imaging in PT (ultrasound)
by convection the left side of the image is what? or to which of the patient's sides?
By convention the left side of the image is always cranial or to the patients right
when the pulses are reflected back to transducer (probe) what is measured and produced?
Time is measured and digital image is reproduced
what are the 4 muscles we use US for biofeedback and training?
TrA Pelvic floor Multifidus Deep neck flexors
describe isoechoic
everything is the same shade of grey
describe the uses for compact linear transducer
for small structures, hands, fingers
what is the normal contraction of EO, IO, and TrA?
has both fascial glide and increase in TrA thickness without IO and EO
what is the advantage with US combined with history and examination?
information can be combined point of care to define the clinical question and ultrasound exam
describe the linear transducer
linear array with higher frequency, higher resolution, superficial imaging
what is the normal pre-contraction of EO, IO, and TrA?
little glide or thickness increase despite appearance of hypertrophied TrA relative to IO
define image "long axis"
longitudinally through the structure
what is US generally unaffected by?
metallic artifacts
define echogenicity
the shade of grey
how is adhesive capsulitis seen with sonographic anatomy? (see slide 29 for picture)
thickened Glenohumeral ligament, neovascularity
how does sound go into the body with US
transducers
define image "short axis"
transversely through the structure, cross sectional
describe Loss of fascial tension (post partum) altering length tension curve
unable to develop fascial tension but muscle may increase in thickness. Alternatively the length tension curve may be so skewed that little change is noted
describe IO dominant
very little TrA thickness increase or glide, initiates and dominates with IO
what are the 3 cues for TrA and obliques activation?
1. "Draw umbilicus towards spine without flattening your back or sucking in under your rib cage" 2. "Gently draw your stomach is as if putting on a tight pair of jeans 3. "Bring your pelvic bones together"
what are the phases of motor learning with motor re-education (3 things)
1. Cognitive : Mentally pre-set the muscle 2. Associative : Combine muscle activation with movement tasks 3. Automatic : Muscle activation occurs without pre-setting
how do you assess TrA and Obliques with cognitive activation? (3 steps)
1. Contract / Relax 2. Hold / Breathe 3. Hold Under Load
what are the 7 different terminology used for ultrasound?
1. Diagnostic Ultrasound (Imaging) 2. RTU(real time US) 3. RUSI (rehab US imaging) 4. MSK Ultrasound 5. MSKUS (Europe) 6. Musculoskeletal Sonography 7. Musculoskeletal Ultrasonography
what are the 4 diagnostic things with the utilization of US imaging in PT
1. Direct treatment / exercise prescription 2. Monitor Healing / Regenerative Repair 3. Make prognostic predictions / Guide return to sport 4. Enhance the provision and safety of existing interventions
what are the 3 ways to get automatic activation of the TrA?
1. Foot Lift and Extend 1" off Bed 2. ASLR 3. Resisted KF / KE isometric contraction
normal sonographic appearance- hyaline cartilage (3 things)
1. Homogenous, anechoic layer covering the bone surface. 2. Smooth, variable thickness dependent on location 3. Cortex is deep to the hyaline cartilage
what 4 things do you need to make sure you are knowledgeable about with image generation?
1. Know your anatomy first 2. Find a bony landmark and keep it in the picture 3. Focus on the area of interest (move focal points) 4. Make only minimal changes in gain, or use auto gain (if turn it up will penetrate deeper but image is bright)
what are the 3 ways to get functional activation of the TrA?
1. Leg Press 2. Resisted Arm Movements 3. Pilates reformer
what are the 7 disadvantages to US?
1. Limited field of view 2. Incomplete evaluation of bones and joints 3. Limited penetration (6 cm is deepest) 4. Operator dependent 5. Lack of formal education 6. Cost 7. Variable quality
what is the MHz for TrA? patient position? and where do you place the probe?
1. Linear Probe : 5-10 MHz 2. Patient Supine in Crook Lying (hook lying) 3. Just Above and Medial to Iliac crest
normal sonographic appearance- tendons (2 things)
1. Tendons have a tapering, linear, anechoic footprint at the attachment to bone. This is normal. (not a tear- sharpey's fibers) 2. Fibers are hyperechoic, surrounding connective tissue is hypoechoic.
what are the categories of uses of US in PT? (2 things)
1. diagnostic 2. rehabilitative
what are the 3 types of transducers?
1. linear 2. compact linear 3. curved linear
what are the 3 rehabilitative things with the utilization of US imaging in PT
1. provides visual biofeedback 2. Can be used to help activate or inhibit 3. For motor re-education follows phases of motor learning
normal sonographic appearance- ligaments
A bright, linear, echogenic structure, more compact in fibrillar structure and more variable in brightness compared to tendons.
normal sonographic appearance- bursae; what is normal? what is it surrounded by?
A potential space normally not visible (except suprapatellar), a black line less than 2mm thick, surrounded by hyperechoic peribursal fat.
US can do a quick assessment of what?
Comparative exams of the contralateral extremity
normal sonographic appearance (cortical bone)
Continuous echogenic line, bright and smooth with acoustic shadowing (below cortex)
define image interpretation
Determine abnormal by knowing normal anatomy and sonographic appearance
with is the frequency used for MSK US?
High frequency (3-17MHz) required
describe En-block IO/TrA with poor slide
IO and TrA activate together with increase in thickness of both but poor fascial glide
define image recognition
Identify Individual Interfaces always from the boney cortex up to the surface.
cross section normal sonographic appearance- nerves; what are 2 names coined to describe it?
In cross section nerves appear as multiple bright dots within an ovoid nerve sheath. "Honeycomb" or "Starry Night" appearance
transverse normal sonographic appearance- tendons
In the transverse axis tendons have a well defined, hyperechoic dense bristle like appearance.
interruptions in tendons on sonographic appearance look like what?
Interruptions in fibers are visualized as black.
longitudinal normal sonographic appearance- tendons
Longitudinally a bright linear band with a fibrillar echotexture.
longitudinal normal sonographic appearance- nerves; compare to tendons
Longitudinally nerves appear as parallel hyperechoic lines with dark separations. Similar to tendons but less bright.
describe the curved linear transducer
Lower frequency, lower resolution, deeper penetration
normal sonographic appearance- skeletal muscle; what is the name of this appearance commonly called?
Muscle septae are thin bright linear bands on longitudinal view, on transverse view the muscle bundles appear as speckled with short curvilinear bands throughout darker background (starry night appearance)
how many images do you need to generate?
One image is no image, always generate at least two images.
what are examples with US uses with diagnostic uses with direct treatment/exercise prescription
Reactive v's Degenerative Tendinopathy (what stage they are in)
what is anisotrophy
When the probe is not perpendicular to the tissue of interest the image will not be accurate, often generates an artifact that may be mistaken for pathology. (black area)
what is the emerging application of US in rehabilitation?
biofeedback and training
describe anechoic
black
describe hyperechoic
brighter, closer to white
describe hypoechoic
darker, closer to black
what is an example with US uses with diagnostic uses with Enhance the provision and safety of existing interventions
dry needling
what is an advantage to the type of imaging US is?
dynamic imaging
what is an example with US uses with diagnostic uses with Make prognostic predictions / Guide return to sport
muscle tears
does ultrasound use radiation?
no
normal sonographic appearance- fibrocartilage
often triangular, homogenous with no anechoic areas.
what is the normal comparison when in rest of EO, IO, and TrA?
ratio of EO, IO and TrA maintained
after structures attenuate the sound pulses from US what occurs?
reflect pulses back to transducer (probe)
what type of soft tissue change can you do with US?
sono-palpation
what happens to the sound pulses with US
structures attenuate
