Ultrasound imaging of the axilla

: Axilla is a pyramidal-in-shape "virtual cavity" housing multiple anatomical structures and connecting the upper limb with the trunk. To the best of our knowledge, in the pertinent literature, a detailed sonographic protocol to comprehensively assess the axillary region in daily practice is lacking. In this sense, the authors have briefly described the anatomical architecture of the axilla-also using cadaveric specimens-to propose a layer-by-layer sonographic approach to this challenging district. The most common sonographic pathological findings-for each and every anatomical compartment of the axilla-have been accurately reported and compared with the corresponding histopathological features. This ultrasound approach could be considered a ready-to-use educational guidance for the assessment of the axillary region. CRITICAL RELEVANCE STATEMENT: Axilla is a pyramidal-in-shape "virtual cavity" housing multiple anatomical structures and connecting the upper limb with the trunk. The aim of this review article was to describe the anatomical architecture of the axilla, also using cadaveric specimens, in order to propose a layer-by-layer sonographic approach to this challenging district

Ultrasound-Guided Interventions For Painful Shoulder: From Anatomy To Evidence

Shoulder pain is a common musculoskeletal disorder of variable etiology, ranging from rotator cuff pathology to peripheral nerve entrapment. Advances in ultrasound (US) technology have allowed static and dynamic evaluation of shoulder problems and most importantly, offer real-time, radiation-free guidance for interventions. The present review aims to describe shoulder anatomy in detail using information from cadaveric models and to illustrate US-guided techniques using clearly labeled figures and videos. The review will also present evidence of specific US-guided therapies for shoulder pain by summarizing landmark studies, systematic reviews, and meta-analyses. The following shoulder structures will be covered: 1) the biceps long head tendon, 2) the acromioclavicular joint, 3) the subacromial–subdeltoid bursa, 4) the glenohumeral joint, 5) the suprascapular nerve, and 6) the axillary nerve

Advanced Ankle and Foot Sonoanatomy: Imaging Beyond the Basics

Ankle/foot pain is a common complaint encountered in clinical practice. Currently, due to the complex anatomy, the diagnosis and management of the underlying musculoskeletal disorders are extremely challenging. Nowadays, high-resolution ultrasound has emerged as the first-line tool to evaluate musculoskeletal disorders. There have been several existing protocols describing the fundamental sonoanatomy of ankle/foot joints. However, there are certain anatomic structures (e.g., Lisfranc ligament complex or Baxter nerve) which are also clinically important. As they are rarely elaborated in the available literature, a comprehensive review is necessary. In this regard, the present article aims to brief the regional anatomy, illustrate the scanning techniques, and emphasize the clinical relevance of the ankle/foot region

Ulnar Wrist Pain Revisited

The triangular fibrocartilage complex (TFCC) serves as the major stabilizer of the wrist. Its injuries can result from trauma or degeneration, both of which are strongly correlated with the loading stress on the ulnar shaft and carpal joints. The TFCC is made of the articular disc, meniscus homologue, ulnocarpal ligament, radioulnar ligament, ulnotriquetral ligament, ulnolunate ligament, and subsheath of the extensor carpi ulnaris tendon. Because of its complexity, it is challenging to confirm the exact component affected in TFCC injuries. The Palmer classification is widely used for investigation of TFCC lesions using magnetic resonance imaging. Recently, high-resolution ultrasound (US) has become more popular in diagnosing musculoskeletal disorders. However, the utility of US imaging in TFCC lesions is less common because its anatomy under US imaging is not described in the current literature. Accordingly, in this review, we aimed to propose a standard US scanning protocol for the TFCC, present relevant images for its pathologies, and illustrate appropriate US-guided injection techniques for their management.PubMedWo

Enhancing diagnosis and treatment of superior cluneal nerve entrapment: cadaveric, clinical, and ultrasonographic insights

Abstract Objectives Low back pain is a prevalent public health issue caused by superior cluneal nerve (SCN) entrapment. This study aimed to explore the course of SCN branches, cross-sectional area (CSA) of the nerves, and effects of ultrasound-guided SCN hydrodissection. Methods SCN distance relative to the posterior superior iliac spines was measured and compared with ultrasound findings in asymptomatic volunteers. The CSA of the SCN, pressure-pain threshold, and pain measurements were obtained from asymptomatic controls and patients with SCN entrapment at various time points after hydrodissection (with 1 mL of 50% dextrose, 4 mL of 1% lidocaine, and 5 mL of 1% normal saline) in the short-axis view. Results Twenty sides of 10 formalin-fixed cadavers were dissected. The SCN locations on the iliac crest did not differ from the ultrasound findings in 30 asymptomatic volunteers. The average CSA of the SCN across different branches and sites ranged between 4.69–5.67 mm2 and did not vary across different segments/branches or pain statuses. Initial treatment success was observed in 77.7% (n = 28) of 36 patients receiving hydrodissection due to SCN entrapment. A group with initial treatment success experienced symptom recurrence in 25% (n = 7) of cases, and those with recurrent pain had a higher prevalence of scoliosis than those without symptom recurrence. Conclusions Ultrasonography effectively localizes SCN branches on the iliac crest, whereby increased nerve CSA is not useful for diagnosis. Most patients benefit from ultrasound-guided dextrose hydrodissection; however, those with scoliosis may experience symptom recurrence and whether structured rehabilitation can reduce recurrence post-injection should be considered as one perspective in future research. Trial registration ClinicalTrials.gov (NCT04478344). Registered on 20 July 2020, https://clinicaltrials.gov/ct2/show/NCT04478344?cond=Superior+Cluneal+Nerve&cntry=TW&draw=2&rank=1 . Critical relevance statement Ultrasound imaging accurately locates SCN branches on the iliac crest, while enlargement of the CSA is not useful in diagnosing SCN entrapment; however, approximately 80% of SCN entrapment cases respond positively to ultrasound-guided dextrose hydrodissection. Graphical abstrac

Ultrasound imaging of the posterior lateral corner of the knee: a pictorial review of anatomy and pathologies

Abstract Assessment of the posterior lateral knee pain poses diagnostic challenges, requiring accurate evaluation of various structures in light of the medical history and physical examination. Despite substantial progress in the ultrasonographic diagnosis of musculoskeletal disorders, the current protocol (EURO-MUSCULUS/USPRM. Basic scanning protocols for knee) fails to conduct a comprehensive investigation into the intricate, tendons, and ligaments of the posterior lateral knee. This pictorial review aims to bridge this gap by offering a systematic approach to utilize ultrasound examination of the less-discussed structures in this specific region. Providing cadaveric and magnetic resonance images, this essay demonstrates the efficacy of ultrasound in diagnosing posterior lateral knee pain. Notably, pathologies such as ligamentous sprains and tears are clearly discernible. Moreover, the integration of ultrasound guidance plays a vital role in reducing the risk of inadvertent neurovascular injury during injection, such as the common peroneal nerve and lateral genicular artery. This comprehensive approach will enhance clinicians’ understanding and equip them with effective management strategies for posterior lateral knee pain. Critical relevance statement In this visual exposition, we delve into the intricacies of the posterior lateral corner of the knee. Offering a methodical approach to employ ultrasound for visualization of the less-explored structures within this region, the authors aim to enhance the diagnosis in posterior lateral knee pain. Key points 1. Ultrasound excels at revealing intricate structures in the posterior lateral knee. 2. Due to proximity of vital structures, extreme caution is crucial during injections. 3. Employing dynamic scan and understanding ligaments enables a comprehensive exploration of pathologies. Graphical Abstrac

Ischiofemoral Impingement Syndrome: Clinical and Imaging/Guidance Issues with Special Focus on Ultrasonography

Ischiofemoral impingement syndrome is a neglected cause of posterior hip pain which is derived from narrowing of the space between the lateral aspect of the ischium and the medial aspect of the lesser trochanter. Its diagnosis is challenging and requires the combination of physical tests and imaging studies. In the present narrative review, we found that femoral anteversion predisposes patients to the narrowing of the ischiofemoral space and subsequent quadratus femoris muscle injury. Magnetic resonance imaging serves as the gold-standard diagnostic tool, which facilities the quantification of the ischiofemoral distance and the recognition of edema/fat infiltration/tearing of the quadratus femoris muscle. Ultrasound is useful for scrutinizing the integrity of deep gluteal muscles, and its capability to measure the ischiofemoral space is comparable to that of magnetic resonance. Various injection regimens can be applied to treat ischiofemoral impingement syndrome under ultrasound guidance and they appear to be safe and effective. Finally, more randomized controlled trials are needed to build solid bases of evidence on ultrasound-guided interventions in the management of ischiofemoral impingement syndrome

Ischiofemoral Impingement Syndrome: Clinical and Imaging/Guidance Issues with Special Focus on Ultrasonography

Ischiofemoral impingement syndrome is a neglected cause of posterior hip pain which is derived from narrowing of the space between the lateral aspect of the ischium and the medial aspect of the lesser trochanter. Its diagnosis is challenging and requires the combination of physical tests and imaging studies. In the present narrative review, we found that femoral anteversion predisposes patients to the narrowing of the ischiofemoral space and subsequent quadratus femoris muscle injury. Magnetic resonance imaging serves as the gold-standard diagnostic tool, which facilities the quantification of the ischiofemoral distance and the recognition of edema/fat infiltration/tearing of the quadratus femoris muscle. Ultrasound is useful for scrutinizing the integrity of deep gluteal muscles, and its capability to measure the ischiofemoral space is comparable to that of magnetic resonance. Various injection regimens can be applied to treat ischiofemoral impingement syndrome under ultrasound guidance and they appear to be safe and effective. Finally, more randomized controlled trials are needed to build solid bases of evidence on ultrasound-guided interventions in the management of ischiofemoral impingement syndrome

EURO-MUSCULUS/USPRM Dynamic Ultrasound Protocols for (Adult) Hip

In this dynamic scanning protocol, ultrasound assessment of the adult hip is described using different maneuvers for various conditions. Real-time patient examination and ultrasound scanning videos are coupled for convenience as well as for better insight. The text covers the common conditions around the hip where especially dynamic ultrasound scanning provides valuable information in addition to static imaging. The protocol is prepared by an international consensus of several experts in the field of musculoskeletal ultrasound