TiP-TV

GE Medical Systems

Program Supplement

US: Musculoskeletal Sonography

GEMS 1769

TiP-TVTM

GE Training in Partnership Television

© 2003 General Electric Company. All rights reserved.

GE Medical Systems US: Musculoskeletal SonographyProgram Supplement

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TABLE OF CONTENTS

SECTION PAGE

PREFACETABLE OF CONTENTS ..................................................................................................................... 2PRESENTER BIOGRAPHIES ............................................................................................................ 3PROGRAM OBJECTIVES, TARGET AUDIENCE, AND PRODUCTIVITY STATEMENT .......................... 5CONTINUING EDUCATION CREDIT ELIGIBILITY .............................................................................. 5

INTRODUCTION .................................................................................................................................................. 6MUSCULOSKELETAL ANATOMY .......................................................................................................................7MUSCULOSKELETAL PATHOLOGIES ............................................................................................................. 12

A. Ankle/FootB. KneeC. ShoulderD. ElbowE. WristF. General

HANDS-ON TECHNIQUES ................................................................................................................................ 14DIAGNOSIS / CASE STUDIES........................................................................................................................... 15APPENDIX A: USEFUL LINKS .......................................................................................................................... 16

Icon Learning Systems Netter Image Copyright

Electronic files of Images created by Dr. Frank H. Netter or Images created in the style established by Dr. Frank H. Netter from The Netter Collection of Medical Illustrations. Some graphics may have been adapted with permission from the publisher, Icon Learning Systems.

Copyright 2003. Icon Learning Systems, LLC. A division of MediMedia USA, Inc. All rights reserved.

2 of 17© 2003 General Electric Company. All rights reserved.


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Icon Learning Systems Netter Image Disclaimer

The Netter images included in this program supplement were licensed from Icon Learning Systems for illustration and educational purposes only. These images should not be used for diagnostic or clinical purposes or for the treatment of any medical condition. There is no guarantee that these images do not contain errors, incomplete, or out of date information.



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PRESENTER BIOGRAPHIES

Marnix van Holsbeeck, MD

Dr. van Holsbeeck is currently an Associate Professor of Radiology, Case Western Reserve. He also holds thepositions of Director of the Section of Musculoskeletal Radiology – Department of Diagnostic Radiology, Director ofRadiology in The Bone and Joint Center – Department of Orthopedic Surgery and Director of the Section ofEmergency Radiology – Department of Diagnostic Radiology at the Henry Ford Hospital in Detroit, Michigan. He isalso a Team Radiologist for the Detroit Lions and Red Wings.

J. Antonio Bouffard, MD

Dr. Bouffard earned his medical degree from the Manila Central University, Manila, Philippines in 1980 and servedhis residency in diagnostic radiology at Wayne State University in Detroit, Michigan. He has worked as a Senior StaffRadiologist at Henry Ford Hospital in Detroit, Michigan since 1989. He is also a Team Radiologist for the Detroit Lionsand Red Wings.

Patricia A. Kolowich, MD

Dr. Kolowich is a Senior Staff Surgeon at the William Clay Ford Hospital Department of Orthopedics, Division ofSports Medicine. Her specialties are orthopedics and sports medicine surgery and joint replacement. Dr. Kolowich iscertified by the American Board of Orthopedic Surgery. She earned her medical degree from the University ofMichigan Medical School. She is also the Team Orthopedic Surgeon for the Detroit Lions, Tigers, and Red Wings.

Mark Diamond, MD

Dr. Diamond earned his medical degree at the University of Texas Medical Branch in Galveston, Texas in 1993. Heserved his residency in Radiology at the University of Illinois at Chicago in the Michael Reese, Mercy, and Children’sMemorial Hospitals. Dr. Diamond served as Musculoskeletal Radiology Fellow at the Henry Ford Hospital in Detroit,Michigan. He is now working as a Senior Staff Radiologist in the Department of Diagnostic Radiology at the HenryFord Hospital in Detroit, Michigan.

Joseph Craig, MD

Dr. Craig earned his medical degree at the University of Otago Medical School in Dunedin, New Zealand in 1981. Heserved as Radiology Resident at Palmerston North Hospital Board in Palmerston North, New Zealand and OtagoArea Health Board in Dunedin, New Zealand. Dr. Craig served as Musculoskeletal Radiology Fellow at the Universityof Michigan Hospitals in Ann Arbor, Michigan. He is now working as a Senior Staff Radiologist in the Department ofDiagnostic Radiology at the Henry Ford Hospital in Detroit, Michigan.

Vigen B. Darian, MD

Dr. Darian is board certified by the American Board of Otolaryngology, the American Board of Plastic Surgery, andthe American Board of Plastic Surgery: Hand Surgery. He has offices in the Henry Ford Hospital in Detroit and inWest Bloomfield.



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PRESENTER BIOGRAPHIES, CONTINUED

Special Contributors

Howard Duncan, MDChief Rheumatology (ret.), Henry Ford Hospital – West Bloomfield, Michigan

Sean Burrows, MDRadiologist Salem Radiology Consultants – Salem, Oregon

Veronica Rodriguez, RDMSGreat Lakes MSUS, Inc., Dearborn, Michigan

Lisa DeWalt, RDMSStaff Sonographer, Henry Ford Hospital

William Medford, RDMSChief Ultrasonographer, Salem Radiology Consultants – Salem, Oregon

Andrew Stonefield – Ultrasound Program Manager, Performance Solutions, GE Medical Systems

Andrew worked as a Registered Vascular Sonographer with Medicalab, Inc. throughout New England and acquireddiverse experience in imaging technology and techniques. Following that position, he worked as an ApplicationsConsultant for MEDITECH, Inc., where he was responsible for the training of several hospital teams in the U.S. andCanada in integrated radiology department software.

Andrew joined GE Medical Systems as a contractor in 2000 and worked with the Ultrasound Marketing teamproducing web content for various ultrasound products and service technical training programs. In 2002, he becamethe Program Manager of Clinical Ultrasound TiP-TV programs and related eLearning products. In addition, he hasresponsibility for product offerings for the GEMS IT, OEC, and Lunar businesses.

Andrew earned a Bachelor’s degree in Biology from Coastal Carolina University and is currently working on an MBA degree at the Keller Graduate School of Management.



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PROGRAM OBJECTIVES, TARGET AUDIENCE, AND PRODUCTIVITY STATEMENT

Program Objectives

By the end of this program, the viewer should be able to:

• Recognize normal anatomical structures using ultrasound.

• Identify musculoskeletal pathology.

• Discuss the diagnosis of musculoskeletal pathologies.

• Describe the clinical indications that are most suited for ultrasound.

Target Audience

Course objectives for this program specifically target Medical Diagnostic Sonographers. While not limited to thisaudience group, the technical content will be most effective when applied to people with this training.

NOTE: Viewers who apply for continuing education (CE) credit and meet the application requirements are eligible for credit, regardless of their audience status.

Productivity Statement

This program was developed to enhance your professional and educational level, and increase your productivity andskills.

CONTINUING EDUCATION CREDIT ELIGIBILITY

IMPORTANT NOTICE!

You may only receive continuing education (CE) credit once for a particular course, regardless of the format in whichit was viewed. This GE Medical Systems TiP-TV course may be available in several different formats, such as, butnot limited to, an Online Web course or videotape.

If you have already applied for and/or received CE credit for this course, you are NOT eligible to receive CE credit forthis TiP-TV broadcast. Contact your CE accreditation organization for additional information as needed.



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INTRODUCTION

With Musculoskeletal Sonography gaining popularity as a means of imaging patients with arthritis and injury to joints, it is important to understand the appropriate uses of the techniques involved and their benefits. We will describe, in detail, areas of interest, such as the shoulder, knee, and elbow, with attention to technique, indications, and abnormalities. The ability to image joints, cartilage, tendons, and bone surfaces with patient-friendly ultrasound can be a useful tool in a patient's diagnosis and follow-up.

Musculoskeletal Sonography is typically performed in similar instances as Magnetic Resonance Imaging (MRI). While MRI may have advantages in fine detail and with the ability to image through bone, ultrasound of the same anatomy can provide doctors with adequate information to make a diagnosis. The ability to image a movable joint in real time can be extremely important in understanding an injury. Also, the safety and comfort of ultrasound makes it ideal for most patients, especially those that can not receive imaging test through another modality such as MRI due to metal bone screws or artificial joint implants.



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MUSCULOSKELETAL ANATOMY

Figure 1 Anterior ankle

Figure 2 Posterior ankle

Fibula

Extensor digitorum tendonsTibialis anterior tendon

Tibia

Extensor hallucis tendon

Extensor retinaculum

Peroneal tendonsLateral malleolus

Medial malleolus

Calcaneal tuberosity

Calcaneal (Achilles) tendon

Tibialis posterior tendon

Flexor digitorum tendon

Flexor retinaculum

Flexor hallucis tendon



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Figure 3 Bones of the ankle and foot

Figure 4 Knee

Calcaneus

Cuboid

Metatarsal bones

Phalanges

Talus

Navicular

Cuneiform bones

Iliotibial band

Lateral collateral ligament

Fibula Patellar ligament

Medial collateral ligament

Patella

Rectus femoris tendon

Tibia

Femur



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Figure 5 Shoulder

Figure 6 Elbow

Clavicle

Scapula

Acromioclavicular joint

Acromion

Supraspinatus tendon

Humerus

Subscapularis tendon

Biceps tendon

Coracoid process

Capsular ligaments

Humerus

Triceps tendon

Joint capsule

Collateral ligament

Biceps tendon

Radius

Ulna



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Figure 7 Wrist (palmar view)

Figure 8 The Carpal Tunnel

Flexor tendons

Median nerve

Transverse carpal ligament

Common flexor sheath

Transverse carpal ligament

Flexor tendons

Hamate TrapezoidCapitate

TrapeziumMedian nerve



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Figure 9 Bones of the wrist

Ulna

Lunate

Radius

Scaphoid

TrapeziumTrapeziod

Metacarpal bones

TriquetrumPisiform

Capitate

Hamate



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MUSCULOSKELETAL PATHOLOGIES

The following represents a brief list of possible musculoskeletal injuries and disorders for which an ultrasound exam may be ordered.

ANKLE/FOOT

• Peroneal tenosynovitis: Inflammation of the lining of the tendon sheath surrounding the peroneal tendon.

• Sprain of anterior talofibular ligament: Rupture or tear of anterior talofibular ligament.

• Calcaneal spur syndrome: Partial separation of the calcaneal tendon from the calcaneal bone.

• Achilles tendon bursitis: Inflammation of the bursa (fluid sac) adjacent to the Achilles tendon.

• Achilles tendinitis: Inflammation of the Achilles tendon.

• Shin splints: Stress on the anterior muscle and tendons of the lower leg.

KNEE

• Popliteus tendinitis: Inflammation of the popliteus tendon, which helps hold the distal fermur in place.

• Popliteal cyst or “Baker’s cyst": A cyst formed by a herniation of synovium in the popliteal fossa.

• Patellofemoral pain or “Runner's knee”: The rubbing of the patella against the distal femur during pronation.

SHOULDER

• Rotator cuff tear: Full or partial rupture of the supraspinatus and subscapularis tendons.

• Rotator cuff tendinitis: Inflammation of the supraspinatus and subscapularis tendons.

• Dislocation: The complete or partial removal of the humerus head from the shoulder ligament socket.

ELBOW

• Cubital tunnel syndrome: Entrapment of the ulnar nerve, or “funny bone.”

• Radial tunnel syndrome: Entrapment of the radial nerve.

• Lateral Epicondylitis or “tennis elbow": Inflammation of the extensor tendon attachment to the lateral epicondyle.

• Medial Epicondylitis or “golfer’s elbow": Inflammation of the common flexor tendon attachment to the medial epicondyle.



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WRIST

• de Quervain's syndrome: Inflammation of the extensor sheath leading to the thumb.

• Carpal tunnel syndrome: Entrapment of the median nerve within the palmar transverse carpal ligament.

• Digital tendinitis: Inflammation of the flexor and extensor tendons and sheaths of the hand.

• Ganglion cysts: Swelling or fluid mass in joint capsules or tendon sheaths.

GENERAL

• Rheumatoid Arthritis: Chronic inflammation and destruction of the joints.

• Bursitis: Inflammation of a synovial fluid sac, usually located in areas of friction within joints.



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HANDS-ON TECHNIQUES

Notes:



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DIAGNOSIS / CASE STUDIES

Notes:



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APPENDIX A: USEFUL LINKS

A Musculoskeletal Atlas of the Human Body. By Carol Teitz, M.D. and Dan Graney, Ph.D.:

http://eduserv.hscer.washington.edu/hubio553/atlas/index.html

International Society for Musculoskeletal Ultrasound:

http://www.ismus.info/

Musculoskeletal Ultrasound at the University of Michigan:

http://www.med.umich.edu/rad/muscskel/mskus/index.html

Your Orthopedic Connection by the American Academy of Orthopedic Surgeons:

http://orthoinfo.aaos.org/

The Virtual Sports Injury Clinic:

http://www.sportsinjuryclinic.net/index.htm

Wheeless' Textbook of Orthopedics:

http://www.ortho-u.net/med.htm


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