MSK/Soft Tissue

Learning Objectives:

  1. Describe the indications and limitations of US of MSK structures

  2. Perform US to evaluate various MSK pathologies

  3. Identify relevant US anatomy, structures of common indications (skin/soft tissues, tendon rupture, tenosynovitis, joint effusion, fractures)

  4. Recognize the relevant findings and pitfalls when evaluating for soft tissue infections, fractures, abscesses and other MSK scans


Indications:

  • Tendon/ligamentous tears or tendonitis

  • Inflammation or fluid (effusions) within the bursae and joints

  • Abscess/Cellulitis/Necrotizing fasciitis

  • Foreign bodies in the soft tissues (such as splinters or glass)

  • Fractures or dislocations


Extended indications:

  • Confirmation of joint dislocation/reduction

  • Diagnosis of fracture

Required Views:

Unaffected tibia in transverse view.

c/o Santiago Tovar, MD

Unaffected tibia in sagittal view.

c/o Santiago Tovar, MD

Affected tibia in transverse view.

c/o Santiago Tovar, MD

Affected tibia in sagittal view demonstrating displaced fracture.

c/o Santiago Tovar, MD

How to Scan:

ACEP Sonoguide: Soft Tissue Ultrasound

ACEP Sonoguide: Pediatric Hip

Core Ultrasound: MSK

POCUS 101: Shoulder Ultrasound Made Easy

ALiEM Educational Videos: Shoulder Dislocation Ultrasound Guided Injection

Taming the SRU - Musculoskeletal US

Tips/Tricks/Pitfalls:

  • Place the patient in a comfortable position so the area of concern is easily accessible

  • Do not skip the unaffected side, this gives a great reference for normal and abnormal

  • Utilize split screen to compare both sides simultaneously to more clearly visualize asymmetry and potential abnormalities

  • Recommend the linear probe for most indications, but in some cases the curvilinear probe may be more useful (deeper structures or joints)

Pathology:

Cobblestoning seen in a patient with cellulitis.

c/o Ibrahim Mansour, MD

Sagittal view of achilles tendon rupture.

c/o Jasmine Hill, MD

Groin abscess.

c/o Katherine Aulis, MD

Extensor tenosynovitis in a patient following a cat bite.

Necrotizing fasciitis. Note air under the tendon.

c/o Adam Roussas, MD

Anterior shoulder dislocation/reduction.

c/o Victoria Gonzalez, MD

Wooden foreign body visualized with water bath.

c/o Samson Frendo, MD

Transverse view of knee effusion.

c/o Michael Dorritie, MD