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Contents Preface: Musculoskeletal Ultrasound ix Diana Gaitini The Shoulder: Rotator Cuff Pathology and Beyond 425 Diana Gaitini and Nirvikar Dahiya Videos of dynamic maneuvers performances accompany this article The scanning technique and normal anatomy are presented, followed by a review of the most common pathologies related to the rotator cuff, biceps tendon, subacro- mial subdeltoid bursa, acromioclavicular joint, and the postoperative shoulder, con- cluding with pearls and pitfalls and what the referring physician should be aware of. Ultrasound of the Wrist and Hand 439 Ian Yu Yan TSOU and Jenn Nee KHOO Musculoskeletal ultrasound (US), with the latest technological advances, is increas- ingly utilized. The advent of high-frequency electronic transducers allows superficial structures to be interrogated comprehensively. This is especially true for the joints of the hands and wrist; high-resolution images with exquisite details can be easily ob- tained. With its affordability, speed, and lack of ionizing radiation, musculoskeletal US is becoming a viable imaging mode. Interobserver variability is a concern because the accuracy of US examinations is operator-dependent. Knowledge of sonographic technique, anatomy, and pathology is paramount. This article comprehensively re- views the above with regard to the hand and wrist. Ultrasonography of the Hip and Groin: Sports Injuries and Hernias 457 Howard Pinchcofsky and Gervais Khin-Lin Wansaicheong Videos of groin anatomy during coughing and at rest, including small hernia, accompany this article. Ultrasonography of the hip and groin can be used to diagnose sports injuries and hernias. The history and physical examination remain the basis for the initial evalu- ation of a patient. However, sonography can elucidate an occult lesion or assist in evaluation of the lesion in a patient with limitation of obesity or pain. This article de- scribes the anatomy and pathology of commonly encountered lesions. Ultrasound of the Knee 475 Joseph G. Craig and David Fessell Advanced imaging of the knee is most commonly performed using MR imaging. However, in certain clinical scenarios, ultrasound examination is very useful. Ultra- sound is less expensive, uses no ionizing radiation, and has multiplanar capability. The authors find ultrasound particularly suited to assess for possible knee joint effu- sion, guide aspiration, examine for quadriceps or patellar tendon rupture, and iden- tify Baker cysts. Ultrasound of the Foot and Ankle 487 Kil-Ho Cho and Gervais Khin-Lin Wansaicheong Ultrasound of the ankle and foot in the diagnosis of pathology is challenging because of the numerous small structures that constitute the anatomy of the region, which is Musculoskeletal Ultrasound

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Page 1: Contents

Musculoskeletal Ultrasound

Contents

Preface: Musculoskeletal Ultrasound ix

Diana Gaitini

The Shoulder: Rotator Cuff Pathology and Beyond 425

Diana Gaitini and Nirvikar DahiyaVideos of dynamic maneuvers performances accompany this article

The scanning technique and normal anatomy are presented, followed by a reviewof the most common pathologies related to the rotator cuff, biceps tendon, subacro-mial subdeltoid bursa, acromioclavicular joint, and the postoperative shoulder, con-cluding with pearls and pitfalls and what the referring physician should be aware of.

Ultrasound of the Wrist and Hand 439

Ian Yu Yan TSOU and Jenn Nee KHOO

Musculoskeletal ultrasound (US), with the latest technological advances, is increas-ingly utilized. The advent of high-frequency electronic transducers allows superficialstructures to be interrogated comprehensively. This is especially true for the joints ofthe hands and wrist; high-resolution images with exquisite details can be easily ob-tained. With its affordability, speed, and lack of ionizing radiation, musculoskeletalUS is becoming a viable imagingmode. Interobserver variability is a concern becausethe accuracy of US examinations is operator-dependent. Knowledge of sonographictechnique, anatomy, and pathology is paramount. This article comprehensively re-views the above with regard to the hand and wrist.

Ultrasonography of the Hip and Groin: Sports Injuries and Hernias 457

Howard Pinchcofsky and Gervais Khin-Lin Wansaicheong

Videos of groin anatomy during coughing and at rest, including small hernia,accompany this article.

Ultrasonography of the hip and groin can be used to diagnose sports injuries andhernias. The history and physical examination remain the basis for the initial evalu-ation of a patient. However, sonography can elucidate an occult lesion or assist inevaluation of the lesion in a patient with limitation of obesity or pain. This article de-scribes the anatomy and pathology of commonly encountered lesions.

Ultrasound of the Knee 475

Joseph G. Craig and David Fessell

Advanced imaging of the knee is most commonly performed using MR imaging.However, in certain clinical scenarios, ultrasound examination is very useful. Ultra-sound is less expensive, uses no ionizing radiation, and has multiplanar capability.The authors find ultrasound particularly suited to assess for possible knee joint effu-sion, guide aspiration, examine for quadriceps or patellar tendon rupture, and iden-tify Baker cysts.

Ultrasound of the Foot and Ankle 487

Kil-Ho Cho and Gervais Khin-Lin Wansaicheong

Ultrasound of the ankle and foot in the diagnosis of pathology is challenging becauseof the numerous small structures that constitute the anatomy of the region, which is

Page 2: Contents

Contentsvi

precisely why ultrasound has an advantage over other imaging modalities. The high-er spatial resolution and ability to perform dynamic maneuvers enables accurate di-agnosis of many diseases affecting the region. Although history and physicalexamination remain the basis for the initial evaluation, ultrasound helps in excludinga more significant condition. This article describes the anatomy and pathology ofcommonly encountered lesions and provides a knowledge basis for evaluation ofthe ankle and foot.

Sonography of Cutaneous and Ungual Lumps and Bumps 505

Ximena Wortsman

There is a wide and growing spectrum of applications of sonography in the derma-tologic field. Here, common causes of cutaneous and ungual lumps and bumps arereviewed, considering the technical requirements, and clinical and anatomic con-cepts. The usage of sonography in dermatology has gone beyond the experimentalphase to become potentially an imaging technique in daily practice that provides an-atomic and functional information otherwise unavailable to the clinical examination.

Rheumatologic Applications of Musculoskeletal Ultrasonography 525

Ralf G. Thiele

Ultrasonography has become a major imaging modality for rheumatologic indica-tions. Advantages include detailed soft tissue visualization, if high frequency trans-ducers are used for superficial structures such as small joints of hands and feet.Color or power Doppler ultrasonography can help identify inflamed tissues. Serialimaging provides information about disease status and helpsmonitor a treatment re-sponse. Ultrasound guidance of procedures in rheumatology leads to higher accu-racy and better outcomes. Training specifically for rheumatologic indications isoffered by the European League against Rheumatism and the American Collegeof Rheumatology. Certification of proficiency can be obtained through the AmericanCollege of Rheumatology.

Ultrasound-Guided Procedures: Soft Tissue Masses, Joints, Tendons, and Muscles 537

Tobias De Zordo and Cesare RomagnoliVideos of ultrasound application to cyst injection; fragmentation and aspirationof calcific tendinosis; aspiration of masses; and foreign body removal accompanythis article.

A wide variability of ultrasound-guided procedures are available and allow minimalinvasive treatment of musculoskeletal disorders. This article describes generalaspects of ultrasound-guided procedures in the musculoskeletal system. Alsodiscussed are different interventional techniques, such as aspiration, injection,biopsy of soft tissue masses, aspiration and lavage of calcific tendinitis, and foreignbody extraction. Finally, best approaches for single joints and tendons aredelineated.

Index 551