Musculoskeletal Ultrasound — МЕДТРЕЙН Asia

Musculoskeletal UltrasoundMusculoskeletal Ultrasound

Ultrasound of joints, muscles, tendons, and nerves — protocols and interpretation.

Musculoskeletal Ultrasound

Bone Erosion on Ultrasound: OMERACT Definition and Diagnostic Pitfalls

Bone erosion on ultrasound is described within the framework of standardized OMERACT (Outcome Measures in Rheumatology) semiotics. The key task for the clinician is to distinguish …

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Musculoskeletal Ultrasound

Foreign bodies in soft tissues on ultrasound: echogenicity and artifacts of wood, glass, and metal

Ultrasound accurately detects and localizes foreign bodies in soft tissues, including radiolucent ones (wood, plastic). Virtually all foreign bodies are hyperechoic and produce a reverberation artifact …

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Musculoskeletal Ultrasound

Olecranon Bursitis: Ultrasound Differentiation of Septic and Aseptic Process

Ultrasound differentiation relies on a complex of signs: aseptic bursitis (trauma, gout, inflammatory arthropathy) presents with bursa distension by fluid containing echogenic inclusions; septic bursitis may …

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Musculoskeletal Ultrasound

Baker's Cyst on Ultrasound: Differentiation from DVT and Aneurysm, Signs of Rupture

On ultrasound, Baker's cyst is a fluid collection in the popliteal fossa, often heterogeneous (fluid, debris, echogenic reflectors). Key differentiation: DVT (visualized thrombus in vein, incompressible …

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Musculoskeletal Ultrasound

Enthesitis in Spondyloarthritis on Ultrasound: OMERACT Definitions and MASEI Index

Ultrasound diagnosis of enthesitis in spondyloarthropathies (including psoriatic arthritis) relies on detection of hypoechogenicity, hyperemia, erosions, and enthesophytes in the tendon attachment zone (Jacobson, 2026). The …

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Musculoskeletal Ultrasound

Dactylitis in Psoriatic Arthritis: Ultrasound Semiotics

Dactylitis is one of the key features of psoriatic arthritis, accessible for detection on ultrasound alongside synovitis, enthesitis, and tenosynovitis. Ultrasound with color Doppler application allows …

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Musculoskeletal Ultrasound

Calcifying Tendinitis: US Semiotics of Deposits and the Gartner Classification Question

In the provided source fragments, the Gartner classification of calcifications in calcifying tendinitis is not described [clarification needed]. Available data cover US semiotics of deposits: from …

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Musculoskeletal Ultrasound

Tarsal Tunnel Syndrome: Ultrasound of the Posterior Tibial Nerve

Ultrasound in tarsal tunnel syndrome is aimed at visualization of the posterior tibial nerve and detection of compressing substrate (ganglion cyst, mass, post-traumatic changes). The method …

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Musculoskeletal Ultrasound

Reference Values for Cross-Sectional Area of Peripheral Nerves on Ultrasound

For the median nerve CSA <6 mm² excludes, and >12 mm² indicates carpal tunnel syndrome; for the ulnar nerve in the cubital tunnel, the norm is …

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Musculoskeletal Ultrasound

Soft tissue lesion on ultrasound: red flags of benign and malignant process (per ESSR/EFSUMB)

On ultrasound of soft tissues, malignancy is indicated by the absence of recognizable features of benign superficial tumors, disorganized internal vascularization on color Doppler ultrasound (CDU), …

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Musculoskeletal Ultrasound

Lipoma and Atypical Lipomatous Tumor/Liposarcoma: Differential Ultrasound Diagnosis

On ultrasound, a typical lipoma appears as a well-demarcated lesion with linear echogenic septa, acoustic enhancement, and minimal blood flow; the diagnosis is usually straightforward. Features …

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Musculoskeletal Ultrasound

Peroneal Tendon Subluxation: Dynamic Ultrasound and Superior Peroneal Retinaculum

Dynamic ultrasound is the method of choice for detecting transient peroneal tendon subluxation behind the lateral malleolus during provocative maneuvers. Key technical aspects include anisotropy correction …

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Musculoskeletal Ultrasound

Plantar Fasciitis on Ultrasound: Threshold Plantar Fascia Thickness >4 mm and Associated Findings

The key and most useful ultrasound sign of plantar fasciitis is thickening of the plantar fascia at the calcaneal attachment zone >4 mm (normal <4 mm …

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Musculoskeletal Ultrasound

Dysfunction of the Posterior Tibial Tendon: Stages and Ultrasound Findings

The provided source fragments do not contain data on posterior tibial tendon dysfunction (PTTD), its stages, and specific ultrasound findings. Preparation of a reliable article on …

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Musculoskeletal Ultrasound

Classification of Muscle Injuries on Ultrasound: Applicability of BAMIC and Related Systems

Basic clinical grading of muscle injuries (grade 1-3) and morphological assessment of contusions, DOMS, and tears are applicable on ultrasound. The BAMIC system (British Athletics Muscle …

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Musculoskeletal Ultrasound

Proximal Hamstring Tendon Avulsion on Ultrasound

On ultrasound, complete avulsion of proximal hamstring tendons is visualized as absence of tendons at the ischial tuberosity with distal retraction of the tendon stump; an …

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Musculoskeletal Ultrasound

Ganglion Cyst of the Wrist on Ultrasound: Differentiation of Cystic Lesions

Ultrasound allows for the diagnosis of most ganglion cysts of the wrist by tracing the stalk to the source joint. Key features: anechoic or hypoechoic multilobular …

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Musculoskeletal Ultrasound

Stenosing Tenosynovitis (Trigger Finger): A1 Pulley Thickness on Ultrasound

In trigger finger, ultrasound reveals a hypoechoic thickening of the A1 pulley at the level of the metacarpophalangeal joint. Normally, the A1 thickness is <0.5 mm, …

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Musculoskeletal Ultrasound

Rupture of Finger Annular Ligaments (A2/A4) in Climbers: Dynamic Ultrasound and Bowstring Assessment

Rupture of A2/A4 annular ligaments in climbers is diagnosed via ultrasound by the bowstring sign — volar displacement of the flexor tendons during forced flexion. Normally, …

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Musculoskeletal Ultrasound

Ulnar Nerve in the Cubital Tunnel: Cross-Sectional Area and Subluxation on Ultrasound

On ultrasound, cubital tunnel syndrome is diagnosed by a hypoechoic fusiform swelling of the ulnar nerve proximal to the tunnel. A cross-sectional area (CSA) >9 mm² …

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Musculoskeletal Ultrasound

Distal Biceps Tendon Rupture: Differentiation of Partial and Complete Tears on Ultrasound

Ultrasound allows differentiation between complete and partial tears of the distal biceps tendon. A medial approach through the 'pronator window' is used for assessment (Smith et …

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Musculoskeletal Ultrasound

Valgus Stress Test of the Ulnar Collateral Ligament on Ultrasound in Throwers

The dynamic valgus stress test is a key step in the ultrasound assessment of the anterior band of the ulnar collateral ligament (UCL) in throwers. The …

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Musculoskeletal Ultrasound

Ultrasound of Newborn Hip Joints by Graf: Norms of Alpha and Beta Angles

According to Graf's method, the maturity of the hip joint is assessed in the standard coronal projection. The alpha angle reflects the bony part of the …

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Musculoskeletal Ultrasound

Greater Trochanteric Syndrome: Gluteal Tendinopathy vs Trochanteric Bursitis on Ultrasound

In greater trochanteric syndrome, ultrasound distinguishes two mechanisms: tendinopathy of the gluteus medius/minimus tendons and trochanteric bursitis. Tendinopathy is characterized by thickening, hypoechogenicity, and loss of …

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Musculoskeletal Ultrasound

Effusion in the Hip Joint on Ultrasound: Measurement of the Anterior Recess and Threshold in mm

The provided source fragments do not contain data on the measurement of the anterior recess of the hip joint, specific millimeter thresholds for effusion, and the …

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Musculoskeletal Ultrasound

Snapping Hip: Dynamic Ultrasound of the Iliopsoas and Iliotibial Tract

Dynamic ultrasound is the method of choice for snapping hip: it visualizes in real-time the internal type (abnormal movement of the iliopsoas tendon relative to anterior …

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Musculoskeletal Ultrasound

Ultrasound of the Triangular Fibrocartilage Complex (TFCC) of the Wrist: Protocol and Tear Features

The TFCC is evaluated during wrist ultrasound with reference points on the distal ulna, triquetrum, lunate, and the extensor carpi ulnaris tendon. However, the provided source …

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Musculoskeletal Ultrasound

AIUM Standard for MSK Ultrasound: Indications, Technique, and Protocol

The current AIUM parameter for musculoskeletal ultrasound was revised in 2022 and published in 2023 as a joint document by AIUM/ACR/SPR/SSR. The document does not introduce …

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Musculoskeletal Ultrasound

Ultrasound Synovitis Scoring in RA: EULAR-OMERACT 2025

EULAR-OMERACT uses a combined joint synovitis score of 0–3: gray-scale synovial hypertrophy 0–3 plus power Doppler 0–3. The 2025 validation demonstrated good construct validity of this …

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Musculoskeletal Ultrasound

Ultrasound-Guided Interventions on Lower Limb Nerves: ESSR Indications

The ESSR consensus on lower limb nerves includes 9 statements, all with strong expert consensus. The main practical conclusion: Ultrasound or other image-guided access is indicated …

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Musculoskeletal Ultrasound

Ultrasound CPPD: OMERACT 0–3 Semi-Quantitative Scale

In 2023, OMERACT proposed a validated ultrasound scale for CPPD with a grading of 0–3 to assess the extent of calcium pyrophosphate deposits. At the joint …

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Musculoskeletal Ultrasound

EULAR 2023: Ultrasound and DECT in Gout and Crystalline Arthropathies

EULAR 2023 presents the first standalone recommendations for imaging in crystalline arthropathies: 5 general principles and 10 practical recommendations, published in 2024. When gout is suspected, …

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Musculoskeletal Ultrasound

Course 'Musculoskeletal Ultrasound According to International Standards': Program and Physician Training

The musculoskeletal ultrasound course is aimed at physicians and is based on international methodological approaches by EFSUMB (European Course Book, 2nd Ed., 2019; EFSUMB Guidelines Part …

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Musculoskeletal Ultrasound

How a Doctor Can Master Musculoskeletal Ultrasound: A Comparison of Training Formats

Mastering musculoskeletal ultrasound (MSK-US) is based on a combination of theoretical training and hands-on practice. International educational guidelines are set by EFSUMB (European Course Book, Guidelines) …

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Musculoskeletal Ultrasound

Ultrasound of the Foot: Morton's Neuroma and Plantar Fasciitis — Technique, Criteria, and Differential Diagnosis

Ultrasound of the foot allows for the diagnosis of Morton's neuroma and plantar fasciitis. For neuroma, the Mulder's maneuver (mediolateral compression of the forefoot) with plantar …

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Musculoskeletal Ultrasound

Elbow Joint Ultrasound: Protocol, Positions, and Dynamic Tests

According to AIUM 2023, a complete elbow ultrasound protocol is structured into 4 zones: anterior, medial, lateral, and posterior. Orthogonal scans along the long and short …

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Musculoskeletal Ultrasound

Ultrasound of the Hand and Wrist: Compartment-Based Protocol

A practical ultrasound protocol for the wrist is structured by anatomical zones: dorsally — 6 extensor compartments, palmarly — the carpal tunnel and Guyon's canal, followed …

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Musculoskeletal Ultrasound

Ultrasound of the Adult Hip Joint: Protocol, Effusion, Synovitis

For the adult hip joint, ultrasound according to AIUM 2023 is a targeted examination of the symptomatic area with documentation of joint effusion, synovial changes, tendons, …

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Musculoskeletal Ultrasound

Ankle Joint Ultrasound: Protocol, Ligaments, Tendons, Effusion

The practical protocol for ankle joint ultrasound is structured around 4 zones: anterior, lateral, medial, and posterior, with separate assessment of tendon sheaths, ligaments, and joint …

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Musculoskeletal Ultrasound

Ultrasound in Elbow Epicondylitis: Tendinosis, Common Extensor Tear, and Treatment Monitoring

Ultrasound identifies epicondylitis ('tennis/golfer's elbow') as tendinosis of the common extensor (lateral) or flexor (medial): a thickened hypoechoic tendon with surface bowing and disrupted fibrillar structure; …

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Musculoskeletal Ultrasound

Ultrasound-Guided Intra-Articular Injections and Blocks: In-Plane and Out-of-Plane Techniques

In ultrasound-guided injections and blocks, the in-plane (long-axis) approach provides visualization of the entire needle, including the tip, and is preferred in most situations. The out-of-plane …

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Musculoskeletal Ultrasound

Ultrasound Signs of Gout: Double Contour, Tophi, and 'Snowstorm' in Differential Diagnosis with CPPD

In gout, ultrasound reveals the double contour sign (urate deposition on the surface of hyaline cartilage — 'urate icing'), tophi ('wet clump of sugar'), and echogenic …

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Musculoskeletal Ultrasound

Ultrasound in Rheumatoid Arthritis: Assessment of Synovitis Using the EULAR-OMERACT Scale (0–3) and Power Doppler

Ultrasound assessment of synovitis in rheumatoid arthritis combines grayscale mode analysis and power Doppler using the standardized consensus EULAR-OMERACT scale. The physician's task is to identify …

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Musculoskeletal Ultrasound

Graf's Ultrasound of Neonatal Hip Joints: Positioning, α/β Angles, and Types I–IV

Graf's ultrasound of the hip joints is a standardized method for assessing the development of a newborn's joint. On a standard coronal section, the α angle …

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Musculoskeletal Ultrasound

Ultrasound of the Median Nerve in Carpal Tunnel Syndrome: Technique and Threshold Values for Cross-Sectional Area

Ultrasound of the median nerve is an accurate and rapid method for diagnosing carpal tunnel syndrome. The key criterion is the increase in cross-sectional area (CSA), …

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Musculoskeletal Ultrasound

Ultrasound of the Achilles Tendon: Tendinopathy, Tears, Enthesopathy, and Neovascularization

Ultrasound of the Achilles tendon allows differentiation between tendinosis, partial and complete tears, as well as enthesopathy. Key indicators include hypo/anechoic zones in partial tears, tendon …

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Musculoskeletal Ultrasound

Anisotropy in Musculoskeletal Ultrasound: How to Differentiate Artifact from Tendon Tear and Avoid Overdiagnosing Tendinosis

Anisotropy is one of the most common artifacts in MSK ultrasound: when the beam deviates by just 5° from perpendicular, tendons, ligaments, or nerves become hypoechoic …

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Musculoskeletal Ultrasound

Knee Joint Ultrasound: Scanning Protocol, Projections, and Norms

Knee joint ultrasound is performed according to a systematic protocol that includes the assessment of the extensor apparatus (quadriceps tendon, patella, patellar tendon), medial and lateral …

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Musculoskeletal Ultrasound

Ultrasound Signs of Rotator Cuff Tear: Differentiation of Full-Thickness, Partial-Thickness Tear, and Tendinosis

A full-thickness tear of the supraspinatus muscle presents as an anechoic/hypoechoic defect across the entire thickness and width of the tendon with retraction and flattening of …

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Musculoskeletal Ultrasound

Ultrasound Protocol for the Shoulder Joint: Standard Positions and Examination Technique (Step-by-Step)

Ultrasound of the shoulder joint is performed according to a standardized protocol rather than a targeted regional approach, as pain is often diffuse or referred. A …

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