Musculoskeletal Ultrasound (eBook)

John O’Neill, MD, is the musculoskeletal fellowship director and an assistant professor at St. Joseph’s Healthcare/McMaster University in Ontario. Dr. O’Neill earned his medical degree at University Cork College and a degree in clinical imaging at the University of Edinburgh. He completed musculoskeletal fellowships at McMaster University and the University of Michigan, Ann Arbor. Dr. O’Neill has served on national guideline committees for the Canadian Association of Radiologists and has presented at the American Roentgen Ray Society. His papers have appeared in journals such as Clinical Radiology and CardioVascular & Interventional Radiology.

Preface 6
Contents 8
Contributors 10
Section 1 Introduction 11
Introduction to Musculoskeletal Ultrasound 12
John O'Neill 12
Muscle 13
Fascia 16
Tendon 17
Ligament 19
Nerve 20
Bursa 21
Bone 22
Cartilage 22
Anisotropy 24
Section 2 The Upper Limb 27
The Shoulder 28
John O'Neill 28
Clinical Indications 28
Technical Equipment 29
Anatomy 29
Surface Anatomy 29
Bones 30
Muscles and Tendons 32
Bursae 36
Rotator Cuff Interval 37
Coracoacromial Arch 37
Acromioclavicular Joint 37
Labrum 38
Scapular Notches and the Suprascapular Nerve 39
Technique 40
Long Head Biceps 40
Subscapularis 43
Supraspinatus 45
Anisotropy 49
Infraspinatus and Teres Minor 50
Posterior Labrum and Spinoglenoid Notch 51
Anterior Labrum 53
Acromioclavicular Joint and Acromion 54
Ligaments 54
Subacromial Impingement 55
Miscellaneous Observations 57
Imaging Protocols 59
The Arm 62
Karen Finlay 62
Imaging Indications 62
Technical Review 62
Anatomy 63
Surface Anatomy 63
Bones 64
Muscles and Tendons 65
Muscle Compartments 66
Anterior Compartment 66
Posterior Compartment 69
Spaces 70
Quadrilateral Space 70
Triangular Space 70
Fascia 70
Superficial and Deep 70
Nerves 71
Median Nerve 71
Ulnar Nerve 71
Radial Nerve 71
Technique 72
Deltoid 72
Anterior Compartment 74
Posterior Compartment 77
Nerves 77
Median Nerve 77
Ulnar Nerve 79
Radial Nerve 80
Imaging Protocols 81
The Elbow 83
Karen Finlay 83
Imaging Indications 83
Technical Review 84
Anatomy 84
Surface Anatomy 84
Elbow Joint 85
Ligaments 87
Muscles and Tendons 88
Anterior Muscle Compartment 88
Lateral Muscle Compartment 91
Medial Muscle Compartment 92
Posterior Muscle Compartment 93
Nerves 93
Bursae 94
Deep Fascia 94
Technique 94
Anterior Approach 95
Lateral Approach 99
Medial Approach 102
Posterior Approach 103
Imaging Protocols 105
The Forearm 108
Karen Finlay and Lawrence Friedman 108
Imaging Indications 108
Technical Review 108
Anatomy 109
Surface Anatomy 109
Bones 110
Muscles and Tendons 111
Nerves 116
Median Nerve 116
Ulnar Nerve 117
Radial Nerve 117
Technique 117
Muscles 117
Flexor Muscles/Volar Compartment 118
Extensor Muscles/Dorsal Compartment 118
Mobile Wad/Proximal Lateral Compartment 121
Nerves 121
Median Nerve 121
Ulnar Nerve 121
Radial Nerve 122
Imaging Protocols 123
The Wrist and Hand 125
Lawrence Friedman 125
Clinical Indications 125
Technical Equipment 126
Anatomy 126
Surface Anatomy 126
Bones 127
Extensor Compartment Wrist 128
Hands and Fingers 131
Extensor Hood 134
Thumb 134
Ulnar Collateral Ligament of the Thumb and Adductor Aponeurosis 134
Flexor Compartment Wrist 134
Flexor Retinaculum 134
Carpal Flexor Tunnel 135
Thenar Eminence 135
Hypothenar Eminence 135
Long Flexor Tendons and Lumbrical Muscles 136
Adductor Pollicis Muscle 136
Interosseous Muscles 136
Flexor Fibrous Sheaths 136
Synovial Flexor Sheaths 136
Digital Attachments of Flexor Tendons 137
Finger Flexor Tendon Pulley System 137
Intrinsic Interosseous Ligaments 137
Scapholunate Ligament 137
Lunotriquetral Ligament 138
Triangular Fibrocartilage Complex 138
Extrinsic Interosseous Ligaments 138
Technique 138
Wrist 138
Dorsal Approach 138
Extensor Tendons 141
Ligaments 142
Intrinsic Ligaments 142
Extrinsic Dorsal Carpal Ligaments 143
Volar Approach 144
Flexor Tendons and Carpal Tunnel 144
Guyon's Canal 147
Volar Intrinsic Ligaments 147
Volar Extrinsic Ligaments 147
Volar-Ulnar 147
Triangular Fibrocartilage Complex 147
Volar-Radial 149
Hands and Fingers 150
Hypothenar Eminence and Flexor Pollicis Longus 150
Flexor Tendons and Pulley System 150
Extensor Tendons 152
Collateral Ligaments 152
Ulnar Collateral Ligament of the Thumb 153
Imaging Protocols 154
Section 3 The Lower Limb 156
The Adult Hip 157
John O'Neill and Gandikota Girish 157
Clinical Indications 157
Technical Equipment 158
Anatomy 158
Surface Anatomy 158
Bones and Hip Joint 159
Capsule and Synovial Membrane 161
Muscles and Tendons 161
The Adult Thigh 181
John O'Neill and Gandikota Girish 181
Clinical Indications 181
Technical Review 182
Anatomy 182
Surface Anatomy 182
Bones 183
Femur 183
Fascia and Compartments 184
Muscles and Tendons 184
Anterior Group 185
Medial Group 188
Posterior Group 191
Gluteal/Lateral Group 191
Bursae 191
Nerves 192
Technique 192
Anterior 193
Medial 194
Lateral and Gluteal 196
Posterior 197
Bursae 198
Nerves 198
Imaging Protocols 199
The Knee 200
Jon A. Jacobson 200
Imaging Indications 200
Technical Equipment 201
Anatomy 201
Surface Anatomy 201
Bones 202
Ligaments 202
Tendons and Muscles 206
Cartilage 207
Joint Recesses 208
Bursae 208
Nerves 209
Technique 209
Anterior Knee Evaluation 210
Medial Knee Evaluation 212
Lateral Knee Evaluation 215
Posterior Knee Evaluation 218
Imaging Protocols 222
The Leg 224
John O'Neill 224
Imaging Indications 224
Technical Review 225
Anatomy 225
Surface Anatomy 225
Bones 226
Interosseous Membrane 227
Ligaments 228
Fascia 229
Muscles and Tendons 229
Nerves 233
Bursae 233
Technique 234
Anterior Compartment 234
Lateral Compartment 235
Posterior Compartment 236
Interosseous Membrane and Ligaments 239
Nerves 240
Bursae: Retrocalcaneal and Retroachillean 241
Imaging Protocols 242
The Ankle and Foot 243
John O'Neill and Aaron Glickman 243
Imaging Indications 243
Technical Review 244
Anatomy 244
Surface Anatomy 244
Bones and Joints 245
Muscles and Tendons 247
Sole of the Foot 252
Ligaments 254
Retinaculae 255
Vessels and Nerves 256
Technique 256
Anterior Ankle 257
Tendons 257
Retinaculum 259
Ankle Joint 260
Posteromedial Ankle 261
Tendons 262
Retinaculum 264
Posterior Ankle 264
Posterolateral Ankle 264
Tendons 265
Retinaculum 267
Bursa 267
Ligaments 267
Nerves 272
Sole of the Foot 272
Plantar Fascia 272
Muscles and Tendons 273
Dorsum Foot 276
Bones and Joints of the Foot 277
Imaging Protocol 279
Section 4 The Peripheral Nerves 281
The Brachial Plexus 311
John O'Neill and Julian Dobranowski 311
Clinical Indications 311
Technical Review 312
Anatomy 312
Surface Anatomy 313
Brachial Plexus 313
Branches 315
Relations 315
Root Level 315
Interscalene Level 317
Supraclavicular Level 317
Infraclavicular and Axillary Levels 317
Technique 317
Root Level 318
Interscalene 320
Supraclavicular 321
Infraclavicular 321
Axillary 321
Imaging Protocols 321
The Peripheral Nervous System 282
Srinivasan Harish 282
Normal Sonohistology of the Peripheral Nerves 282
Technique 284
Anatomy of the Upper Limb Nerves 284
Nerves of the Arm (Figure 12.3) 284
Suprascapular Nerve 284
Regional Anatomy 284
Indications, Sonographic Anatomy, and Technique 285
Axillary Nerve 286
Regional Anatomy 286
Indications, Sonographic Anatomy, and Technique 288
Musculocutaneous Nerve 289
Regional Anatomy 289
Indications, Sonographic Anatomy, and Technique 289
Median Nerve 289
Regional Anatomy 289
Indications, Sonographic Anatomy, and Technique 290
Radial Nerve 290
Regional Anatomy 290
Indications, Sonographic Anatomy, and Technique 291
Ulnar Nerve 291
Regional Anatomy 291
Indications, Sonographic Anatomy, and Technique 292
Nerves of the Forearm and Wrist 293
Median Nerve 293
Regional Anatomy 293
Indications, Sonographic Anatomy, and Technique 296
Ulnar Nerve 297
Regional Anatomy 297
Indications, Sonographic Anatomy, and Technique 297
Radial Nerve 298
Regional Anatomy 298
Indications, Sonographic Anatomy, and Technique 299
Anatomy of the Lower Limb Nerves 299
Nerves of the Groin 299
Sciatic Nerve 299
Regional Anatomy 299
Indications, Sonographic Anatomy, and Technique 301
Femoral Nerve 302
Regional Anatomy 302
Indications, Sonographic Anatomy, and Technique 302
Lateral Femoral Cutaneous Nerve 303
Regional Anatomy 303
Indications, Sonographic Anatomy, and Technique 303
Nerves around the Knee 303
Common Peroneal Nerve 303
Regional Anatomy 303
Indications, Sonographic Anatomy, and Technique 303
Tibial Nerve 304
Regional Anatomy 304
Indications, Sonographic Anatomy, and Technique 305
Pudendal Nerve 305
Regional Anatomy 305
Indications, Sonographic Anatomy, and Technique 305
Nerves of the Calf and Ankle 306
Saphenous Nerve 306
Regional Anatomy 306
Branches of the Common Peroneal Nerve 306
Regional Anatomy 306
Sonographic Anatomy and Technique 306
Tibial Nerve 306
Regional Anatomy 306
Indications, Sonographic Anatomy, and Technique 307
Nerves of the Foot 308
Branches of the Tibial Nerve 308
Regional Anatomy 308
Indications, Sonographic Anatomy, and Technique 309
Appendix 325
Musculoskeletal Ultrasound Imaging Protocols 326
Index 335