Chapter 15 Abdominal Wall, Musculoskeletal sonography, and Pediatric Hip

a nonneoplastic fusiform enlargement of the digital branch of the medial or lateral plantar nerves

Morton's neuroma

A sagittal image of the Achilles tendon shows which of the following findings? a. normal tendon b. tendonitis c. complete tear d. incomplete tear

a. normal tendon

Muscle attaches to bone by which of the following structures? a. tendon b. fibril c. ligament d. synovial membrane

a. tendon

sharp burning pain radiating from foot to toes numbness of the ball of the foot hypo echoic inter-metatarsal mass

clinical and sono findings of Morton's neuroma

protrudes into the inguinal canal "indirectly" from a superolateral direction after passing through the internal inguinal ring

indirect inguinal canal

achilles tendon tear

irregular tendon contour hematoma surrounding the defect MOST COMMONLY LOCATED in the distal portion 2-6 cm from the calcaneus

tissue composed of fibers and cells that are able to contract, causing movement of the body parts or organs

muscle

consists of all the muscles, bones, joints, ligaments, and tendons that function in the movement of the body and organs

musculoskeletal system

thickness: 5-7 mm diameter: 12 - 15 mm

normal size of achilles tendon

attaches the gastrocnemius and soleus muscles

Achilles tendon

a synovial cyst adjacent and posterior to the knee joint

Baker cyst

preferred term to describe the abnormal relationship of the femoral head to the acetabulum; a congenital or acquired deformation or misalignment of the hip joint

Development Displacement of the Hip (DDH)

relocates the femoral head within the acetabulum. hip is flexed and abducted while gently pulling anteriorly. Demonstrates whether the dislocated hip is reducible

Ortolani maneuver

valsalva

What maneuver should be used when evaluating the abdominal wall

the presence of a single or multiple palpable cyst in the breast

fibrocystic disease

alpha angle less than 60 degrees beta angle greater than 50 degrees shallow acetabulum femoral head not in contact with acetabular floor

sono findings of hip displacement

strands of connective tissue serving as a support structure of the breast; provides shape and consistency to the breast parenchyma

Cooper ligament

Flattening of the medial nerve is a sonographic finding associated with: a. rotator cuff tear b. ganglion cyst c. carpal tunnel syndrome d. Morton's neuroma

c. carpal tunnel syndrome

A toddler presents with a history of limping. On the basis of the clinical history, the sonographic finding is the most suspicious for which of the following conditions? a. joint effusion b. hip dislocation c. hip subclavian d. synovial cyst formation

a. joint effusion

Morton's neuroma

benign growth of the plantar nerve tissue

A soft tissue image over the area of discomfort demonstrates a hyperechoic linear structure outlined by the calibers. This is the most suspicious for a: a. lipoma b. ligament c. foreign body d. fascial plane

c. foreign body

A defect in the muscles of the abdominal wall is most likely related to a: a. cyst b. polyp c. hernia d. diverticulum

c. hernia

pertaining to back or posterior

dorsal

one of a pair of anterolateral abdominal wall muscles located lateral to the line alba

rectus abdominis muscle

ganglion cyst

repetitive motion small bulge found on the wrist anechoic fluid collection at tendon connection to bone

autoimmune disorder affecting the lining of joints

rheumatoid arthritis

increase in age lifting above the head sports strains cigarette smoking corticosteroid medications

risk factors for muscle tear

determines if hip can be dislocated. Hip is flexed and the thigh adducted while gently placing posterior pressure on the femoral head

Barlow maneuver

a test used to evaluate the integrity of the Achilles tendon where the toes are pointing down while squeezing the calf

Thompson test

The Graf technique is used to evaluate which of the following joints? a. hip b. knee c. wrist d. shoulder

a. hip

A direct inguinal hernia arises: a. inferior and medial to the inferior epigastric artery b. superior and medial to the superior epigastric artery c. inferior and medial to the superior epigastric artery d. superior and lateral to the inferior epigastric artery

a. inferior and medial to the inferior epigastric artery

A patient complains of severe calf pain following hyperextension of the knee while playing soccer. The sonographic finding is suspicious for: a. muscle tear b. a synovial cyst c. tenosynovitis d. a lipoma

a. muscle tear

Bursae appear on ultrasound as: a. thin, linear hypoechoic structures b. thick, convex hypoechoic structures c. thin, linear hyperechoic structures d. thick, concave hyperechoic structures

a. thin, linear hypoechoic structures

protrusion of peritoneal contents through a defect in the abdominal wall

abdominal hernia

hypo echoic sonographic artifact caused when the ultrasound beam is not perpendicular to the fibrillar structure of a tendon

anisotropy artifact

septic hip

asymmetry in the anterior hip recess exceeding 2 mm when compared with the contralateral hip infection

The location of the rectus abdominis muscles is described as lateral to the: a. iliac crests b. linea alba c. external oblique muscles d. internal oblique muscles

b. linea alba

Which of the following is NOT a risk factor for developmental dysplasia of the hip? a. club foot b. male infant c.neonatal torticollis d. breech presentation

b. male infant

The fascial interface of the anterior abdominal wall is located directly anterior to the: a. linea alba b. peritoneum c. subcutaneous fat d. rectus abdominis muscles

b. peritoneum

Which of the following most accurately describes the location of the transverse abdominis muscle? a. medial to the external oblique muscle b. posterior to the internal oblique muscle c. lateral to the internal oblique muscle d. anterior to the external oblique muscle

b. posterior to the internal oblique muscle

Which of the following patient positions is used when evaluating the supraspinatus tendon? a. sitting with hand on opposite shoulder b. sitting with arm behind back c. sitting with arm close to body and palm up d. sitting with arm close to body and elbow bent at 90 degrees

b. sitting with arm behind back

The anechoic structure is most suspicious for a: a. torn ligament b. synovial cyst c. joint effusion d. thrombosed superficial vein

b. synovial cyst

Measurement of the Achilles tendon should be made in the: a. sagittal plane b. transverse plane c. coronal plane d. supine position

b. transverse plane

Which of the following joints is associated with a positive Tinel's sign? a. knee b. wrist c. ankle d. shoulder

b. wrist

connects the biceps muscle to the shoulder joint in two planes are called the proximal biceps tendons. The tendon that attaches the biceps muscle to the bones of the forearm (radius and ulna) is called the distal biceps tendon

biceps tendon

a fibrous sac found between the tendon and bond; lined with a synovial membrane and secretes synovial fluid; facilitates movement of the musculoskeletal structures

bursa

The thickness of a normal Achilles tendon should not exceed: a. 3 mm b. 5 mm c. 7 mm d. 10 mm

c. 7 mm

The Thompson test is used to check the integrity of the: a. calf muscles b. rotator cuff c. Achilles tendon d. anterior abdominal wall

c. Achilles tendon

Which of the following artifacts is likely to occur when the ultrasound beam is not perpendicular witha fibrillar tendon? a. duplication b. refraction c. anisotropy d. shadowing

c. anisotropy

Which approach is used to evaluate for hip effusion: a. medial b. lateral c. anterior d. posterior

c. anterior

The Valsalva maneuver is a common technique used when evaluating the: a. pediatric hip b. Achilles tendon c. anterior abdominal wall d. gastrointestinal tract

c. anterior abdominal wall

The pathology demonstrated in the sonogram is most suspicious for a: a. bakers cyst b. joint effusion c. ganglion cyst d. radial artery aneurysm

c. ganglion cyst

A teenage arrives at the emergency department following a skiing injury. A nonvascular hypoechoic mass is identified in the posterior popliteal fossa. This mass most likely represents a(n): a. Baker cyst b. lymph node c. hematoma d. pseudoaneurysm

c. hematoma

A patient presents to the ultrasound department with a palpable umbilical mass. The finding in this sonogram is most consistent for a(n): a. abscess b. hematoma c. hernia d. urachal sinus

c. hernia

Which of the following is an early stage of rheumatoid arthritis? a. tendon tear b. tendonosis c. hyperemia d. tenosynovitis

c. hyperemia

Which of the following vascular structures is used as a landmark when evaluating for an inguinal hernia? a. internal iliac artery b. common femoral artery c. inferior epigastric artery d. suerior epigastric artery

c. inferior epigastric artery

Which of the following muscles extends the entire length of the anterior abdominal wall? a. linea alba b. external oblique c. rectus abdominis d. internal oblique

c. rectus abdominis

A patient hospitalized with pneumonia presents with a palpable abdominal wall mass. This finding is most suspicious for a(n); a. urachal sinus b. umbilical hernia c. rectus sheath hematoma d. ovarian cyst

c. rectus sheath hematoma

An indirect inguinal hernia arises: a. inferior and medial to the inferior epigastric artery b. inferior and medial to the superior epigastric artery c. superior and lateral to the inferior epigastric artery d. superior and lateral to the superior epigastric artery

c. superior and lateral to the inferior epigastric artery

Degenerative changes in a tendon without signs of inflammation is termed: a. strain b. sprain c. tendinosis d. anisotrophy

c. tendinosis

Anechoic fluid within a tendon sheath is most suspicious for: a. a tendon tear b. tendinosis c. tenosynovitis d. a Baker's cyst

c. tenosynovitis

skin

composed of epidermis and dermis layers

external oblique muscles

composes portion of lateral abdominal wall located anterior to internal oblique and transverse abdominis muscles

internal oblique muscles

composes portion of lateral abdominal wall located posterior to external oblique muscle anterior to transverse abdominis muscle

transversus abdominis muscles

composes portion of the lateral abdominal wall located immediately posterior to internal and external oblique muscles

What is the normal alpha angle when evaluating for developmental displacement of the hip in a 2 month old? a. less than 50 degrees b. 50 degrees or greater c. less than 60 degrees d. 60 degrees or greater

d. 60 degrees or greater

A patient presents with a history of sharp burning foot pain radiating to the third and fourth toes. Based on this clinical history, the calipers are most likely measuring a: a. lipoma b. muscle tear c. synovial cyst d. Morton neuroma

d. Morton neuroma

An increase in distance between the rectus abdominis muscles is a sonographic finding associated with: a. a ventral hernia b. an umbilical hernia c. an epigastric hernia d. diastasis recti abdominis

d. diastasis recti abdominis

The sonogram is most likely demonstrating a(n): a. normal hip b. immature hip c. subluxed hip d. dislocated hip

d. dislocated hip

A lipoma located in the anterior abdominal wall most commonly appears on ultrasound as: a. anechoic mass b. complex mass c. hyperechoic mass d. hypoechoic mass

d. hypoechoic mass

A complete tear of the Achilles tendon is most commonly located: a. at the superior insertion b. in the medial portion of the tendon near the medial malleolus c. approx. 2-6 cm from the superior tendon insertion d. in the distal portion of the tendon near the calcaneus

d. in the distal portion of the tendon near the calcaneus

The triadiate cartilage is located: a. superior to the labrum b. lateral to the ilium c. posterior to the femoral head d. medial to the femoral head

d. medial to the femoral head

When evaluating the Achilles tendon, the patient should be placed in which of the following positions? a. prone with leg abducted b. supine with leg in frog position c. lateral with foot supported on a pillow d. prone with foot overhanging the stretcher

d. prone with foot overhanging the stretcher

Which of the following is an autoimmune disorder affecting the lining of joints? a. tendinosis b. osteoarthritis c. tendonitis d. rheumatoid arthritis

d. rheumatoid arthritis

Which of the following joints has the largest range of motion? a. hip b. wrist c. knee d. shoulder

d. shoulder

Which of the following patient positions is used when evaluating the biceps tendon? a. sitting with arm resting close to the body and palm facing down b. sitting with the arm held closely to body and elbow bent at 90 degrees c. sitting with hand resting on contralateral shoulder d. sitting with arm resting close to body and palm facing up

d. sitting with arm resting close to body and palm facing up

A femoral hernia is located: a. superior to the inguinal ligament b. inferior to the great saphenous vein c. lateral to the common femoral vein d. superior to the saphenofemoral junction

d. superior to the saphenofemoral junction

Which of the following tendons is located under the acromion? a. biceps b. subscapularis c. infraspinatus d. supraspinatus

d. supraspinatus

umbilical hernia

defect in the abdominal muscles visual or palpable umbilical mass

protrudes into the inguinal canal "directly" from posteriorly

direct inguinal hernia

herniation within the femoral canal, inferior to the inguinal ligament and superior to the saphenofemoral junction

femoral hernia

a small filamentous fiber that is often a component of a cell

fibril

Achilles tendon tear

focal disruption in the tendon fluid collection within the tendon MOST COMMONLY LOCATED IN THE DISTAL PORTION

movement of the torso

function of the anterior abdominal wall

movement of body parts and organs

function of the musculoskeletal systm

a cyst caused by obstruction of a lactating duct

galactocele

small tumor or fluid collection that can occur at the connection of any tendon

ganglion cyst

lipoma

growth of fat cells in a thin, fibrous capsule palpable superficial mass

an abnormal enlargement of a male breast or breasts

gynecomastia

abdominal wall abscess

hypo echoic or anechoic mass anterior to the peritoneal fascial plane may demonstrate posterior acoustic enhancement or shadowing infection

rectus sheath hematoma

hypo echoic or anechoic mass located in the rectus muscle or between the sheath and the muscle

with the contralateral external oblique

internal oblique muscles act with what muscles to achieve side bends

one of the many channels that carry milk for the lobes of each breast to the nipple

lactiferous duct

an area of enlargement in a lactiferous duct near the areola

lactiferous sinus

a flexible band of fibrous tissue binding joints together; provides flexibility to a joint

ligament

a midline tendon of the anterior abdominal wall extending form the xiphoid process to the symphysis pubis

linea alba

lateral borders of the rectus abdominis muscles

linea semilunaris

the simplest functional unit of the breast

lobule

rectus abdominis muscles

located on either side of lines alba extends entire length of anterior abdominal wall

linea alba

midline tendon extending from the diploid process to the symphysis pubis located posterior to the subcutaneous fat

shoulder joint

most mobile joint of the body

transverse

plane that achilles tendon should be measured in

subcutaneous fat layer

premammary layer composed of fat and connective tissue

family history of congenital dislocation of the hip female infant breech presentation pregnancies with oligohydraminios foot deformity that requires further treatment neonatal torticollis

risk factors for developing displacement of the hip

a musculotendinous structure about the capsule of the shoulder joint, formed by the inserting fibers of the supraspinatus, infraspinatus, teres minor, and subscapularis muscles, which blend with the capsule and provide mobility and strength to the shoulder joint

rotator cuff

is usually considered an anterior abdominal wall hernia that occurs inferior to the umbilicus at the linea semilunaris border (lateral) of the rectus abdominis muscle

spigelian hernia

a painful wrenching or laceration of the ligaments of a joint

sprain

to inquire or impair by overuse or overexertion; wrench

strain

double-walled tubular structures surrounding some tendons

synovial sheath

term used to describe degenerative changes in a tendon without signs of tendon inflammation; associated with overuse injuries

tendinosis

bands of dense, fibrous connective tissue that attach muscle to bone

tendon

small lobular unit formed by the acini and terminal ducts

terminal ductal lobular unit (TDLU)

8 bursae and 5 ligaments

the should joint includes ______ and ___________

achilles tendonitis

thickening of the tendon tendon thickness >7mm irregular wall margins hypervascularity

achilles tendon

thickest and strongest tendon in the body

2-3mm

thickness of the skin

relating to the palm of the hand or sole of the foot

volar

limited blood supply

what increases the risk of injury to the achilles tendon