2024 Workshop Handout Bundle-W81A Basic US of Lower Limb Nerves

W81A Basic US of Lower Limb Nerves

Pdf Summary

The provided document is a comprehensive guide to using Musculoskeletal (MSK) Ultrasound (US) for diagnosing pathologies in tendons, ligaments, joints, muscles, and nerves. Authored by John Norbury, MD, and Jeffrey Strakowski, MD, the scope of this instructional text spans the practical uses, advantages, limitations, and specific techniques of MSK US.<br /><br />MSK US is advantageous for its high spatial resolution, cost-efficiency compared to MRI, absence of radiation risk, ease of point-of-care use, and ability to dynamically evaluate real-time pathology such as snapping hip or shoulder impingement. However, it cannot fully assess internal joint derangements or structures obscured by bone and heavily relies on operator skill.<br /><br />High-frequency linear array transducers are typically used in MSK US, facilitating optimal imaging through various transducer movements, including sliding, rocking, and rotating. The document stipulates detailed positional techniques for different body parts and conditions to locate target structures effectively.<br /><br />Sonographic appearances of tissues have characteristic patterns and echogenicities: tendons appear hyperechoic with a high degree of anisotropy, nerves exhibit a fascicular architecture, muscles show a pennate architecture, joints are identified using bony landmarks, and ligaments are described as hyperechoic or hypoechoic based on their surroundings.<br /><br />A significant portion of the guide addresses the identification and differentiation of tendon pathologies, such as ruptures and tendinosis, highlighting their sonographic features. The authors discourage the generalized use of “tendinitis,” preferring terms like “tendinopathy” to describe degenerative disorders.<br /><br />Detailed checklists for upper and lower limb imaging are included, specifying patient positioning and targeted structures for effective assessment.<br /><br />Overall, the document serves as both a didactic and practical resource for practitioners, aiming to enhance their proficiency in using MSK US for orthopedic diagnoses, ultimately provided as a member service by the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM).

Keywords

Musculoskeletal Ultrasound

MSK US

diagnostic imaging

tendon pathologies

John Norbury

Jeffrey Strakowski

high-frequency transducers

tendinopathy

real-time pathology

AANEM