1158

Ultrasound of the hand, wrist, and elbowYang I, Kangnam Sacred Heart Hospital, Hallym University MedicalCenter, Korea

Compared with large shoulder joint, examination of the elbow, wristand hand is simple and easy due to their superficial anatomy and easyaccessibility. When the radiographic examination is normal, ultrasoundis indicated to evaluate persistent pain and swelling. Not only is theanatomy of the hand, wrist and elbow but also its pathologic conditionsare quite diverse. Although plain radiographs, CT, arthrography andMRI have traditionally been used to evaluate the hand, wrist and elbow,nowadays ultrasound is beginning to take its place alongside thesemore traditional imaging modalities and is being ordered with increas-ing frequency used to scan the hand, wrist and elbow. Ultrasoundexamination of the hand, wrist and elbow is a cost-effective accuratemodality for the diagnosis of focal pathology in those areas. Grossanatomy of the hand, wrist and elbow will be discussed with theirsonographic imaging. A high-frequency linear array transducer shouldbe used to scan the upper extremity (hand, wrist and elbow). Availabletransducers are up to 12 MHz that provide excellent resolution. Tissueharmonic imaging improves tissue contrast and spatial resolution withdecreases side-lobe and noise artifact. Color and power Doppler imagesare useful in hyperemic changes and tumor vascularity. Sonographicpanorama imaging also has the advantage to demonstrate the wholeextension of the lesion. Early experience of 3D sonography in diagnosisof musculoskeletal diseases will be presented. There is the ability toperform a dynamic study of the hand, wrist and elbow. This actionduring sonographic examination not only helps to diagnosis to exam-iner to the anatomic structures, but also localizes the pathologic processto a target organ. Usually we use a mound of gel, instead of a stand-offpad, but sometimes use the water-bath immersion technique. Water-bath immersion technique is easy, simple and a useful tool for assess-ment of the superficial lesions in hand without image distortion. Thislecture will be described the sonographic findings associated with themost common hand, wrist and elbow pathologic conditions. Theseinclude soft tissue tumors (AVM, lipoma, neurogenic tumor, cyst,epidermod, glomus tumor, hemangioma, giant cell tumor of tendonsheath), tenosynovitis including De Quervain tenosynovitis, tendinousand ligamentous injuries of the hand including calcific tendinitis, Mal-let finger, Dupuytren’s contracture, button hole deformity, foreignbodies, carpal tunnel syndrome, chip bone fracture, boxer’s fracture,degenerative osteoarthritis, pseudoaneurysm and nerve entrapmentsyndrome. Cases of elbow joint are tendonitis, tenosynovitis, andtendon injuries, including tennis elbow and golfer’s elbow, olecranonbursitis, ulnar nerve entrapment, calcific myositis etc.

1159

Ultrasonography of the extra-articular kneeBouffard JA, Henry Ford Hospital, United States of America

This lecture will demonstrate that MSUS is excellent for visualizing theextra-articular structures of the knee. The extensor mechanism is op-timal both for practice and diagnosis. Quadriceps and patellar tendontears can easily be located. Tendon discontinuity can be differentiatedfrom partial tears. Juvenile diseases of Sinding-Larsen-Johansen andOsgood-Schlatter are characterized by MSUS. The patellar tendon canbe evaluated for jumper’s knee, mucoid degeneration or tears. Lateralpatellar dislocation is accompanied by a torn medial retinaculum andlateral femoral condylar osteochondral defect. Prepatellar bursitis,prevalent in gout, shows not only the rabid synovitis but also subcu-taneous edema. Superficial infrapatellar bursitis can be separated fromdistal patellar tendinitis. Deep infrapatellar bursa can be visualized. The“window” to the knee joint is the potentially capacious suprapatellar

bursa. Inflammatory or infectious diseases and erosive arthritides causechanges in the thickness and contour of the synovial lining, createintraluminal debris, increase effusion, allow hypervascularization andspawn tophi or pannus. The knee is susceptible to valgus injury leadingto medial collateral ligament (MCL) strain or tears. The degree andextent of the tears can be diagnosed as to location, depth, thickness andlength. MCL tears often occur at the femoral level, affecting the deepor superficial layer, more than likely partial-thickness tear and runningin a zigzag pattern in a femorotibial direction. Tears, bursitis, ganglioncysts, avulsion fractures or tendinitis of the pes anserinus can berecognized. Ganglion cyst will yield thick viscous fluid while bursitissubmits serous fluid on U/S-guided needle aspiration. The lateral sta-bilizers of the knee are the biceps femoris, lateral collateral ligament(LCL) and the iliotibial band. Tendinitis of the biceps femoris usuallyoccurs at its musculotendinous junction, tears occur just above its distalfibular head insertion. The LCL strains and tears occur mostly at thelevel of the tibial condyle. The iliotibial band syndrome demonstratesthickening of the fascia at the femorocondylar level and an interveningbursitis plus subcutaneous edema. Insertion fascitis shows fusiformenlargement and cortical irregularities of Gerdy’s tubercle. The effu-sive knee decompresses through the virtual space of the semimembra-nosus-gastrocnemius bursa thru a spontaneous communication with theposterior capsule, evolving into a Baker’s cyst, readily investigatedwith MSUS. We, therefore, conclude that MSUS can pinpoint anddiagnose extraarticular lesions of the knee.

1160

Ultrasound of ankle ligaments: PathologyPeetrons P, Vanderhofstadt, Hopitaux IRIS SUD, Belgium

On the lateral part of the joint, anterior talofibular (ATF) and calca-neofibular (CF) ligaments can be easily demonstrated. Loss of con-tours, disruption of the fibers, tears and loss of stretching (as far as theCF is concerned) are the key signs. When healing, the ligaments areoften thicker than normal. Anterior tibiofibular ligament must also beinvestigated for sprains. On the medial part, deltoid ligament is bestseen in dorsal flexion. The same signs exist as with lateral ligaments.Some smaller ligaments are important too and will be demonstratedsuch as dorsal talonavicular, lateral calcaneocuboid, the Y-ligamentbetween calcaneus and navicular on one side and cuboid on the otherside and the spring ligament on the medial part of the midfoot.

CONGENITAL ANOMALY

1161

Sonography of first trimester pregnanciesKliewer M, University of Wisconsin, United States of America

The evaluation of first trimester pregnancies requires an understandingof normal and abnormal sonographic findings, which can be placedwithin the context of clinical and biochemical information. This lecturewill discuss guidelines for what constitutes a normal finding, as well asthe ultrasound signs of abnormality and what these might portend.Normal ultrasound landmarkA. Gestational sac. (1) First ultrasound finding: intradecidual sign;small cystic structure in the endometrium with a mean sac diameter�2.5 mm; occurs at 4.5 weeks. (2) Second ultrasound finding: doubledecidual (sac) sign; endometrial cavity separates parallel crescents ofechogenic decidua (capsularis and parietalis); do not expect completerings (sacs). (3) Rule of thumb: gestational age in days � 30 � MSD(mm); mean sac diameters increase at approximately 1.1 mm/d for thefirst eight weeks.

P50 Ultrasound in Medicine and Biology Volume 32, Number 5S, 2006