Eus Msk Advance

8/8/2019 Eus Msk Advance

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急診進階軟組織及關

節超音波

台大雲林分院急診醫學部

急診醫學會超音波委員會

蔡揚名



使用探頭

線型：High frequency (7~12 MHz)

解像力好穿透力較差適合淺層

soft tissue 血管神經等掃描



(尤其只有腹部探頭時)

WATER -FILLED GLOVE



高解析線形探頭 (5-10MHz) 為第一首選注意深度(depth) 和焦點(focus) 的設定

至少掃描兩個介面 (longitudinal & transverse)

考慮和正常側比較 & 呈現在同一畫面 (Splitscreen)

如何改善掃描品質

– Stand-off pad

– Water/gel-filled glove

– Water bath technique



ECHOGENICITY

Skin – Echogenic

Subcutaneous tissue – Hypoechoic and traverse by

irregular strands of hyperechoic connective tissue

Fascial planes – Hyperechoic; regular thickness

Muscles – Striated appearance on long axis scan

Tendon – Fibrillar; echogenic

Vascular structures – Anechoic

Lymph nodes – Irregular, circular, echogenic; withhypoechoic rim

Bones – Echogenic cortices and dense acoustic shadows



TENDONS



MUSCLELongitudinal Cross section







NERVES





BONE





ANISOTROPY ACHILLES TENDON



Piezo electric crystals

Ultrasound waves

Anisotropy





ADVANCED MSK ULTRASOUND

Shoulder

Knee

Ankle and Foot



LIGAMENT AND TENDON INJURY

1. Increased vascularity

2. Increased thickness

3. Reduced echogenicity or heterogenous

4. Loss of fibrous structures



SHOULDER

1. Long head of Biceps Tendon



SubS, subscapularis tendon; SupraS, supraspinatus tendon; Arrow, long

head of the biceps tendon;

LT, lesser tuberosity; GT, greater tuberosity; SH, short head of the biceps;

LH, long head of the biceps; H,

humeral shaft; Arrowheads, pectoralis major tendon



2. Subscapularis tendon



Legend: Arrow, long head of the biceps tendon; dashed line, insertion of the

subscapularis tendon; Co, coracoid;

Del, deltoid muscle; LT, lesser tuberosity; SubS, subscapularis tendon; void

arrowheads, tendon fascicles

of the subscapularis; white arrowheads, muscle tissue interposed between tendon

fascicles



3.



4. Supraspinatus tendon



Legend: Acr, acromion; asterisk, myotendinous junction; Del, deltoid muscle; GT,

greater tuberosity; void

arrow-head, articular cartilage; curved arrow, hypoechoic artifact related to

anisotropy; straight arrow, long

head of the biceps tendon; SupraS, supraspinatus tendon; white arrowhead,

subacromial subdeltoid bursa





5.



Legend: asterisk, spine of the scapula; dashed line, spine of the scapula; Del,

deltoid muscle; GT, greater tuberosity;

InfraS, infraspinatus muscle; Tm, teres minor muscle; void arrow, teres minor

tendon; white arrows,

infraspinatus tendon



K NEE

1. Suprapatellar recess

Supine, forceful extention



2. Quadricep tendon

Flexion 30 degree

Legend: arrows, quadriceps tendon; 1,

superficial layer (from rectus femoris); 2,intermediate layer (from vastus lateralis

and vastus medialis); 3, deep layer

(from

vastus intermedius); F, femur; P, patella;

Vlat, vastus lateralis muscle; Vmed,

vastus

medialis muscle; Vint, vastus interme

dius muscle



3. Patellar tendon

Flexion 60~70 degree



4. MCL and Medial meniscus

MCL: flexion 60~90 degree,

Meniscus: extension and Hip external rotation

Legend: void arrows, medial collateral ligament;

asterisk, medial meniscus; void arrowheads,superficial portion of

medial collateral ligament; white arrowheads,

meniscofemoral ligament; white arrows, pes

anserinus complex insertion



5. LCL and Medial meniscus

LCL: flexion 60~90 degree,

Meniscus: extension and Hip internal rotation



6. Baker’s cystsemimembranosus-gastrocnemius bursa

(Prone and full extension)



ANKLE

1. Anterior recess of ankle joint



2. Anterior Talofibular Ligament (ATFL)



3. Anterior Inferior Tibiofibular Ligament (AITFL)



4. Calcaneofibular Ligament (CFL)



5. Deltoid Ligament

Legend: Deltoid ligament components. 1,tibiotalar ligament; 2, tibiocalcanear

ligament; 3, tibionavicular ligament



Legend: arrows, posterior tibial tendon; MM,

medial malleolus; void arrowheads, tibiotalar ligament; white

arrowheads, tibiocalcanear ligament;

Calc, calcaneus



6. Achilles Tendon



7. Plantar Fascia



SPECIAL THANKS TO~~

台大復健部的指導老師們

Reference:

1.European Society of MusculoskeletalRadiology

2. 醫用超音波學會骨骼肌肉系統工作坊



線上超音波教學推薦網站

http://vimeo.com/hqmeded/videos

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THANKS FOR YOUR

ATTENTION !!

Eus Msk Advance

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