fluid and synovium: compressibility and displacement, power Doppler; (b) articular cartilage; (c) cortex: smooth/irregular/erosions. 4. Overlying tendons and sheaths. Musculoskeletal Ultrasound Imaging Protocols 337 Synovitis Protocol: Ankle and Foot Date: History: Ankle Joint Intermetatarsal Joint Spaces 1 2 3 4 5 MTPJ PIPJ DIPJ Tarsometatarsal Joint Spaces Additional comments: Sonographer Notes: 1. Usually a dedicated examination limited to the symptomatic joints is performed and agreed upon with referring clinicians. 2. Assess joints in longitudinal and transverse planes, volar and dorsal aspects, and, where accessible, the lateral joint recesses. 3. Assess the following: (a) fluid and synovium: compressibility and displacement, power Doppler; (b) articular cartilage; (c) cortex: smooth/irregular/erosions. 4. Overlying tendons and sheaths. Index A attachment site of, 159, 186 magnetic resonance imaging of, Abductor digiti minimi muscle, ultrasound evaluation of, 174, 243, 251 126, 131, 249, 250, 253, 273, 193, 194 ultrasound evaluation of, 275 Adductor magnus muscle 256–279 accessory, 298, 299 anatomy of, 157, 160, 162, 163, anterior ankle, 257–260 Abductor digiti minimi tendon, 245 180, 181, 183, 184, 186, anterior joint, 260–261 Abductor hallucis muscle, 245, 187–188, 193, 194, 201, bones and joints of the foot, 249, 250, 252, 253, 273, 275 205, 206 277–279 Abductor pollicis brevis muscle, attachment site of, 159, 186, 203 clinical indications for, 110, 124, 126, 135, 137, 145 ultrasound evaluation of, 193, 243–244 Abductor pollicis brevis tendon, 194, 196 of the dorsum foot, 276–277 130 Adductor pollicis brevis tendon, imaging protocol for, 279 Abductor pollicis longus muscle, 130 muscle compartments, 257 106, 110, 123, 126, 127, 135, Adductor pollicis muscle, 123, 124, posterior ankle, 264 137, 145, 295 126, 132, 135 posterolateral ankle, 264–272 Abductor pollicis longus tendon, Adductor transverses hallucis postomedial ankle, 261–264 137, 138 muscle, 274, 276 sole of the foot, 272–276 Abscess, soft-tissue, 179 Adductor tubercle, 206 technical aspects of, 244 Acetabular ligament, transverse, Anatomical snuff box, 122 Annular ligament, 81 164 Anconeus epitrochlearis muscle, Arcade of Frohse, 112, 299 Acetabular notch, 158 87, 293 Arcuate ligament, 202 Acetabulum, 158 Anconeus muscle Arm, 55–75 Achilles tendon anatomy of, 56, 62, 78, 85, 87, anatomy of, 56–65 anatomy of, 225, 230–231, 250 104, 110 anterior (flexor) muscle as muscle insertion site, 235 function of, 62 compartment, 59–62 ultrasound evaluation of, 223, bones, 57–58 insertion site of, 82, 106 237, 245, 259, 272–273 fascia, 59, 63 as lateral elbow landmark, Acromioclavicular joint magnetic resonance imaging 97–98 anatomy of, 22, 30–31 of, 61, 111 Aneurysm, popliteal, 199–200 instability of, 47 muscles and tendons, 58–63 Anisotropy, in ultrasound, 15–16 ultrasound evaluation of, 47 nerves, 64–65, 285–294 of the knee, 211 Acromioclavicular ligament, posterior (extensor) muscle of the posterior cruciate 30–31, 48 compartment, 59, 61, ligament, 219, 220 Acromion 62, 63 of the semimembranosus anatomy of, 22, 31 quadrilateral space, 63 tendon, 217, 218, 219 fusion of, 47 surface anatomy, 56–57 of the shoulder, 42, 43 ultrasound evaluation of, 47, 48 triangular (interval) space, 63 Adductor aponeurosis, 130 of the tibialis posterior tendon, ultrasound evaluation of 262 Adductor brevis muscle, 160, 162, anterior compartment, 67–69 163, 174, 183, 184, 188, 193, Ankle and foot, 243–280 deltoid muscle, 65–66 194 anatomy of, 244–256 indications for, 55 Adductor canal, 180 blood vessels and nerves, 256 nerves, 70–74, 285–294 Adductor hallucis muscle, 249, bones and joints, 245–247 posterior compartment, 70 254, 274 ligaments, 254–255 technical aspects of, 55–56 Adductor insertion avulsion muscles and tendons, 244, technique, 65 syndrome, 192–193 247–252 Arthritis Adductor longus muscle nerves, 307–310 of the elbow, 77 anatomy of, 156, 157, 160,