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Introduction/Getting Started

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Manual of Musculoskeletal Ultrasound

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Abstract

This chapter is the launching pad. It explains how musculoskeletal ultrasound can enhance patient care and the reasoning behind protocol-based image acquisition. This book differs from other musculoskeletal ultrasound textbooks since the focus is on image acquisition and clinical utility and is directed toward the practitioner without formal ultrasound training or access to an ultrasound teacher. We attempt to avoid dry recitation of facts but instead use various mnemonic devices, particularly whimsical cartoon images, to amusingly (or painlessly) emphasize information. Every field of endeavor has jargon, with musculoskeletal ultrasound being no exception. This chapter explains terms such as echotexture, forms of echogenicity, frequency, longitudinal and transverse axes, grayscale, and Doppler imaging. Probe techniques, including positioning, and movements, are explained and illustrated. Ultrasonic characteristics of a variety of normal and abnormal tissues are also described. Ultrasound offers a virtual representation of actual reality. Certain artifacts are formed as by-products. Once the mechanism of artifact creation is understood, these pesky artifacts transform into indispensable assets. This chapter also offers practical tips about image acquisition, crafting useful ultrasound reports, methods of integration into a busy practice, pitfalls inevitably encountered, and pragmatic reference book recommendations.

The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.

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References

  1. Brandli L. Benefits of protocol-driven ultrasound exams. Radiol Manag. 2007;29(4):56–9.

    Google Scholar 

  2. Jacobson JA. Fundamentals of musculoskeletal ultrasound. 3rd ed. Philadelphia, PA: Elsevier; 2018.

    Google Scholar 

  3. Bianchi S, Martinoli C. Ultrasound of the musculoskeletal system. New York: Springer; 2007.

    Google Scholar 

  4. Minagawa H, Wong KH. Musculoskeletal ultrasound: echo anatomy & scan technique. Amazon Digital Services; 2017.

    Google Scholar 

  5. Kohler MJ. Musculoskeletal ultrasound in rheumatology review. Cham: Springer International Publishing; 2016.

    Book  Google Scholar 

  6. Enriquez JL, Wu TS. An introduction to ultrasound equipment and knobology. Crit Care Clin. 2014;30(1):25–45, v.

    Article  PubMed  Google Scholar 

  7. Kim SY, Cheon JH, Seo WJ, Yang GY, Choi YM, Kim KH. A pictorial review of signature patterns living in musculoskeletal ultrasonography. Korean J Pain. 2016;29(4):217–28.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Ihnatsenka B, Boezaart AP. Ultrasound: basic understanding and learning the language. Int J Shoulder Surg. 2010;4(3):55–62.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Connolly DJ, Berman L, McNally EG. The use of beam angulation to overcome anisotropy when viewing human tendon with high-frequency linear array ultrasound. Br J Radiol. 2001;74(878):183–5.

    Article  CAS  PubMed  Google Scholar 

  10. Jacobson JA. Introduction. In: Fundamentals of musculoskeletal ultrasound. 3rd ed. Philadephia, PA: Elsevier; 2018. p. 1–15.e1.

    Google Scholar 

  11. Boote EJ. AAPM/RSNA physics tutorial for residents: topics in US: Doppler US techniques: concepts of blood flow detection and flow dynamics. Radiographics. 2003;23(5):1315–27.

    Article  PubMed  Google Scholar 

  12. Torp-Pedersen ST, Terslev L. Settings and artefacts relevant in colour/power Doppler ultrasound in rheumatology. Ann Rheum Dis. 2008;67(2):143–9.

    Article  CAS  PubMed  Google Scholar 

  13. Torp-Pedersen S, Christensen R, Szkudlarek M, Ellegaard K, D’Agostino MA, Iagnocco A, et al. Power and color Doppler ultrasound settings for inflammatory flow: impact on scoring of disease activity in patients with rheumatoid arthritis. Arthritis Rheumatol. 2015;67(2):386–95.

    Article  PubMed  Google Scholar 

  14. Jaeger KA, Imfeld S. The damaging effect of ultrasound—to the examiner. Ultraschall Med. 2006;27(2):131–3.

    Article  CAS  PubMed  Google Scholar 

  15. Schmidt W. Introduction: musculoskeletal ultrasound indications and fundamentals. In: Kohler MJ, editor. Musculoskeletal ultrasound in rheumatology review. Cham: Springer International Publishing; 2016. p. 1–21.

    Google Scholar 

  16. Bruyn GA, Iagnocco A, Naredo E, Balint PV, Gutierrez M, Hammer HB, et al. OMERACT definitions for ultrasonographic pathologies and elementary lesions of rheumatic disorders 15 years on. J Rheumatol. 2019;46(10):1388.

    Article  PubMed  Google Scholar 

  17. Blankstein A. Ultrasound in the diagnosis of clinical orthopedics: the orthopedic stethoscope. World J Orthop. 2011;2(2):13–24.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Martinoli C, Derchi LE, Pastorino C, Bertolotto M, Silvestri E. Analysis of echotexture of tendons with US. Radiology. 1993;186(3):839–43.

    Article  CAS  PubMed  Google Scholar 

  19. Kory PD, Pellecchia CM, Shiloh AL, Mayo PH, DiBello C, Koenig S. Accuracy of ultrasonography performed by critical care physicians for the diagnosis of DVT. Chest. 2011;139(3):538–42.

    Article  PubMed  Google Scholar 

  20. Martinoli C, Serafini G, Bianchi S, Bertolotto M, Gandolfo N, Derchi LE. Ultrasonography of peripheral nerves. J Peripher Nerv Syst. 1996;1(3):169–78.

    CAS  PubMed  Google Scholar 

  21. Ceponis A, Kissin E. Ultrasound of the hand and wrist. In: Kohler MJ, editor. Musculoskeletal ultrasound in rheumatology review. 2nd ed. Springer; 2021. p. 53–82.

    Chapter  Google Scholar 

  22. Hamidi M, Kliot M, Gallagher T, Hopkins B, Younger J, Liu B, et al. The utility of multimodality perioperative imaging in peripheral nerve interventions. J Neurosurg Imaging Techn. 2017;2(1):106–17.

    Google Scholar 

  23. Franchi MV, Raiteri BJ, Longo S, Sinha S, Narici MV, Csapo R. Muscle architecture assessment: strengths, shortcomings and new frontiers of in vivo imaging techniques. Ultrasound Med Biol. 2018;44(12):2492–504.

    Article  PubMed  Google Scholar 

  24. Alves TI, Girish G, Kalume Brigido M, Jacobson JA. US of the knee: scanning techniques, pitfalls, and pathologic conditions. Radiographics. 2016;36(6):1759–75.

    Article  PubMed  Google Scholar 

  25. D’Agostino MA, Terslev L, Aegerter P, Backhaus M, Balint P, Bruyn GA, et al. Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce-part 1: definition and development of a standardised, consensus-based scoring system. RMD Open. 2017;3(1):e000428.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Ettema AM, Zhao C, Amadio PC, O’Byrne MM, An KN. Gliding characteristics of flexor tendon and tenosynovium in carpal tunnel syndrome: a pilot study. Clin Anat. 2007;20(3):292–9.

    Article  PubMed  Google Scholar 

  27. Mascarenhas S. A narrative review of the classification and use of diagnostic ultrasound for conditions of the achilles tendon. Diagnostics (Basel, Switzerland). 2020;10(11):944.

    PubMed  Google Scholar 

  28. Benjamin M, Kaiser E, Milz S. Structure-function relationships in tendons: a review. J Anat. 2008;212(3):211–28.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Robinson P. Sonography of common tendon injuries. Am J Roentgenol. 2009;193(3):607–18.

    Article  Google Scholar 

  30. Suzuki T, Shirai H. SAT0570 Clinical significance of finger extensor paratenonitis detected by musculoskeletal ultrasound. Ann Rheum Dis. 2020;79(Suppl 1):1243–4.

    Article  Google Scholar 

  31. Wakefield RJ, Balint PV, Szkudlarek M, Filippucci E, Backhaus M, D’Agostino MA, et al. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol. 2005;32(12):2485–7.

    PubMed  Google Scholar 

  32. Schmidt WA, Schmidt H, Schicke B, Gromnica-Ihle E. Standard reference values for musculoskeletal ultrasonography. Ann Rheum Dis. 2004;63(8):988–94.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Craig JG, Jacobson JA, Moed BR. Ultrasound of fracture and bone healing. Radiol Clin N Am. 1999;37(4):737–51, ix.

    Article  CAS  PubMed  Google Scholar 

  34. Kele H. Ultrasonography of the peripheral nervous system. Pers Med. 2012;1(1):417–21.

    Google Scholar 

  35. Grassi W, Lamanna G, Farina A, Cervini C. Sonographic imaging of normal and osteoarthritic cartilage. Semin Arthritis Rheum. 1999;28(6):398–403.

    Article  CAS  PubMed  Google Scholar 

  36. Gutierrez M, Schmidt WA, Thiele RG, Keen HI, Kaeley GS, Naredo E, et al. International consensus for ultrasound lesions in gout: results of Delphi process and web-reliability exercise. Rheumatology. 2015;54(10):1797–805.

    Article  PubMed  Google Scholar 

  37. Nazarian LN, Jacobson JA, Benson CB, Bancroft LW, Bedi A, McShane JM, et al. Imaging algorithms for evaluating suspected rotator cuff disease: Society of Radiologists in ultrasound consensus conference statement. Radiology. 2013;267(2):589–95.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Jacobson JA. Shoulder US: anatomy, technique, and scanning pitfalls. Radiology. 2011;260(1):6–16.

    Article  PubMed  Google Scholar 

  39. Smith J, Finnoff JT. Diagnostic and interventional musculoskeletal ultrasound: part 2. Clinical applications. PM R. 2009;1(2):162–77.

    Article  PubMed  Google Scholar 

  40. Dong Q, Fessell DP. Achilles tendon ultrasound technique. AJR Am J Roentgenol. 2009;193(3):W173.

    Article  PubMed  Google Scholar 

  41. Carroll M, Dalbeth N, Allen B, Stewart S, House T, Boocock M, et al. Ultrasound characteristics of the achilles tendon in tophaceous gout: a comparison with age- and sex-matched controls. J Rheumatol. 2017;44(10):1487–92.

    Article  PubMed  Google Scholar 

  42. Speer KP, Lohnes J, Garrett WE. Radiographic imaging of muscle strain injury. Am J Sports Med. 1993;21(1):89–96.

    Article  CAS  PubMed  Google Scholar 

  43. Pillen S, van Alfen N. Skeletal muscle ultrasound. Neurol Res. 2011;33(10):1016–24.

    Article  PubMed  Google Scholar 

  44. Bianchi S, Martinoli C. Detection of loose bodies in joints. Radiol Clin N Am. 1999;37(4):679–90.

    Article  CAS  PubMed  Google Scholar 

  45. Jacobson JA, Lancaster S, Prasad A, van Holsbeeck MT, Craig JG, Kolowich P. Full-thickness and partial-thickness supraspinatus tendon tears: value of US signs in diagnosis. Radiology. 2004;230(1):234–42.

    Article  PubMed  Google Scholar 

  46. Martinoli C, Bianchi S, Prato N, Pugliese F, Zamorani MP, Valle M, et al. US of the shoulder: non-rotator cuff disorders. Radiographics. 2003;23(2):381–401; quiz 534.

    Article  PubMed  Google Scholar 

  47. Zhang A, Falkowski AL, Jacobson JA, Kim SM, Koh SH, Gaetke-Udager K. Sonography of wrist ganglion cysts: which location is Most common? J Ultrasound Med. 2019;38(8):2155–60.

    Article  PubMed  Google Scholar 

  48. Abhishek A, Doherty M. Update on calcium pyrophosphate deposition. Clin Exp Rheumatol. 2016;34(4 Suppl 98):32–8.

    PubMed  Google Scholar 

  49. Baad M, Lu ZF, Reiser I, Paushter D. Clinical Significance of US artifacts. Radiographics. 2017;37(5):1408–23.

    Article  PubMed  Google Scholar 

  50. Day AL, Greenberg MH. Reverberation artifacts. Unpublished Data; 2020.

    Google Scholar 

  51. Taljanovic MS, Melville DM, Scalcione LR, Gimber LH, Lorenz EJ, Witte RS. Artifacts in musculoskeletal ultrasonography. Semin Musculoskelet Radiol. 2014;18(1):3–11.

    Article  PubMed  Google Scholar 

  52. Feldman MK, Katyal S, Blackwood MS. US artifacts. Radiographics. 2009;29(4):1179–89.

    Article  PubMed  Google Scholar 

  53. Lichtenstein D. Lung ultrasound in the critically ill. Curr Opin Crit Care. 2014;20(3):315–22.

    Article  PubMed  Google Scholar 

  54. Bonhof JA. Ultrasound artifacts—part 1. Ultraschall Med. 2016;37(2):140–53; quiz 54–5.

    CAS  PubMed  Google Scholar 

  55. Thiele RG. Rheumatologic findings. In: Daniels JM, Dexter WW, editors. Basics of musculoskeletal ultrasound. New York: Springer; 2013. p. 119–26.

    Chapter  Google Scholar 

  56. AIUM practice guideline for documentation of an ultrasound examination. J Ultrasound Med. 2014;33(6):1098–102.

    Google Scholar 

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Acknowledgment

While writing this Manual, we encountered several commonly used descriptive terms (e.g., tram-tracking, Popeye’s sign, etc.) that have become part of the MSUS lexicon. Every effort has been made to track down the first usage of these terms to acknowledge their provenance and recognize their creator. Sometimes, however, we can not find the origin of these widely used terms. We do not assume credit for or imply authorship of these terms and would like to recognize the unheralded creators of these wonderfully evocative terms and expressions.

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Authors and Affiliations

  1. Division of Rheumatology, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, SC, USA

    Mark H. Greenberg

  2. Division of Rheumatology, Columbia VA Health Care System, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, SC, USA

    Alvin Lee Day

  3. Department of Medicine, Division of Rheumatology, Advocate Christ Medical Center, Advocate Medical Group, Chicago, IL, USA

    Suliman Alradawi

Authors
  1. Mark H. Greenberg
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  2. Alvin Lee Day
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  3. Suliman Alradawi
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Corresponding author

Correspondence to Mark H. Greenberg .

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Greenberg, M.H., Day, A.L., Alradawi, S. (2023). Introduction/Getting Started. In: Manual of Musculoskeletal Ultrasound . Springer, Cham. https://doi.org/10.1007/978-3-031-37416-6_1

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  • DOI: https://doi.org/10.1007/978-3-031-37416-6_1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-37415-9

  • Online ISBN: 978-3-031-37416-6

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