Elbow, wrist/hand ultrasound 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 • Radial tuberosity • 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 .