Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5802_Библиотеки_им_академика_М_И_Перельмана.pdf
Musculoskeletal system
206
Medial elbow
PREPARATION
None.
POSITION
Patient seated with elbows extended on a table.
TRANSDUCER
10.0–15.0 MHz linear transducer.
METHOD
The transducer is placed in the longitudinal oblique position at the
medial elbow joint.
APPEARANCE
The common exor tendon arises at the medial epicondyle of the
humerus. The anterior band of the ulnar collateral ligament arises from
the medial epicondyle of the humerus and inserts on the medial coronoid process of the ulna.
The common exor tendon origin (arrow) arises from the medial epicondyle (MED EPI) of the
humerus. Anterior band of the ulna collateral ligament (arrowheads).
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.
This page intentionally left blankThis page intentionally left blank
Musculoskeletal system
208
UPPER LIMB: WRIST
Dorsal tendons
PREPARATION
None.
POSITION
Palm placed face down on examination table.
TRANSDUCER
10.0–15.0 MHz linear transducer.
METHOD
The transducer is placed transversely across the wrist at the level of
the dorsal radial tubercle, Lister’s tubercle, and then moved to follow individual tendons. Each tendon is then examined transversely and
longitudinally.
APPEARANCE
The dorsal tendons course through six separate synovial compartments. The dorsal radial tubercle acts as an anatomical landmark separating the extensor pollicis longus, which lies on its ulnar side, from the
extensor carpi radialis brevis and longus, which lie on its radial side.
MEASUREMENTS
Compartments
Radial side 1. Abductor pollicis longus tendon (forms the volar
margin of anatomical snuff box) and extensor
pollicus brevis tendon (lies deep in the anatomical
snuff box)
2. Extensor carpi radialis longus and extensor carpi
radialis brevis tendons
3. Extensor pollicus longus tendon (forms dorsal margin
of anatomical snuff box and crosses over ECRL/
ECRB radially, distal to Lister’s tubercle)
4. Extensor digitorum and extensor indicis tendons
5. Extensor digiti minimi tendon
Ulnar side 6. Extensor carpi ulnaris tendon lying in a groove on
the medial ulna
Dorsal tendons
Transverse view of the dorsal tendons of the wrist. 1, APL and EPB; 2, ECRL and ECRB; 3,
EPL on the ulnar aspect of Lister’s tubercle (arrow); 4, ED and EI; 5, EDM; 6, ECU lying in a
groove on distal ulna.
FURTHER READING
Klauser AS, Halpern EJ, De Zordo T, Feuchtner GM, Arora R,
Gruber J, Martinoli C, Löscher WN. Carpal tunnel syndrome
assessment with US: Value of additional cross-sectional area
measurements of the median nerve in patients versus healthy
volunteers. Radiology. 2009; 250: 171–177.
Min-Kyu Kim MK, Jeon HJ, Park SH, Park DS, Nam HS. Value
of ultrasonography in the diagnosis of carpal tunnel syndrome:
Correlation with electrophysiological abnormalities and clinical
severity. J Korean Neurosurg Soc. 2014; 55:78–82.
Sofka CM. Ultrasound of the hand and wrist. Ultrasound
Quarterly. 2014; 30: 184–192.
209
Musculoskeletal system
210
Carpal tunnel
PREPARATION
None.
POSITION
Patient seated with palm face up on the examination table.
TRANSDUCER
10.0–15.0 MHz linear transducer.
METHOD
The transducer is placed transversely and then longitudinally across
the volar wrist at the level of the distal carpal crease.
APPEARANCE
The oor of the carpal tunnel is formed by the carpal bones and its roof
by the exor retinaculum, which attaches to the scaphoid tubercle and
the trapezium laterally and the pisiform and hook of hamate medially.
The median nerve lies just deep to the retinaculum at the radial aspect
of the carpal tunnel. Also within the tunnel lie the exor digitorum
supercialis and profundus tendons, and within its radial aspect, exor
pollicis longus and exor carpi radialis. Supercial to the ulna side
of the carpal tunnel lies Guyon’s canal containing the ulna nerve and
artery. Flexor carpi ulnaris lies medially and inserts into the pisiform.
Identication of the median nerve is aided by noting that in the distal
forearm it lies deep to exor digitorum supercialis, and more distally it courses around the radial aspect of these tendons to reach the
supercial carpal tunnel. In addition, it shows less movement on nger
exion/extension than the exor tendons. The cross-sectional area of
the nerve should be measured at the distal carpal crease (i.e., the level
of the pisiform and scaphoid tubercle). The wrist should be in neutral
position for a reproducible measurement.
Carpal tunnel
Transverse view through the carpal tunnel at the distal carpal crease, at the level of the
pisiform (PISI), showing the median nerve in cross-section (dashed line). (S, distal scaphoid)
211
Transverse view of the median nerve (dashed line) at the level of the pronator quadratus (PQ).
MEASUREMENTS
Improved diagnostic accuracy is obtained by determining the difference in the cross-sectional area of the median nerve at the carpal tunnel
and level of pronator quadratus.
Normal mean cross-sectional area
at the distal carpal crease (± SD)
Difference between cross-sectional
area at the distal carpal crease and
level of pronator quadratus
2
9.0 mm
(± 1.5 mm2) 0.25 mm2 (±0.43 mm2)
Musculoskeletal system
212
FURTHER READING
Klauser AS, Halpern EJ, De Zordo T, Feuchtner GM, Arora R,
Gruber J, Martinoli C, Löscher WN. Carpal tunnel syndrome
assessment with US: Value of additional cross-sectional area
measurements of the median nerve in patients versus healthy
volunteers. Radiology. 2009; 250:171–177.
Min-Kyu Kim MK, Jeon HJ, Park SH, Park DS, Nam HS. Value
of ultrasonography in the diagnosis of carpal tunnel syndrome:
Correlation with electrophysiological abnormalities and clinical
severity. J Korean Neurosurg Soc. 2014; 55:78–82.
Sofka CM. Ultrasound of the hand and wrist. Ultrasound
Quarterly. 2014; 30:184–192.
This page intentionally left blankThis page intentionally left blank
Musculoskeletal system
214
LOWER LIMB: HIPS
Hip effusion
PREPARATION
None.
POSITION
Supine.
TRANSDUCER
7.0–10.0 MHz linear transducer dependent on patient’s age.
METHOD
The transducer is placed along the length of the femoral neck.
APPEARANCE
The high-reective anterior capsule is identied anterior to the femoral
neck.
MEASUREMENTS
In children, separation of the capsule from the femoral neck is normally
2–4 mm, and a difference of 2 mm or more between symptomatic and
asymptomatic sides is considered signicant for a joint effusion.
In adults, the distance of the capsule from the femoral neck is normally
< 7 mm, and a difference of 1 mm or more between symptomatic and
asymptomatic sides is considered signicant for a joint effusion.
FURTHER READING
Bierma-Zeinstra SM, Bohnen AM, Verhaar JA, Prins A, Ginai-
Karamat AZ, Laméris JS. Sonography for hip joint effusion in
adults with hip pain. Ann Rheum Dis. 2000; 59:178–182.
Rohrschnieder WK, Fuchs G, Troger J. Ultrasonographic evaluation
of the anterior recess in the normal hip: A prospective study on
166 asymptomatic children. Pediat Radiol. 1006; 26: 629–634.
Hip effusion
Hip joint effusion can be assessed by measuring the distance between the femoral neck
(FN) and anterior joint capsule (not seen on this normal hip). (AC, acetabulum; FH, femoral
head; IL, iliopsoas muscle).
215