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急診進階軟組織及關
節超音波
台大雲林分院 急診醫學部
急診醫學會 超音波委員會
蔡揚名
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使用探頭
線型:High frequency (7~12 MHz)
解像力好 穿透力較差 適合淺層
soft tissue 血管 神經等掃描
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(尤其只有腹部探頭時)
WATER -FILLED GLOVE
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高解析線形探頭 (5-10MHz) 為第一首選 注意深度(depth) 和焦點(focus) 的設定
至少掃描兩個介面 (longitudinal & transverse)
考慮和正常側比較 & 呈現在同一畫面 (Splitscreen)
如何改善掃描品質
– Stand-off pad
– Water/gel-filled glove
– Water bath technique
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ECHOGENICITY
Skin – Echogenic
Subcutaneous tissue – Hypoechoic and traverse by
irregular strands of hyperechoic connective tissue
Fascial planes – Hyperechoic; regular thickness
Muscles – Striated appearance on long axis scan
Tendon – Fibrillar; echogenic
Vascular structures – Anechoic
Lymph nodes – Irregular, circular, echogenic; withhypoechoic rim
Bones – Echogenic cortices and dense acoustic shadows
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TENDONS
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MUSCLELongitudinal Cross section
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NERVES
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BONE
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ANISOTROPY ACHILLES TENDON
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Piezo electric crystals
Ultrasound waves
Anisotropy
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ADVANCED MSK ULTRASOUND
Shoulder
Knee
Ankle and Foot
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LIGAMENT AND TENDON INJURY
1. Increased vascularity
2. Increased thickness
3. Reduced echogenicity or heterogenous
4. Loss of fibrous structures
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SHOULDER
1. Long head of Biceps Tendon
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SubS, subscapularis tendon; SupraS, supraspinatus tendon; Arrow, long
head of the biceps tendon;
LT, lesser tuberosity; GT, greater tuberosity; SH, short head of the biceps;
LH, long head of the biceps; H,
humeral shaft; Arrowheads, pectoralis major tendon
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2. Subscapularis tendon
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Legend: Arrow, long head of the biceps tendon; dashed line, insertion of the
subscapularis tendon; Co, coracoid;
Del, deltoid muscle; LT, lesser tuberosity; SubS, subscapularis tendon; void
arrowheads, tendon fascicles
of the subscapularis; white arrowheads, muscle tissue interposed between tendon
fascicles
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3.
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4. Supraspinatus tendon
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Legend: Acr, acromion; asterisk, myotendinous junction; Del, deltoid muscle; GT,
greater tuberosity; void
arrow-head, articular cartilage; curved arrow, hypoechoic artifact related to
anisotropy; straight arrow, long
head of the biceps tendon; SupraS, supraspinatus tendon; white arrowhead,
subacromial subdeltoid bursa
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5.
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Legend: asterisk, spine of the scapula; dashed line, spine of the scapula; Del,
deltoid muscle; GT, greater tuberosity;
InfraS, infraspinatus muscle; Tm, teres minor muscle; void arrow, teres minor
tendon; white arrows,
infraspinatus tendon
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K NEE
1. Suprapatellar recess
Supine, forceful extention
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2. Quadricep tendon
Flexion 30 degree
Legend: arrows, quadriceps tendon; 1,
superficial layer (from rectus femoris); 2,intermediate layer (from vastus lateralis
and vastus medialis); 3, deep layer
(from
vastus intermedius); F, femur; P, patella;
Vlat, vastus lateralis muscle; Vmed,
vastus
medialis muscle; Vint, vastus interme
dius muscle
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3. Patellar tendon
Flexion 60~70 degree
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4. MCL and Medial meniscus
MCL: flexion 60~90 degree,
Meniscus: extension and Hip external rotation
Legend: void arrows, medial collateral ligament;
asterisk, medial meniscus; void arrowheads,superficial portion of
medial collateral ligament; white arrowheads,
meniscofemoral ligament; white arrows, pes
anserinus complex insertion
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5. LCL and Medial meniscus
LCL: flexion 60~90 degree,
Meniscus: extension and Hip internal rotation
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6. Baker’s cystsemimembranosus-gastrocnemius bursa
(Prone and full extension)
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ANKLE
1. Anterior recess of ankle joint
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2. Anterior Talofibular Ligament (ATFL)
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3. Anterior Inferior Tibiofibular Ligament (AITFL)
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4. Calcaneofibular Ligament (CFL)
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5. Deltoid Ligament
Legend: Deltoid ligament components. 1,tibiotalar ligament; 2, tibiocalcanear
ligament; 3, tibionavicular ligament
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Legend: arrows, posterior tibial tendon; MM,
medial malleolus; void arrowheads, tibiotalar ligament; white
arrowheads, tibiocalcanear ligament;
Calc, calcaneus
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6. Achilles Tendon
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7. Plantar Fascia
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SPECIAL THANKS TO~~
台大復健部的指導老師們
Reference:
1.European Society of MusculoskeletalRadiology
2. 醫用超音波學會 骨骼肌肉系統工作坊
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線上超音波教學推薦網站
http://vimeo.com/hqmeded/videos
T
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THANKS FOR YOUR
ATTENTION !!