A brief Introduction to musculoskeletal ultrasound in rheumatology

1. Musculoskeletal Ultrasound
in Rheumatology
Samar Tharwat Radwan
Lecturer of Internal Medicine
(Rheumatology & Immunology )
Musculoskeletal Ultrasound –EULAR
Mansoura University

2. Agenda
Musculoskeletal Ultrasound in
Rheumatology & Immunology
Unit (Mansoura University)
Musculoskeletal Ultrasound
in Rheumatology

4. Radiology
 Inexpensive
 bone pathology
 Soft tissue???

5. Magnetic Resonance Imaging
 Expensive
 Claustrophobia
600 cases /week
8 MRI

6. Ultrasound Machine

7. 2017-2014
‫ميزانية‬ ‫مفيش‬
‫تاني‬ ‫الطلب‬ ‫قدمي‬

9. August ,2017

10. Musculoskeletal Ultrasound
in Rheumatology

11. History Taking & Clinical Examination

12. Musculoskeletal System
 Bones
 Cartilage
 Muscles
 Tendons
 Ligaments
 Nerves
 Other Tissues

13. Articular and periarticular Structures (US)

14. Echogenicity

15. Bones
Bone
(Hyperechoic)
Erosion

16. Cartilage
Normal Cartilage
(Hypoechoic)
Cartilage Thinning (OA)
Cartilage Calcification
(chondrocalcinosis)

17. Synovium (Normal & Proliferation)

18. Joint Effusion

19. Muscles
Normal Muscle Muscle Tear

20. Tendons
Normal (T.S) Normal (L.S) Tenosynovitis Tendon Tear

21. Nerves
Nerve (T.S) Nerve (L.S) Swollen nerve
Swollen
,bifid,hypoechoic
Nerve Tracing Nerve Tumour

22. Masses

23. Ganglion Cyst

24. Foreign bodies
Hyperechoic foreign body with an anechoic ring of reactive fluid around it (blue
arrow)

25. Bursae

26. Multiple Joints ,Multiple Pathological Findings
Shoulder Elbow Wrist Hand
Hip Knee Ankle

27. Ultrasound Guidance
For Injection

28. Shoulder ACJ Elbow Olecranon
Bursitis
Dequrvan Small joints
Trigger finger Hip joint Knee Baker cyst Ankle

29. Rheumatoid Arthritis
Synovitis Active Synovitis Tenosynovitis Active Tenosynovitis
Bone Erosion Bone Erosion
X-Ray
US guided aspiration
& Injection

30. Seronegative Arthropathy

31. Osteoarthritis

32. Gouty Arthritis
Punched out erosions & double contour appearance

33. Musculoskeletal Ultrasound
 Hands-on
 Dynamic
 Interventional procedures
 Rapid contralateral limb
examination for comparison
 Low cost
 Lack of radiation
 No known contraindications
 Incomplete evaluation of bony and
joint anatomy
 Small area
 Expense of the US equipment
 Examiner’s skill level
 Time consuming
Advantages Disadvantages

34. Conservative /Injection /Surgery

35. Musculoskeletal Ultrasound is like
a stethoscope for the musculoskeletal system

36. Ultrasound Guided Procedures
(2017-2019..15 cases per day)
4000 cases
Diagnostic , 48%
Joint Aspiration , 15%
Intraarticular Joint Injection with
steroids , 15%
Intraarticular joint injection with
Hyaluronic acid , 3%
Intraarticular joint Injection with
PRP, 3%
Tenosynovitis Injection , 7%
Bursitis Aspiration & Injection , 2%
Nerve Hydrodissection, 7%
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