Table Of ContentDiagnosUtlitcr asound
Musculoskle leta
ii
DiagnoUslttirca sound
Musculoskle leta
JameFs. G riffith
MD,M RCP,F RCR
ProfessoIrm aogfi nagn dI nterventiRoandailo logy
DepartmeonftI maginagn dI nterventiRoandailo logy
TheC hinesUen iversoiftH yo ng Kong
Hong Kon(gS AR)C,h ina
iii
ELSEVIER
1600J ohnF .K ennedByl vd.
Ste 1800
PhiladelpPhAi 1a9,1 03-2899
DIAGNOSTIUCL TRASOUNDM:U SCULOSKELETAL ISBN9:7 8-1-937242-17-6
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Notices
Knowledagned b esptr actiicnte h ifise ladr ec onstancthlayn ginAgs.n ewr esearacnhd
experiebnrcoea deonu ru nderstandcihnagn,g eisnr esearmceht hodsp,r ofessipornaaclt ices,
orm edicatlr eatmemnaty b ecomen ecessary.
Practitiaonnder ress earcmhuesrtsa lwayrse loyn t heiorw ne xperieanncdek nowledigne
evaluatainndgu sinagn yi nformatimoent,h odsc,o mpoundosr,e xperimednetssc ribed
hereiInn.u sinsgu chi nformatoirom ne thodtsh eys houlbde m indfuolft heiorw n safety
and tshaef eotfyo therisn,c ludipnagr tifeosrw hom theyh ave par ofessiroensaplo nsi.b ility
With restpoea cnty drourgp harmaceutpircoadlu citdse ntifireeda,d earrsea dvisteod check
them ostc urreinntf ormatpiroonv id(eido) n procedufreeast uroer(d i i) bym antuhfea cturer
ofe achp roducttob ea dministetroev de,r itfhye recommended fdoorsmeu lotarh, e
methoda ndd uratioofna dministratiocno,n tarnadi ndicaItti toihnsesr .e sponsiboifl ity
practitiorneelrysio,nn g t heiorw ne xperieanncdek nowledget hoefi r pattioem natkse,
diagnosteosd ,e termidnoes ages and tthree abtemseftno tre achi ndividpuaatli enatn,dt o
take aaplplr oprisaatfee ptrye cautions.
Tot hef ulleexstte notft he lnaewi,t htehreP ublisnhoerrt he authors, contributors, or
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PublisChaetra loging-in-PuDbaltiac ation
Diagnosutlitcr aso:um nudsculoskeIl[ eetdailt beyd]J ameF.s Griffith.
page;s cm
Musculoskeletal
Includbeisb liograprheifcearle nacnedis n dex.
ISBN9 78-1-937242(-h1a7r-d6b ack)
1.M usculoskeslyesttaelm --Ultriamsaogniincg2 ..D iagnosutlitcr asoinmiacg ing.
I.G riffitJha,m es IFI.T. i tlMeu:s culoskeletal.
[DNLM:1 .M usculoskeDliesteaals es--ultrasonography--Atlases.
2.E xtremities--ultrasonogrWaEp 1h4y1-]- Atlases.
RC925.7.D521051 4
616.7075--dc23
InternatiSotnaanld aBrodo kN umber9:7 8-1-937242-17-6
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iv
DiagnosUtlitcr asound
Musculoskle leta
SECTION1
Limb
Upper
Sternaovcilcular and AcromiJoocilnatvsi cula.r 1-1-2
Shoulder . 1-1-8
Axill.a. . .1 -1-26
Arm ... . . 1-1-34
Arm Vessels . 1-1-42
Elbow ... . 1-1-50
Forear.m. .1 -1-70
ForearVme ssels . . 1-1-78
Wrist. .. . . 1-1-86
Hand ... . 1-1-100
Hand Vessels 1-1-112
Thumb .. . 1-1-118
Finger.s. . 1-1-128
Radial Nerve 1-1-140
MedianN erv.e 1-1-148
UlnaNre rv.e . 1-1-158
STERNOCLAVICULAR AANCDR OMIOCLAVICULAJRO INTS
.c
E
:.:::i LigamenotfsA C joint
TERMINOLOGY
I.... 0 SuperiAoCr l igament
Q)
Cl.Cl... Abbrieavtions • Stronger tahnidc k(e2r. 0-m5.m5) thatnh ino r
::J Sternoclavi(cSuClj)ao ri nt absenitn ferAiCo rl igament
>- Acromioclavi(cAuCl)ja ori nt • Inseratlso ng lateral( c8mlm a)v aincdl em edial
E
0 acromio(n1 0m m)
-ra GROSSA NATOMY ° Coracoclavilciuglaamre nts
c:
<C StenroclavicJuolianrt • Conoid atnrda pezoid ligaments
• Varys ignificainnlt elnyg tahn d width
Betweemne diaeln do fc laviclem aannudb rium • Conoid ligament ploosctaetreodm edially
0 Synoviasle llar-(tsyapded ljeo)i nt • Inserttos conoid tuwbheircchil sle o catwehde re
0 Medial eonfcd l avi=cllaer ge and bulbous middl1e/ 3o fc lavicculrev eisn tloa ter1a/l3o f
0 Muchl argtehra nm anubrial concavity clavicle
0 < 1/2o fm ediacll aviacrltei culwaittehs manubrium • Mainlpyr evenutpsw armdo vemenot fc lavicle
• Stabiltihtryo ugcha psuloligamesnttrouucst ures • Trapezoliidg amelnotc ataendt erolaterally
Intraartidciuslca r • Inserttots r apezoriidd gweh,i chr unsa long
0 Attachteodj oincta psualnet erioarnldyp osteriorly infersiuorrf aocefl, a teralo f1c /l3a vicle
° Completei nocro mple±t pee rforations • Mainlpyr evenltast ercaolm pressioofcn l avicle
0 Thickepsots terosuper(i3mo mr)l y againasctr omion
Ligamenotfss ternoclavijcouilnatr 0 Muscle attachtmoel nattse ral clavicle
° Capsular ligaments • Deltoid atttaoca hnetde risourr falcaet eralo f1 /3
• Covearn terosupearnidop ro sterior aosfp ects clavicle
sternoclavijcouilnatr • Trapeziautst achteodp ostersiuorrf alcaet eralo f1 /3
• Prevent upward dispolfma ecedmieacnllt a vicle, clavicle
whichm ayb ec ausebdy d ownwarfdo rcoen
shoulder ANATOMY IMAGIINSGS UES
• Anterisotrr onger ptohsatne rpioorrt ion
ImagiRnegc ommendations
0 Interclavilciuglaamre nt
• Connectssu peromedaisaple cotfc lavitcol e High-resolultiinoetnar ra nsducer
capsullairg aments andm aunpupberri um Aligtnr ansdutcrearn sverasleolnySg C o rA C joints
• Coverasn terosupearnidop ro steraisopre cotfsj oint AC joinlta xictayn baes sessbeypd u llidnogw no na rm
• Prevenetxsc essuipvwea rmdo tioonf c lavicle whiloeb servicnhga ngien joint wiudltthr aosno und
° Costoclavilciuglaamre nts ° Comparwei thc ontralatseirdael
• Unitien fersiuorrf amceed iaeln d clavtiocu lpep er Mainc linipcraels entatoifSo Cnj oinitsp ainlelsusm p
surfaocfe1 st rib 0 Mildd egreoefsc apsultahri ckenirnega dialpyp arent
• Anterifoirb earrsi sfer oma nteromedsiuarlf aocfe clinicaslilnycj eo injtu st beneatshu rsfkaicne
1str iban dr esiusptw armdo tion • Clinical swoefltleidnnu get or elatfiovrew ard
• Posterior afriibsleear tse raaln tteor ifoirb earnsd positionoifna gp parenstwloyl leSnCj oindtu et o
residsotw nwarmdo tion axiarlo tatioofun p per trunk
Muscle attachtmoem netdsi al clavicsltee rannudm • Occasionalltyo m diuled capssuwlealrl i±n gmild
0 Pectoramlaijso frr oma nteriaosrp ect me2d/i3a l subluxation sectooSn Cdo asrtye oarthritis
claviccllea v(i cuhleaard ) 0 Mainc linipcraels entatoifAo Cn j oinitsp aind ue to
0 Sternocleidomafsrtoompi ods tersiuorrf amceed ial osteoarthArCit jiosi,ni tm pingemenitn,f lammatory
1/3o fc lavi(ccllea vichuelaadr) arthropatahnyds, u bluxation/dislocation
0 Sternohyoids taenrdn othymruosicdl esse paragtree at ImagiPnigt falls
vesseflrso ms ternoclavijcouilnatr
SCo r AjCo ints
Acromioclavicular Joint 0 Normallays tep-boeftfw eemne dial claavnidc le
Synoviajlo inbte tween laetnedro afcl l aviacnlde manubriuamn d,t ol essdeerg ree, betlawteeerna l
mediaeln do fa cromion claviclea carnodm ion
0 Articusluarrf aocfec laviocrliee ntpeods terolaterall0y S houlndo tb ei nterpreatsse udb luxation
whereaasr ticusluarrf aocfea cromion oriented 0 Acromionno rmalellye vatferso mr espto sition
an terodmiaelly durinagr ma dduction
• Angloef i nclinatbieotnw eeonp posinagr ticular 0 AC joinitn dexA=C joint wiodfut nhi njurseidd AeC/
surfacveasr iweist hc laviocvleer ridaicnrgo mion joint wiodfit nhj ured s1i.d0ne o =r mally
(50%)v,e rtiocraile ntatbieotnw eeanc romioann d 0 Determiwnhee ther
clavic(l2e5 %), clavicle uancdreormriiod(ni5 n%g) , • AC joinnotts ubluxed (stiomo iplpaors istied e:)
andm ixedp atte(r2n0 %) Grade1
• Maximumw idtho fn ormajlo inotn ultrasound= 5 • AC joipnatr tiaslulbyl ux(ecdl avisculbel ux<e d
mm if3< 5y earasn d< 4.4m m if>3 5y ears 50% deptho fA C joint) : Grade 2
• Maximumt hickneosfcs a psuflreo mb onys urfa=c e • AC joisnetv eresluyb luxed or dislocated (clavicle
I 2.7m m if3< 5y earasn d< 3.6 mimf >3 5y ears subluxe5d0 >% deptho fA C joint) : Grade 3
Intraartidciuslca r
0 Undergoreasp idde generatbieogni nniinng2 nd
1
decad-+e markedde generatoifod ins bcy 4th decade
2
STERNOCLAVICULAARN D ACROMIOCLAVICULJAORI NTS
TRANSVERSUES ,S TERNOCLAVICULAJRO INT
Int erclavliicgualmaern t
Clavicle
1srti b
Articduilsacr
Antersitoerr noclavicul--a--r-"=- --l-�-i--gament
1scto stcaalr tilage
Costoclavliicgualmaern t
Manubrisutme rnum
Sternoclajvoiicnutl ar Manubrium, sternum
Interclalviigcaumleanrt
Medieanld o f clavicle
Interclalviigcaumleanrt
Joicnatp sule
Manubrium, sternum
(TopG)r aphsihco wtsh ea nteraisopre cotft hes ternoclavijcouilnNator.t et hjeo incta psulaer,t icudliasrca, n di nterclavliicgualmaern t.
(MiddTlraen)s vergsrea yscuallter asosuhnodw tsh ea nterosupaesrpieocortf t hes ternoclavijcouilnTathr.e m ediacll aviicsml uec hl arger
thatnh ea rtilcautisnugr faocfet hem anubriuTmh.e t hiinn terclavliicgualmaeirnsc t l soelayp pliteodt hes uperiaospre cotfm anubriuamn,d
itcso nnectiowint thh em ediaeln dso fb otchl avicilsde esp ict(eBd.o ttToramn)s vergsrea yscuallter asosuhnodw st hes uperior oafst pheec t I
sternoclavjiociunTltha.erc ostoclavliciuglaamrep nrte venutpsw armdo vemenotf t he medcilaalv iwchleen t he lactlearvailoc rls eh ouldiesr
depressed.
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