2026 Workshop Handout Bundle-W81A - Basic US of Lower Limb Nerves

W81A - Basic US of Lower Limb Nerves - Strakowski

Pdf Summary

The document introduces musculoskeletal ultrasound (MSK US), describing its uses, basic technique, tissue appearances, common tendon abnormalities, and practical scanning checklists.<br /><br />MSK US uses sound waves to assess tendons, ligaments, joints, muscles, and nerves. It offers high spatial resolution, relatively low cost, no radiation, point-of-care convenience, and dynamic real-time assessment. Limitations include operator dependence, poor assessment of structures hidden by bone, and inability to fully evaluate some internal joint injuries.<br /><br />High-frequency linear transducers are generally preferred. Good practice includes using appropriate machine presets, positioning comfortably, scanning structures in both short and long axis, completing standard protocols, comparing sides, and correlating findings with clinical and other diagnostic information. Common transducer movements include sliding, rocking, tilting, rotation, and compression.<br /><br />Tissues have characteristic ultrasound patterns. Tendons are typically bright and fibrillar, with substantial anisotropy; nerves have a fascicular pattern and should be assessed for consistent size and architecture along their course. Muscles show pennate or “starry night” patterns, while ligaments appear compact and striated. Bony and vascular landmarks help locate less conspicuous structures.<br /><br />Tendon disorders commonly include tendinosis and tears. Tendinopathy may show enlargement, reduced echogenicity, disrupted fibrillar architecture, and increased Doppler signal. Tears may show atrophy, underlying bone irregularity, and a clearly defined defect; they can be partial, longitudinal, or full thickness. “Tendinitis” is generally discouraged because many tendon disorders are degenerative rather than inflammatory.<br /><br />The lower-limb checklist outlines examinations by region and patient position. Hip scanning includes medial, anterior, lateral, and posterior structures, including the femoral and obturator nerves and sciatic nerve. Knee scanning covers anterior, medial, lateral, and posterior anatomy, including the saphenous, fibular, tibial, and medial sural nerves. Ankle and foot protocols include the deep fibular, tibial, and sural nerves, along with related tendons, ligaments, vessels, and plantar structures.

Keywords

musculoskeletal ultrasound

MSK US

high-frequency transducer

tendon abnormalities

anisotropy

point-of-care imaging

dynamic assessment

nerve fascicular pattern

tendinosis

lower-limb scanning checklist