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Ankle and Foot Anatomy Osseous Anatomy The ankle joint is a hinged synovial articulation between the talus and the distal tibia and fibula ( Fig. 8.1 ). Inferiorly, the talus articulates with the calcaneus through three facets, joined by the cervical and interosseous talocalcaneal ligaments located in a cone-shaped region termed the sinus tarsi, which opens laterally. The Chopart joint represents the articulations between the talus…
Knee Anatomy The knee is a synovial joint that consists of hyaline cartilage articulations between the femur, the tibia, and the patella ( Fig. 7.1 ). The menisci are C-shaped fibrocartilage structures between the femur and the tibia ( Fig. 7.1E ). A prominent joint recess, the suprapatellar recess or pouch, extends superiorly from the knee joint between the patella and the femur and communicates with…
Hip and Thigh Anatomy The hip joint is a synovial articulation between the acetabulum of the pelvis and the proximal femur. The joint recess extends from the acetabulum over the femur to the level of the intertrochanteric line, just beyond the femoral neck. The joint capsule becomes thickened from the iliofemoral, ischiofemoral, and pubofemoral ligaments ( Fig. 6.1 ), and a reflection of the joint capsule…
Wrist and Hand Anatomy The wrist consists of several synovial articulations among the distal radius, the distal ulna, the proximal carpal row (scaphoid, lunate, triquetrum, pisiform), and the distal carpal row (trapezium, trapezoid, capitate, and hamate). The radiocarpal joint between the distal radius and the proximal carpal row and the distal radioulnar joint between the radius and the ulna are separated by fibrocartilage, called the triangular…
Elbow Anatomy The elbow is a synovial joint composed of three elbow joint articulations: the trochlea and ulna, the capitellum and the radial head, and the proximal ulna and radius ( Fig. 4.1 ). The elbow joint has prominent joint recesses located in the coronoid and radial fossae anteriorly and within the olecranon fossa posteriorly. Within each joint recess exists an intracapsular but extrasynovial fat pad,…
The rotator cuff is composed of four tendons ( Fig. 3.1 ). Anteriorly, the subscapularis with its tendons converges onto the lesser tuberosity. Superiorly, the supraspinatus inserts on the superior aspect of the greater tuberosity; its footprint or attachment averages 2.25 cm anterior to posterior, which covers the superior facet and the anterior portion of the middle facet of the greater tuberosity ( Fig. 3.2 ). Uncommonly,…
Muscle and Tendon Injury Muscle and tendon injuries may be categorized as acute and chronic. Acute injuries tend to take the form of direct impact injury, stretch injury during contraction (strain), or penetrating injury. Acute muscle injury can be clinically categorized as grade 1 (no appreciable fiber disruption), grade 2 (partial tear or moderate fiber disruption with compromised strength), and grade 3 (complete fiber disruption). At…
Introduction Single-injection ultrasound-guided peripheral nerve blocks (USGNBs) are ideal for pain relief from acute injuries and adjunct analgesic for painful procedures. By injecting local anesthetic adjacent to the nerve, both motor and sensory innervation distally can be “blocked.” Depending on the efficacy of the USGNB, adjunctive therapies (such as intravenous medications) can be employed to achieve maximal patient comfort. Incorporation of USGNBs into clinical practice allows…
Introduction Since 2001 the Agency for Healthcare Research and Quality (AHRQ) and the American College of Emergency Physicians (ACEP) have recommended the use of ultrasound guidance for the placement of central venous catheters. The superiority of ultrasound guidance over traditional landmark-based approaches is well established in the emergency medicine literature and is a skill that all acute care practitioners should master. Ultrasound is utilized to improve…
Pericardiocentesis Introduction Performing a pericardiocentesis in an unstable patient with cardiac tamponade is a lifesaving procedure. Pericardial fluid is a common finding on point-of-care echocardiography examination and can occur from many systemic disease processes or trauma. The normal pericardial space usually contains 15 to 50 mL of fluid, which acts as a lubricant between the visceral and parietal layers of the pericardium. An increase in fluid…
Introduction Musculoskeletal ultrasound has become increasingly common over the last two decades. The possibility of a real-time, dynamic imaging modality that is both low cost and safe are among the key driving forces making this an important component of patient care for orthopedic presentations. Ultrasound-guided diagnostic and therapeutic procedures have become the cornerstone of many nonoperative sports medicine practices, as ultrasound guidance increases the efficacy and…
Clinical Considerations Ultrasound is an ideal modality to supplement evaluation of the soft tissue. The high–frequency linear transducer produces a detailed image of the area in question. By adding dynamic interrogation, such as manual compression or color flow, we can further characterize the findings to help confirm or rule out many common diagnoses. Soft tissue infections, including cellulitis and abscess, are extremely prevalent, and becoming more…
Peripheral Artery Disease Patients may present with acute or chronic lower extremity arterial insufficiency. Chronic lower extremity arterial insufficiency is typically secondary to atherosclerosis. Atherosclerosis is a gradual, degenerative disease where plaque accumulates in the wall of the artery and typically causes gradual, progressive clinical manifestations. However, plaques may become unstable and result in acute ischemic symptoms as well. The two primary risk factors for chronic…
Anatomy This chapter is different from other chapters, in that there may be a variety of causes and different anatomic regions may be the etiology of pain in later pregnancy. As for anatomic considerations, the main focus of this chapter will be on obstetrical etiologies of pain and/or bleeding. Much of the focus will be on the placenta, cervix, umbilical cord, and amniotic fluid. During the…
Normal First-Trimester Ultrasound Appearance Pelvic ultrasound is the key imaging modality in the diagnosis of early pregnancy and its associated complications. Both transabdominal and transvaginal sonography (TVS) techniques are used. Gestational Sac Intradecidual Sign The intradecidual sign refers to an eccentric, extraluminal, rounded, cystic structure located within the endometrium. It is the earliest imaging sign of an intrauterine pregnancy (IUP) on TVS and is observed as…
Normal Anatomy The uterus is composed of the muscular layer, or myometrium. The body is the main portion of the uterus. The fundus is a more superior portion above the body of the uterus. The areas of the uterus where the fallopian tubes enter are called the cornua . The inferior portion of the uterus is the cervix. Peritoneal reflections are noted both anterior to the…
Scrotum Normal Anatomy The surface of the testis is surrounded by the tunica vaginalis, which extends to the inner surface of the scrotal wall in continuity. A trace amount of fluid in between both layers allows a high mobility of the testis. This arrangement is similar to the pleura with the visceral and parietal layers that allow the lung excursion. Adult measurements of the testis are…
Bowel Ultrasound Normal Anatomy The small bowel consists of the bowel distal to the stomach and proximal to the colon. It is approximately 5 meters long and includes the duodenum, jejunum, and ileum. The small bowel contains prominent mucosal folds known as plicae circulares or valvular connvinetes . The jejunum has the most developed and highest concentration of these folds, which remain present even in distended…
Introduction Patients with aortic pathology often present with nonspecific complaints or presentations such as back pain, abdominal pain, myocardial infarction (MI), or even stroke, making the diagnosis difficult. The adage of “abdominal pain plus one other organ system” should prompt the physician to consider aortic pathology as the unifying diagnosis. The level and acuity of pain often is secondary to the etiology of the pain. For…