INTRODUCTION TO MUSCULOSKELETAL US

HOSSAM MOUSSA SAKR

Professor of Radiology
Ain Shams University
Cairo, Egypt
 Objectives
By the end of this lecture, we should know:
➢ Ethical aspects of MSK US.
➢ Technical aspects of MSK US.
➢ Components of the MSK system that could be
examined by MSK US.
➢ Normal US appearance of different components of
the MSK system.
➢ Advantages & Limitations of MSK US.
 Ethical considerations

➢ Keep patient’s privacy & respect his/her ethics.

➢ Revise the patient request & Do not perform an
examination you are not capable of doing it.
➢ Listen to the patient’s complaint on his/her own words.
➢ Ask about prior studies, surgical interventions, …. etc.
➢ Explain the procedure to the patient.
➢ Explain the result of the study to the patient.
➢ Avoid any possible “ conflict of interest”
 Technical aspects

➢ Use the highest possible & suitable probe frequency

(usually 7-18 MHz).
➢ In superficial lesions use plenty of coupling
material.
➢ Proper exposure of the examined area but avoid
over exposure.
➢ Follow instructions for infection control.
 STRUCTURES TO BE EXAMINED

BONES CARTILAGE
SYNOVIUM
LIGAMENTS TENDONS
MUSCLES
NERVES OTHERS
 Cortical surface of bones

Sharply defined smooth continuous

hyperechoic line with posterior shadowing

PEDIATRIC
BONES
Non-ossified epiphysis
 Articular cartilage

Sharply defined smooth hypoechoic

structure of uniform thickness parallel to

the underlying bone

 SYNOVIUM

Thin (less than 1 mm) hypoechoic structure

lining the joint space, surrounding most of

the tendons or make the wall of the bursa

 Ligaments & tendons

Tubular structures mainly hyperechoic with hypoechoic

streaks

Rounded or oval hyperechoic structures with hypoechoic

streaks
ANISOTROPY
ACHILLIS TENDON
LIGAMENT
Ligament
ITT
Plantar fascia
Plantar fascia
 MUSCLES

Isoechoic structures showing multiple

hyperechoic streaks of fibrous sepate

 nerves

Tubular structures slightly hypoechoic as compared to

tendons

Rounded or oval structures with equal distribution of

hypo & hyperechoic dots “Honeycomb appearance “
 Meniscal horns

Well defined triangular hyperechoic

structures
KNEE MENISCI
Glenoid
labrum
Glenoid labrum
 Advantages of MSK US

➢ Widely available.
➢ Cheap.
➢ Dynamic.
➢ No ionizing radiation, contrast injection or
sedation.
➢ Can examine multiple regions & both sides in
one session.
 Limitations of MSK US

➢ Operator dependent.
➢ Affected by body built.
➢ Needs special patient position that could be
difficult.
➢ Difficult to be standardized