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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5802_Библиотеки_им_академика_М_И_Перельмана.pdf
Musculoskeletal system
196
Infraspinatus tendon
PREPARATION
None.
POSITION
The patient is imaged while seated. The ipsilateral hand is placed on
the contralateral shoulder to stretch out the infraspinatus. The transducer is placed on the posterior shoulder, inferior and parallel to the
scapular spine, sweeping laterally to identify the muscle belly and then
tendon.
TRANSDUCER
7.0–10.0 MHz linear transducer.
METHOD
The transducer is placed transversely and longitudinally across the
infraspinatus.
APPEARANCES
The infraspinatus tendon appears as an elongated soft tissue triangle
that attaches to greater tuberosity of the humerus. The infraspinatus
tendon needs to be differentiated from teres minor tendon. The latter
is inferior to the infraspinatus tendon and appears trapezoidal with
bers that run obliquely as opposed to horizontal lines of infraspinatus
tendon.
Longitudinal view of the infraspinatus tendon (INF) overlying the posterior aspect of the
humeral head (HH) and glenoid (GL).
Infraspinatus tendon
FURTHER READING
Karthikeyan S, Rai SB, Parsons H, Drew S, Smith CD, Grifn DR.
Ultrasound dimensions of the rotator cuff in young healthy
adults. J Shoulder Elbow Surg. 2014; 23:1107–1112.
197
Musculoskeletal system
198
UPPER LIMB: ELBOW
Anterior joint space and distal biceps tendon
PREPARATION
None.
POSITION
The patient is seated with the forearm supinated and elbow initially
slightly exed.
TRANSDUCER
10.0–15.0 MHz linear transducer.
METHOD
The anterior joint space is imaged in longitudinal section with the
elbow fully extended and the transducer over the anterior radiocapitellar joint. The distal biceps tendon is imaged in longitudinal and transverse section with the elbow slightly exed. It is often difcult to fully
visualize due to anisotropy in this position. The elbow is then exed to
70°–80° and the distal biceps tendon is identied through a window
from the anteromedial elbow. The very distal biceps tendon is imaged
by completely exing the elbow and pronating the forearm in a “cobra
position” and scanning in transverse section along the dorsal proximal
forearm.
APPEARANCE
The anterior capsule of the elbow joint is a high-reective line that
follows the ventral contours of the proximal radial head and distal
humeral capitellum. Between the capsule and the bone lies a 1-mmthick, low-reective layer representing articular cartilage, which
should not be mistaken for abnormal joint uid. The distal biceps tendon appears as a highly reective brillary structure extending from
the musculotendinous junction of the biceps to the radial tuberosity.
Anterior joint space and distal biceps tendon
Transverse view through the anterior joint space of the elbow (RAD, radius; CAP,
capitellum). The arrow points to the anterior synovial recess, where the joint may be
evaluated for the presence of an effusion.
199
Longitudinal view of the distal biceps tendon (arrows) seen through a window from the
anteromedial elbow (RAD, radius; CAP, capitellum).
MEASUREMENTS
Please note that these are cadaveric measurements.
Mean width distal biceps tendon
(range)
Mean length distal biceps tendon
(range)
7 mm (6–10 mm) 21 mm (17–25 mm)
Musculoskeletal system
200
Longitudinal view of the attachment of the distal biceps tendon (arrows) onto the radius
(RAD).
FURTHER READING
Athwal GS, Steinmann SP and Rispoli. The distal biceps tendon:
Footprint and relevant clinical anatomy. J Hand Surg. 2007;
32A:1225–1229.
Brasseur JL. The biceps tendons: From the top and from the bottom.
J Ultrasound. 2012; 15:29–38.
De Maeseneer M, Marcelis S, Cattrysse E, Shahabpour M, De Smet
K, De Mey J. Ultrasound of the elbow: A systematic approach
using bony landmarks. Eur J Radiol. 2012; 81:919–922.
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Musculoskeletal system
202
Olecranon fossa, ulnar nerve, and distal triceps
PREPARATION
None.
POSITION
For the olecranon fossa and distal triceps, the patient is seated with the
elbow exed at 90° in a “crab” position with the palm resting on the
table. The ulnar nerve can be visualized in the crab position or with the
elbow extended and the arm outstretched.
TRANSDUCER
10.0–15.0 MHz linear transducer.
METHOD
The distal triceps tendon is imaged in longitudinal and transverse section. Deep to the distal triceps, the olecranon fossa and posterior fat
pad can be seen in longitudinal and transverse section. The ulnar nerve
is visualized in transverse section within the cubital tunnel, just dorsal
to the medial epicondyle. Once identied, the nerve can be visualized
in longitudinal section also.
APPEARANCE
Within the olecranon fossa is the posterior fat pad. The cubital tunnel
and ulnar nerve can also be identied. The ulnar nerve is fascicular in
appearance but in the cubital tunnel is hypoechoic.
MEASUREMENTS
Mean cross-sectional area of the ulnar nerve at the cubital tunnel 0.065
± 0.01 cm
2
.
Longitudinal view of the triceps muscle (TRI) and distal triceps tendon (arrows) as it inserts
onto the olecranon (OLE).
Olecranon fossa, ulnar nerve, and distal triceps
Transverse view through the cubital tunnel bordered by the medial epicondyle (MED
EPI) and (olecranon). The ulna nerve (dashed line) is positioned adjacent to the medial
epicondyle and its cross-sectional area can be assessed in this position.
FURTHER READING
Wiesler ER, Chloros GD, Cartwright MS, Shin HW, Walker FO.
Ultrasound in the diagnosis of ulnar neuropathy at the cubital
tunnel. J Hand Surg Am. 2006; 31:1088–1093.
203
Musculoskeletal system
204
Lateral elbow
PREPARATION
None.
POSITION
Patient seated with elbows exed and resting on the table.
TRANSDUCER
10.0–15.0 MHz linear transducer.
METHOD
The transducer is placed over the lateral epicondyle in the plane of the
common extensor tendon origin.
APPEARANCE
The common extensor tendon arises from the lateral epicondyle of the
humerus. The radial collateral ligament lies deep to the tendon and
attaches to the annular ligament at the radial head. The lateral ulnar
collateral ligament forms a sling around the posterior radial neck to
insert into the proximal ulna. These ligaments may be followed from
their origin at the lateral epicondyle. The radiocapitellar joint is seen
and can be assessed for the presence of uid.
The common forearm extensor origin (arrow) arises from the lateral epicondyle of the
humerus (LAT EPI) and lies superior to the radial head (RAD).
FURTHER READING
Radunovic G, Vlad V, Micu MC, Nestorova R, Petranova T,
Porta F, Iagnocco A. Ultrasound assessment of the elbow. Med
Ultrason. 2012; 14:141–146.
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