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Enzo Silvestri Alessandro Muda Davide Orlandi
Ultrasound Anatomy of Lower Limb Muscles
A Practical Guide
Foreword by
123
Ultrasound Anatomy of Lower Limb Muscles
Enzo Silvestri • Alessandro Muda Davide Orlandi
Ultrasound Anatomy of Lower Limb Muscles
A Practical Guide
Foreword by Nicola Maffulli
Enzo Silvestri Struttura Complessa di Diagnostica per Immagini ed Ecografi a Interventistica Ospedale Evangelico Internazionale Genoa Italy
Alessandro Muda Dipartimento di Radiologia IRCCS Ospedale San Martino IST Genoa Italy
Davide Orlandi Dipartimento di Radiologia Università degli studi di Genova Genoa Italy
ISBN 978-3-319-09479-3 ISBN 978-3-319-09480-9 (eBook) DOI 10.1007/978-3-319-09480-9 Springer Cham Heidelberg New York Dordrecht London
Library of Congress Control Number: 2014954746
© Springer International Publishing Switzerland 2015 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifi cally for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher’s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.
Printed on acid-free paper
Springer is part of Springer Science+Business Media (
www.springer.com)

Foreword

The principles of musculoskeletal medicine have been established centuries ago, and serve us well. The ‘look, feel move’ paradigm is engrained in our psyche. It allows us to be effi cient and effective, and guides accurate diagnosis and appropriate management. Nevertheless, to be accurate and effective, at times we need to extend the reach of our senses, and make sure that we have more objective elements to formulate a diagnosis, and to objectively assess whether our proposed management is working.
Ultrasonography has come to the forefront in the last few years: it is non- invasive, it is widely available, it has reached a level of image quality and a sophistication in techniques that allows a resolution of less that 2 mm, and it is relatively cheap. It has been criticised for being operator-dependent. This is partially true, but standardisation of imaging techniques and of reporting styles minimizes this latter concern. Health care professionals need to be trained in ultrasonography: it requires time, and to become experienced, errors have to be made, and cherished. Therefore, Drs. Silvestri, Muda, and Orlandi should be congratulated for several reasons: they have had the foresight of putting together a text which can be used as baseline for reference and teaching; they have succeeded in recruiting a whole series of authors who are at the forefront in this fi eld; and, last but not least, they have produced for themselves perpetual work: advances in this fi eld will require themselves and their authors to continue to update their knowledge, and put it forward to the readers.
I expect that my own copy will be well thumbed: one never ends learning in our fi eld, and Ultrasound Anatomy of Lower Limb Muscles: A Practical Guide makes it topical and pleasant.
Enjoy it!
London, UK N. Maffulli
v

Contents

Part I Basic Principles of Muscles Ultrasound
1 US Basic Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Silvia Perugin Bernardi, Alice Arcidiacono, and Enzo Silvestri
2 Doppler Technologies and Ultrasound Elastography . . . . . . . . 11
Riccardo Sartoris and Alessandro Muda
3 Normal Anatomy and Biomechanics . . . . . . . . . . . . . . . . . . . . . 17
Davide Orlandi and Silvia Perugin Bernardi
4 Ultrasound Basic Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Riccardo Sartoris and Enzo Silvestri
5 Muscles Dynamic US Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Davide Orlandi, Angelo Corazza, and Piero Gatto
6 Muscle Injuries: Pathophysiology
and New Classifi cation Models . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Nicola Maffulli, Angelo Del Buono, and Enzo Silvestri
Part II Thigh Muscles
7 Sartorius and Tensor Fasciae Latae . . . . . . . . . . . . . . . . . . . . . . 41
Davide Orlandi, Enzo Silvestri, and Luca Maria Sconfi enza
8 Iliopsoas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Emanuele Fabbro and Alessandro Muda
9 Quadriceps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Davide Orlandi and Giulio Ferrero
10 Adductors, Gracilis, and Pectineus . . . . . . . . . . . . . . . . . . . . . . 75
Angelo Corazza and Enzo Silvestri
11 Gluteal and Piriformis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Alice Arcidiacono and Alessandro Muda
12 Hamstrings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Davide Orlandi and Luca Maria Sconfi enza
vii
viii
Part III Leg Muscles
13 Popliteus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Riccardo Sartoris and Enzo Silvestri
14 Peroneal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Silvia Perugin Bernardi and Alessandro Muda
15 Triceps Surae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Davide Orlandi and Angelo Corazza
16 Flexor Muscles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Emanuele Fabbro, Giulio Ferrero, and Alessandro Muda
17 Extensor Muscles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Davide Orlandi and Alice Arcidiacono
Part IV Sectional Anatomical Tables
18 Thigh Compartments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Enzo Silvestri and Claudio Mazzola
19 Leg Compartments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
Alessandro Muda and Amedeo Baldari
Contents
Part I
Basic Principles of Muscles Ultrasound