Musculoskeletal Ultrasound Examination Quiz

11 Questions

Which position is recommended for imaging the infraspinatus using ultrasound?

Seated with arm across the chest

How should the wrist be positioned during ultrasound imaging to follow the median nerve?

Palm face up

What should be the indication of plantar fasciitis when imaging the ankle and foot with ultrasound?

Plantar fascia exactly 4mm

How should the knee be positioned during ultrasound imaging to visualize anatomy effectively?

Perpendicular to anatomy

What type of features may tears exhibit when viewed through ultrasound imaging?

Anechoic and blurry

Which of the following is NOT an indication for using bedside musculoskeletal ultrasonography?

Assessing bone fractures

Which of the following musculoskeletal structures appears as an echogenic linear fibrillar texture on ultrasound?

Tendon

When scanning the supraspinatus tendon, what is the correct patient positioning?

Superman pose (hand in back pocket)

Which of the following musculoskeletal structures appears as a thin anechoic line on ultrasound?

Bursa

When scanning the long head of the biceps brachii tendon, what is the correct patient positioning?

Sitting with palm up, scanning in transverse and long axis

Which of the following musculoskeletal structures appears as an echogenic linear structure attaching bone to bone on ultrasound?

Ligament

Study Notes

Musculoskeletal Ultrasound

Infraspinatus muscle is imaged using the posterior approach under the scapular spine, with the patient seated in the "pledge of allegiance stance" (arm across the chest).
Increasing depth in this view helps to visualize the glenoid joint and labrum.

Wrist and Hand Ultrasound

Wrist ultrasound: scan with the palm facing up, starting in the middle of the forearm and moving distally to the wrist, to follow the median nerve (transverse and sagittal/long axis).
Finger ultrasound: scan with the palm up (flexor) or down (extensor) to visualize tendons.

Knee and Ankle Ultrasound

Knee ultrasound: lift the knee up a bit, keeping the transducer perpendicular to the anatomy.
Ankle and foot ultrasound: point the notch towards the heel, and the plantar fascia should be approximately 4mm in thickness, indicating fasciitis if thicker.

Tears and Ultrasound

Tears on ultrasound have anechoic features and appear blurry.

Ultrasound-Guided Procedures

Ultrasound is used to guide procedures such as fracture and joint relocation, arthrocentesis, and fracture hematoma block to visualize the exact location for aspiration, block, or relocation.

Musculoskeletal Ultrasound Indications

Bedside ultrasonography is used to evaluate suspected musculoskeletal pathology and guide related procedures.
Indications include visualizing small tears or joint instability.
Use the high-frequency linear transducer and MSK exam preset.
Ensure the transducer is perpendicular to the anatomy to avoid anisotropy and distorted images.

Musculoskeletal Anatomy on Ultrasound

Subcutaneous fat: located right under the skin.
Muscle: echogenic with linear bands (striations) in the tissue.
Tendons: echogenic with linear fibrillar texture bands attaching muscles to bones.
Bursa: thin anechoic line in the joint.
Ligaments: echogenic linear structures attaching bone to bone.
Nerve: has a honeycomb appearance.

Scanning Technique

Correct scanning technique involves selecting the appropriate probe and patient positioning.
Shoulder ultrasound: image the long head of the biceps brachii tendon with the patient sitting, palm up, and scan in transverse and long axis.
Supraspinatus tendon ultrasound: use the transverse view with the patient in the "superman pose" (hand in back pocket) and scan on the anterior side.
Subscapularis ultrasound: use the transverse approach, anteriorly, with the patient abducting the forearm with the elbow next to the side, and palm up.