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Diagnostic musculoskeletal / joint ultrasound
Evaluation of patients with musculoskeletal symptoms:
- Joint (articular) pain and/or swelling and/or effusion and/or tenderness
- Peri-articular pain and/or swelling and/or tenderness
- Enthesal symptoms (sites where tendon and ligament attach to bone)
- Non-traumatic or posttraumatic regional musculoskeletal symptoms (e.g. pain, swelling, clicking) without clear localization
- Currently asymptomatic patients with prior established articular or peri-articular symptoms
- Articular or peri-articular symptoms in cases with difficult physical examination
Evaluation of regional neuropathic pain / suspected peripheral nerve entrapment:
- Median nerve at forearm and wrist (Carpal tunnel)
- Radial nerve at forearm
- Ulnar nerve at elbow (Cubital tunnel) and wrist (Guyon’s canal)
- Posterior tibial nerve at ankle
- Interdigital nerves (Morton’s neuroma)
- Peroneal nerve at fibular head
Evaluation of localized or diffuse muscle weakness
- Patients with inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis)
- Patients with crystal induced arthropathies (gout, CPPD)
- Patients with degenerative joint disease (osteoarthritis)
- Joint aspiration
- Non-synovial fluid aspiration (abscess, cyst)
- Aspiration of tophaceous mass
- Injections of medications into joints (steroid, viscous supplements)
- Injections of medications into tendon sheets, peritendons, perientheses
- Perineural injections (e.g. carpal tunnel, cubital tunnel, etc.)
- Injection of Dupyuptren’s lesions
- Needle tenotomy
- Barbotage /removal of calcium deposits
B-mode examination
- Joint effusion, hemarthrosis
- Synovial thickening
- Damage to menisci (knees) and labral (shoulders, hips) joint structures
- Erosions of cortical bone
- Osteophytes
- Enthesophytes
- Avulsion fractures
- Chondrocalcinosis (aka CPPD deposition in TFC, intrinsic wrist ligaments, and femoral cartilage)
- Sodium urate deposits (tophi, “double contour” sign)
- Retinaculum and tendon pulley thickening, tears
- Tendon abnormalities (tears, tendonopathy, calcifications, impingement, subluxations)
- Fascial pathology (plantar, palmar)
- Ligament pathology (tears, sprains)
- Bursitis
- Loose and foreign bodies
- Cystic lesions, hematoma, abscess
Dynamic B-mode examination
- Impingement of tendons and bursa (e.g. rotator cuff)
- Subluxation and determining cause of the clicking /snapping of tendons (e.g. biceps, peroneus, iliotibial band or iliopsoas, extensor carpi ulnaris)
- Subluxation of nerves (e.g. ulnar nerve at elbow)
- Ligament tears and sprains (wrist, knee, ankle)
Power Doppler examination
- Synovial hyperemia / synovitis
- Tendon sheet hyperemia /tenosynovitis
- Tendon and ligament hyperemia / tendinitis
- Soft tissue hyperemia / cellulitis, panniculitis
- Enthesal hyperemia /enthesitis