25-05-2016

1

Ultrasound of musculoskeletal injuriesMICHEL BACH HELLFRITZSCH, M.D.

DEPT. OF RADIOLOGY, AARHUS UNIVERSITY HOSPITAL

Disclaimer•Working with MSUS for the last 17 years.

•Been on resocialization programme all that period (MSK CR/DR/CT/MR).

Do not underestimate the power of sonography

25-05-2016

2

Trauma-VAS

No contraindications

25-05-2016

3

MRI?CT?

X-ray

€£$

US US/MRI?

25-05-2016

4

AnatomySkin

Subcutis

Muscles

Tendons

Vessels

Nerves

Bones

Joints

Bursae

Tendon lesionsMuscle lesionBone lesionJoint lesionForeign bodiesInfection

25-05-2016

5

General principles: Tendons

Anisotropy

Generel principles: Tendons

Long axis Short axis

25-05-2016

6

Tendon lesions

Split tear lesion(Peroneal tendons)

Is there a radiograph – or do we need one?

25-05-2016

7

Fluid in the subdeltoid/acromialbursa and intraarticular

95%: Supraspinatus lesion

25-05-2016

8

Biceps tendon luxation

MedialLateral

Sulcusintertubercularis

The kitchen

25-05-2016

9

EHL tendon: Partial lesion

Extension

Flexion

25-05-2016

10

Achilles tendon lesion: Extendet field of view

Achilles tendon lesion: Intactfibers?

DistalProximal

25-05-2016

11

Achilles tendon lesion: Plantaris tendon

10%

25-05-2016

12

36 years old male. 10 days old trauma. Achilles tendon?

36 years old male. 10 days old trauma: Tennis leg

50% slow

twitch fibres

70% slow

twitch fibres

25-05-2016

13

Tendon lesionsMuscle lesionBone lesionJoint lesionForeign bodiesInfection

Elevator principle

25-05-2016

14

Distal biceps brachii tendonlesion?

Left Right

Left Right

25-05-2016

15

Edema of the biceps muscledue to over exercise

Small muscle lesion (Biopsyproven!)

25-05-2016

16

Small muscle lesion (Biopsi proven!)

Rectus femoris lesion: Comparison with contralateral side

25-05-2016

17

Rectus femoris lesion

Proximal to distal

25-05-2016

18

Tendon lesionsMuscle lesionBone lesionJoint lesionForeign bodiesInfection

Incidental finding

25-05-2016

19

1½ year old boy with trauma to the chest (Brother fell on him)

US two months later (Sarcoma center)

25-05-2016

20

Tendon lesionsMuscle lesionBone lesionJoint lesionForeign bodiesInfection

Boy 5 years old: Coxitis

25-05-2016

21

”Primary radiographs” – Plica? (Pacemaker so no MRI)

Listen to your patient !

25-05-2016

22

Dynamic US: Supination to pronation

Radius

Humerus

25-05-2016

23

Tendon lesionsMuscle lesionBone lesionJoint lesionForeign bodiesInfection

Find the needle!

25-05-2016

24

Foreign bodies

?

Foreign bodies: Angle of insonation

25-05-2016

25

Angle of insonation

Sea urchin from Senegal

25-05-2016

26

Metallic foreign bodies: Radiographs – unless the location is of importance

Metallic foreign bodies: Radiographs – unless the location is of importance

Reverberation

25-05-2016

27

Foreign bodies: Tenosynovitis

Tendon lesionsMuscle lesionBone lesionJoint lesionForeign bodiesInfection

25-05-2016

28

Dermis

Subcutis

Muscle

25-05-2016

29

2+2=5!?

Distal biceps tendon: OK!Rotator cuff: OK!

25-05-2016

30

Proximal part of the humerus!

Humerus

Humerus

25-05-2016

31

Humerus

Pathologicfracture

25-05-2016

32

MRUS guided biopsy: Prostatic cancer

LitteratureE.G.McNally ”Practical Musculoskeletal Ultrasound”, 2nd ed. Elsevier, 2014 (First choice)

Holsbeeck and Introcaso ”Musculoskeletal Ultrasound”, 3rd ed. Jaypee, 2016

25-05-2016

33

Congresses and CoursesMusculoskeletal Ultrasound Society: 8-12th of October, 2016, Ibiza, Spain, musoc2016.org

DUDS: 26. - 28. oktober 2016: 20. kursus i muskuloskeletal ultralyd, København

In my opinion:Use the most appropriate imaging modality for the problem (x-rays, CT, US, MR) – if you need imaging at all!

MSUS is difficult – it is a craft and has to be learned in practice (and theory).

Be familiar with the anatomy in the region.

Listen to your patients

Use the other side for comparison.

Elevator principle.

Dynamic investigation.

Combine with radiographs to evaluate bony lesions.

25-05-2016

34