Dres. Héctor Domínguez Hernández y Victor Hugo Cruz
Residentes de Imagenología
Dan Inicio al módulo de musculoesquelético.
Anatomía básica de tobillo por ultrasonido.
la utilidad de la resonancia magnetica para la valoracion de lesiones articulares se hace imprescindible cuando evaluamos estructura blandas, ayudando a determinar un diagnostico con mayor sensibilidad. El estudio del hombro implica un conocimiento anatómico y secuencial para visualizar detalles articulares. se intenta enfocar caracteristicas imagenologicas del hombro enfocados en resonancia magnética.
Se muestra de forma sencilla y practica lo que se debe buscar en la evaluación por resonancia magnética en la patología del Manguito rotador y la porción larga del bíceps.
Presentación realizada por el Dr. Cesar Augusto Herrera Méndez, R1 de Imagenología Diagnostica y Terapéutica del Hospital Regional de Alta Especialidad de la Península de Yucatán.
la utilidad de la resonancia magnetica para la valoracion de lesiones articulares se hace imprescindible cuando evaluamos estructura blandas, ayudando a determinar un diagnostico con mayor sensibilidad. El estudio del hombro implica un conocimiento anatómico y secuencial para visualizar detalles articulares. se intenta enfocar caracteristicas imagenologicas del hombro enfocados en resonancia magnética.
Se muestra de forma sencilla y practica lo que se debe buscar en la evaluación por resonancia magnética en la patología del Manguito rotador y la porción larga del bíceps.
Presentación realizada por el Dr. Cesar Augusto Herrera Méndez, R1 de Imagenología Diagnostica y Terapéutica del Hospital Regional de Alta Especialidad de la Península de Yucatán.
Presentación realizada por el Dr. Cesar Augusto Herrera Méndez, R1 de Imagenología Diagnostica y Terapéutica del Hospital Regional de Alta Especialidad de la Península de Yucatán.
Presentación realizada por el Dr. Juan Carlos Vázquez García, R1 de Imagenología Diagnostica y Terapéutica del Hospital Regional de Alta Especialidad de la Península de Yucatán.
Presentación realizada por el Dr. Cesar Augusto Herrera Méndez, R1 de la especialidad de Imagenología Diagnostica y Terapéutica del Hospital Regional de Alta Especialidad de la Península de Yucatán.
Presentación realizada por el Dr. Juan Carlos Vázquez García, R1 de Imagenología Diagnostica y Terapéutica del Hospital Regional de Alta Especialidad de la Península de Yucatán.
Presentación realizada por el Dr. Juan Carlos Vázquez García, R1 de Imagenología Diagnostica y Terapéutica del Hospital Regional de Alta Especialidad de la Península de Yucatán.
Dr. Federico Navarrete. Módulo Tórax.
R2 Imagenología Diagnóstica
Tema relevante en el estudio de pacientes con Cirrosis.
Basado en artículo de Radiographics.
Presentación realizada por el Dr. Cesar Augusto Herrera Méndez, R1 de Imagenología Diagnostica y Terapéutica del Hospital Regional de Alta Especialidad de la Península de Yucatán.
MRI anatomy of ankle radiology ppt pk is nice presentation that covers cross sectional anatomy as well as relevant anatomy from standard radiology book like CT MRI whole body by Hagga . cross section of mri is taken from mrimaster.com. This will help for radiology resident as well radiographers.
Clase del módulo de Tórax.
Dr.Daniel Sosa Chi.
R2 Imagenología, Diagnóstica y Terapéutica.
Nos habla acerca de los hallazgos radiográficos y tomográficos más frecuentes en la Paracoccidiomicosis.
Dra. Marisela López Ramos
Residente Imagenología Diagnóstica y Terapéutica
En esta plática se concluye con la anatomía del tórax y se da una breve introducción con los patrones radiográficos.
Dr.Héctor Domínguez Hernández
Residente Imagenología
Platica básica acerca de las estructuras que conforman la silueta cardíaca, mediciones básicas en la placa simple, incluye también mediastina e hilios pulmonares.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Ultrasonido de tobillo anatomía
1. Ultrasonido de tobillo
Dres. Héctor Domínguez Hernández y Victor Hugo Cruz
Residentes Imagenología, Diagnóstica y Terapéutica
2. Introducción
• La articulación del tobillo es la articulación que con
más frecuencia sufre lesión y el compartimiento
lateral es el que más se daña.
• US con un rango de frecuencia de 10 a 18MHz.
• Los huesos deben ser usados como punto de
referencia.
• El rayo debe de encontrarse lo mas perpendicular
posible a la estructura para analizar para evitar el
defecto de anisotropía.
3. longitudinal or transverse imaging, respectively, US pro
show the normal hyperechoic EDL tendon (white arrow) at the level of the
rows) appears as a thin curvilinear band of hypoechoic tissue superficial to
Fi
th
a
te
re
ar
fib
U
us
ce
SIN ANISOTROPÍA CON ANISOTROPÍA
5. • Paso 1
¿Que te paso? ¿Como te paso? ¿Hace cuanto
tiempo? ¿Tienes dificultad para caminar? ¿ El dolor
es con la marcha o cuando apoyas el pie? ¿Hay
algún lugar donde se acentúe el dolor?.
6. • Paso 2
Posición. El paciente puede
estar sentado con la rodilla
flexionada 45º.
and sweep it up
the tibialis ante
longus. These
from the myote
and the adjacen
7. • La articulación del tobillo “Hindfoot” esta estabilizada por
dos sistemas de ligamentos (el ligamento colateral
lateral (LCL) y el complejo ligamentario colateral
medial) y dos sistemas accesorios (ligamentos
anteriores y posteriores).
8. • La evaluación del tobillo se realiza por
compartimientos.
• ANTERIOR.
• LATERAL.
• MEDIAL.
• POSTERIOR.
9. • COMPARTIMIENTO ANTERIOR
Compartimiento Extensor ( Tibial Anterior, (TOM) Extensor
del Hallux (HARRY), Extensor de los Dígitos (DICK)).
Retinaculo extensor superior e inferior.
Sindesmosis anterior.
Ligamento Talo-Navicular.
Receso Anterior.
Arteria Pedia.
Nervios Peronéo Superficial.
2048 November-December 2013
Figure 1. Normal anatomy
of the ankle extensor com-
partment. (a) Frontal draw-
ing of the foot and ankle
shows the AT, EHL, and
EDL tendons.The deep pe-
roneal nerve ( ) and its
medial and lateral
branches are shown
descending deep to the trans-
versely oriented superior
extensor retinaculum
andY-shaped inferior
extensor retinaculum
. (b) Axial T1-weighted
MR image shows the normal
relationships of the AT, EHL,
and EDL tendons as well as
the superior extensor retinac-
ulum and the DPN
(*) within the neurovascular
10. • Origen: En el cóndilo lateral
de la tibia y el tercio superior
de la tibia lateral.
• Inserción: La superficie medial
e inferior del cuneiforme
medial (1er cuneiforme) y la
base del primer metatarsiano.
• Función: Dorsiflexión del pie y
el tobillo.
TIBIAL ANTERIOR
SUBASHKC/NMC-15TH/2014
11. • Origen: En el tercio medio de
la fíbula y la membrana
interósea.
• Inserción: Base dorsal del
primer dedo en la falánge
distal.
• Función: Extensión del dedo
gordo.
EXTENSOR DEL HALLUX
SUBASHKC/NMC-15TH/2014
12. • Origen: Condilo Lateral de la
tibia, Fíbula superior y anterior
y la membrana interósea.
• Inserción: En las falanges
medias y distales del 2-5o
dedo.
EXTENSOR LARGO DE LOS DEDOS
SUBASHKC/NMC-15TH/2014
13. it up and down over the dorsum of the ankle to examine
anterior, extensor hallucis longus and extensor digitorum
se tendons must be examined in their full length starting
yotendinous junction. Look at the tibialis anterior artery
acent deep peroneal nerve.
xamine the superior extensor retinaculum and the insertion of the ti
which lies distally and medially. Follow the tibialis anterior tendon u
onto the first cuneiform.
ta
edl
ehl
Talus
av
and sweep it u
the tibialis ante
longus. These
from the myot
and the adjace
Be sure to exa
rior tendon, wh
its insertion ont
TENDONES EXTENSORES
14. xamine
gitorum
starting
artery
ehl
av
En esta imagen se observa la arteria y vena tibial anterior,
con su íntima relación con el nervio peronéo profundo.
SUBASHKC/NMC-15TH/2014
ARTERIA TIBIAL ANTERIOR Y
NERVIO PERONÉO PROFUNDO
16. RECESO TIBIOTALAR ANTERIOR
sks, anterior fat pad; arrows, anterior recess of the tibiotalar
D, talar dome; TH, talar head
T
Talus
TH* *
TD
2
Place the transducer in the
mid longitudinal plane over
the dorsum of the ankle to
examine the anterior re-
cess of the tibiotalar joint.
Fluid may be shifted away
from this recess using ex-
cessive plantar flexion.
60%-70% of the talar dome
can be easily assessed by
moving the probe medially
and laterally.
Legend: aste
joint; T, tibia;
&,$"%-.%*%"/"++*.0*$1"*&,2'"*3.-,
A este nivel podremos identificar líquido más objetivamente
pidiendo al paciente que una flexión plantar máxima.
17. • IMPORTANTE:
• Las lesiones del compartimiento extensor del tobillo son
infravaloradas y pueden requerir un diagnóstico
temprano para preservar la función.
• El ligamento más frecuentemente lesionado es el tibial
anterior, seguido del extensor del Hallux.
19. • Ligamento Tibiofibular Anterior Inferior.
• Origen: Se extiende oblicuamente hacia abajo y
lateral desde el margen anterior de la tubérculo
fíbular de la tibia.
• Inserción: Al borde anterior del eje distal del
maléolo lateral.
• El grosor normal varia de 2.6 a 4mm.
• Ligamento Tibiofibular Posterior Inferior. No
evaluado generalmente por ultrasonido.
LIGAMENTOS TIBIOFIBULARES
20. ary-February 2015 radiographics.rsna.org
Figure 1. Anterior inferior TFL. This ligament extends obliquely
downward and laterally from the anterior margin of the fibular
tubercle of the tibia to the anterior border of the distal fibular
shaft and lateral malleolus. (a) Schematic drawing of the anterior
inferior TFL anatomic structure. (b) Probe positioning on the lat-
eral ankle. (c) US scan of the anterior inferior TFL (arrowheads).
F = fibula, Ti = tibia.
probes that had lower performance parameters,
compared with more recent high-end equip-
ment.Thus, it is possible that the already high
detection values reported in the literature have
improved. Milz et al (41) reported visibility of
the anterior inferior TFL in 89.6% of cases in a
series of 48 ankle specimens.
The anterior inferiorTFL plays a crucial role
in increasing the stability of the distal tibiofibular
joint and is involved in up to 11% of ankle sprains
(10). In these cases, patients may complain about
instability resulting from the widening of the ankle
nostic accuracy of the detection of tears and
fferentiate a partial from a complete tear (36–
Pertinent dynamic maneuvers are discussed
e relevant sections of this article.
Ankle Ligaments
ofibular Ligaments
mechanics.—The tibia and fibula are articu-
d at their distal end at the inferior tibiofibular
.This joint is mechanically linked to the an-
eral ankle. (c) US scan of the anterior inferior TFL (arrowheads).
F = fibula, Ti = tibia.
rior inferior TFL. This ligament extends obliquely
laterally from the anterior margin of the fibular
tibia to the anterior border of the distal fibular
malleolus. (a) Schematic drawing of the anterior
omic structure. (b) Probe positioning on the lat-
S scan of the anterior inferior TFL (arrowheads).
bia.
Ligamento Tibiofibular Anterior Inferior
• E l g r o s o r
normal varia
d e 2 . 6 a
4mm.
Se encuentra dañado
en el 11% de los
esguinces de tobillo.
1mm de espesor más de la
mortaja implica una pérdida
del 42% del área de contacto
de la articulación tibiotalar,
aumentando la posibilidad de
osteoartritis temprana.
• Dorsiflexión
y V a r o .
(Inversión)
21. first sentence), keep the posterior edge of the
rotate its anterior edge upwards to image the
ucer will pass over a part of the talar cartilage,
ofibular ligament and the anterior tibiofibular
LM
Tibia
Legend: arrowheads, anterior tibiofibular ligament; LM, la
5
With the ankle lying on its medial aspect, p
oblique coronal plane with its superior edge
malleolus and its inferior margin slightly po
heel, while the foot is dorsiflexed to im
ligament.
pl
pb
Calcaneus
LM
/!,/!"$'*&)+,!%(,& !!$"#
23. 6
Look at the following midtarsal
ligaments: dorsal talonavicular,
dorsal calcaneocuboid and calca-
neo-cuboido-navicular ligament
(avulsion of the anterolateral tu-
bercle of the calcaneus).
Legend: arrowheads, dorsal talonavi-
cular ligament; NAV, navicular bone
$%&'!()!+$,!&'!()(+ !!./,'
NAVTalus
LIGAMENTO TALONAVICULAR
25. • El LCL consiste en tres elementos separados:
• El ligamento talofibular anterior.
(peronéoastragalino)
• Ligamento calcáneofibular. (peronéocalcaneo)
• Peronéo largo y Peronéo corto.
26. • Ligamento Anterior Talofibular.
• Es el más débil y el más frecuentemente lastimado
de los tres componentes del LCL.
• Conecta el borde anterolateral del maléolo lateral y la
superficie lateral del cuello talar.
y-February 2015 radiographics.rsna.org
gure 4. Anterior talofibular ligament. This ligament originates
om the anterolateral border of the lateral malleolus and inserts
n the lateral surface of the talar neck. (a) Schematic drawing of
e anterior talofibular ligament anatomic structure. (b) Probe po-
ioning on the lateral ankle. (c) US scan of the anterior talofibular
ament (arrowheads). F = fibula, Ta = talus.
27. Figure 5. US appearances of injured anterior talofibular ligament. F = fibula, Ta = talus. (a) Acute full-thickness tear of
ligament (arrowheads). F = fibula, Ta = talus.
rior talofibular ligament. This ligament originates
ateral border of the lateral malleolus and inserts
rface of the talar neck. (a) Schematic drawing of
fibular ligament anatomic structure. (b) Probe po-
ateral ankle. (c) US scan of the anterior talofibular
heads). F = fibula, Ta = talus.
Sirve como un estabilizar del tálus,
previniendo el desplazamiento anterior
con respecto a la fíbula y tibia.
Puede haber una lesión aislada, o
asociada con CFL (Calcáneofibular),
cuando el pie es invertido.
• El grosor
normal es de 2
a 3.5mm.
Ligamento talofibular anterior
• Rotación Interna
28. !"#$%&'
(%&)"%*$"+$
* *
* *
1
2
2
1
!"#$%&'
(%&)"%*$"+$
* *
* *
1
2
2
1
erior talofibular ligament
Paciente con ruptura del ligamento Talofibular anterior
Evaluación del Cajón
Anterior
LM
When distinguishing a partial from a
complete tear is difficult, perform a so-
nographic anterior drawer test by pla-
cing the patient prone with the foot
hanging over the edge of the exami-
nation table while pulling the forefoot
anteriorly when in plantar flexion and
inversion. When the ligament is torn,
the anterior shift of the talus against
the tibia will open the gap in the sub-
stance of the ligament.
Legend: LM, l
anterior talofib
29. Figure 5. US appearances of injured anterior talofibular ligame
the anterior talofibular ligament in a 27-year-old basketball play
together with fluid effusion in the anterolateral recess (*). (b) F
after trauma. The ligament is remarkably thickened and inhom
over the proximal insertion (arrows). (Courtesy of Luca De Flavii
the LCL complex of the ankle joint. It connects
the anterolateral border of the lateral malleolus
and the lateral surface of the talar neck (Fig 4).
Along its course, it blends with some fibers of
the capsule of the tibiotalar joint.The anterior
talofibular ligament serves to stabilize the talus,
preventing anterior talar motion.The primary
function of the anterior talofibular ligament is
Becaus
plantar
freque
tion w
turned
diffuse
of the
linearr ligament. F = fibula, Ta = talus. (a) Acute full-thickness tear of
Lesión del ligamento
talofibular.
Lesión aguda.
Lesión crónica
Normal
30. • CFL. Es el más largo de los ligamentos en LCL. Es una
estructura fuerte que cruza oblicuamente debajo de los tendones
peronéo.
• Origen.Se extiende desde el borde inferior del maleo lateral.
• Inserción. Eminencia troclear en la superficie lateral del
calcáneo.
• Función. Estabilizador de la articulación subtalar. La función
principal es evitar la inversión del calcáneo con respecto a la
fíbula.
anuary-February 2015 radiographics.rsna.org
Figure 7. CFL. This ligament originates from the lateral mal-
leolar tip and inserts on the lateral surface of the calcaneus.
(a) Schematic drawing of the CFL anatomic structure. (b) Probe po-
sitioning on the lateral ankle. (c) US scan of the CFL (arrowheads).
C = calcaneus. F = fibula, PBT = peroneus brevis tendon, PLT =
peroneus longus tendon.
• Si no hay lesión del ligamento
talofibular anterior la lesión del CFL
es poco probable.
31. t parallel to the sole of the foot (Fig 4b).
nterior talofibular ligament can be seen as a
echoic fibrillar band in tension between the
l malleolus and the talus (Movie 2 [online]).
unctionality of the anterior talofibular liga-
can be tested by using the anterior drawer
This test consists of stressing the plantar
peroneus longus tendon.
Figure 8. US scan shows a partial tear of the CFL.
The ligament appears inhomogeneous and hy-
poechoic (arrowheads), with periligamentous effu-
sion (*). C = calcaneus, F = fibula, PBT = peroneus bre-
vis tendon, PLT = peroneus longus tendon, Ta = talus.
originates from the lateral mal-
teral surface of the calcaneus.
anatomic structure. (b) Probe po-
US scan of the CFL (arrowheads).
peroneus brevis tendon, PLT =
Ligamento Calcáneofibular.
Flexión dorsal
32. edial aspect, place the transducer in an
s superior edge over the tip of the lateral
argin slightly posterior to it, towards the
rsiflexed to image the calcaneofibular
Calcaneus
LM
pl
pb
pb LM
5
With the ankle lying on its medial aspect, place the transducer in an
oblique coronal plane with its superior edge over the tip of the lateral
malleolus and its inferior margin slightly posterior to it, towards the
heel, while the foot is dorsiflexed to image the calcaneofibular
igament.
Calcaneus
LM
pl
pbpl
pb
Calcaneus
LM
/!,/!"$'*&)+,!%(,& !!$"#
5
With the ankle lying on its medial aspect, place the transducer in an
oblique coronal plane with its superior edge over the tip of the lateral
malleolus and its inferior margin slightly posterior to it, towards the
heel, while the foot is dorsiflexed to image the calcaneofibular
igament.
Calcaneus
LM
pl
pbpl
pb
Calcaneus
LM
/!,/!"$'*&)+,!%(,& !!$"#5
With the ankle lying on its medial aspect, place the transducer in an
oblique coronal plane with its superior edge over the tip of the lateral
malleolus and its inferior margin slightly posterior to it, towards the
heel, while the foot is dorsiflexed to image the calcaneofibular
ligament.
Calcaneus
LM
pl
pbpl
pb
Calcaneus
LM
/!,/!"$'*&)+,!%(,& !!$"#
5
With the ankle lying on its medial aspect, place the transducer in an
oblique coronal plane with its superior edge over the tip of the lateral
malleolus and its inferior margin slightly posterior to it, towards the
heel, while the foot is dorsiflexed to image the calcaneofibular
gament.
Calcaneus
LM
pl
pbpl
pb
Calcaneus
LM
/!,/!"$'*&)+,!%(,& !!$"#
Ligamento Calcáneofibular
Dorsiflexión
33. Lesión parcial del CFL.
as a
the
e]).
a-
er
may
s
ent
of the probe should be held over the tip of the
lateral malleolus and the probe should be ro-
tated caudad to reach a coronal plane, with the
distal edge of the probe slightly posterior to
the CFL.
and hy-
us effu-
eus bre-
a = talus.
34. • Origen: Cabeza y los dos
tercios superiores de la fíbula
lateral.
• Inserción: Base del primer
metatarsiano y cuneiforme
medial.
• Función: Eversión y Flexión
plantar del pie.
PERONEO LARGOSUBASHKC/NMC-15TH/2014
35. • Origen: Dos tercios inferiores
de la fíbula lateral.
• Inserción: Base Dorsolateral
del 5o metatarsiano.
• Función: Eversión del pie.
PERONEO CORTOSUBASHKC/NMC-15TH/2014
36. or approximately 5 cm and downwards through the inframalleola
LM
!
" pbm
Check them at the level of the peroneal tubercle of calcaneus,
own to the area where the os peroneum can be found. Follow
he base of the 5th metatarsal. Look at the superior and inferior p
Legend: arr
curved arro
LM, lateral m
muscle; void
arrow, peron
!
#
peroneal tendons to examine
). Because these tendons arc
beam perpendicular to them
ollow these tendons upwards
eolar region.
LM
pbm
"
TENDONES PERONÉOS
7
Behind the lateral mall
them in their short-axis
around the malleolus, t
and avoid anisotropy a
for approximately 5 cm
!
"
0123410)156
37. "
Check them at the le
down to the area wh
the base of the 5th m
#
When intermittent
suspected clinically,
LM
evel of the peroneal tubercle of calcaneus, and the
ere the os peroneum can be found. Follow the per
etatarsal. Look at the superior and inferior peroneal
Legend: arrowheads, p
curved arrows, superio
LM, lateral malleolus; p
muscle; void arrow, per
arrow, peroneus longus
subluxation of the peroneals is
! "
#
38. • COMPARTIMIENTO MEDIAL
• Ligamento Deltoideo.
• Arteria y Nervio Tibial Posterior.
• Tibial posterior (TOM), Flexor del Hallux (HARRY) y
Flexor de los dedos (DICK) (orden supramaleolar).
40. • Origen: En la membrana interósea y
la superficie posterior de la tibia y el
peroné.
• Inserción: Navicular, Cuneiforme
medial, base del 2, 3 y 4o
metatarsianos.
• Función: Inversión y Flexión plantar.
TIBIAL POSTERIOR
SUBASHKC/NMC-15TH/2014
41. • Origen: Tibia medial y
posterior y sobre la
aponeurosis de la fíbula.
• Inserción: Base de las
falanges distales del 2o al 5o
dedo.
• Función: Flexión de los 4to
dedos.
FLEXOR LARGO DE LOS DEDOS
SUBASHKC/NMC-15TH/2014
42. • Origen: Fibula posterior e
inferior y la membrana
interósea.
• Inserción: Base de la falange
distal del Hallux.
FLEXOR LARGO DEL HALLUX
SUBASHKC/NMC-15TH/2014
43. skin over the medial ankle. The examination of tendons
formed first.
Legend: a, tibialis posterior artery; MM, medial malleolus; v, posterior tibial
digitorum longus tendon; white arrowheads, flexor retinaculum; white arrow
Behin
the tra
the ti
digitor
tibialis
ous ju
short-
ce of
on lon
of the
!#
##
$$
TENDONES DEL COMPARTIMIENTO FLEXOR
n of the medial ankle, the patient is seated with
ace of the foot rolled internally or in a “frog-leg”
atively, the patient may lie supine with the foot
aterally. A small pillow under the lateral malleo-
o improve the contact between transducer and
edial ankle. The examination of tendons is per-
Ank
)230-4156*6!(671"975:;69;1!<+1&(:=9;1+6 659;?!1(9< ?715:<+9<7
44. ARTERIA TIBIAL POSTERIOR Y NERVIO TIBIAL
5
at the flexor retinaculum, the posterior tibial vessels and the tibial nerve with its divisional
branches (medial and lateral plantar nerves). Compression may help to assess whether
the veins are patent.
Legend: AbdH, abductor hallucis muscle; curved arrow,
tibial nerve; fhl, flexor hallucis longus tendon; ST,
sustentaculum tali; straight arrows, flexor digitorum
longus tendon; void arrowhead, posterior tibial artery;
white arrowheads, posteiror tibial veins
%% %%&'( &'(
)*+&
nd: a, tibialis posterior artery; MM, medial malleolus; v, posterior tibial veins; void arrowheads, flexor
orum longus tendon; white arrowheads, flexor retinaculum; white arrows, tibialis posterior tendon
on long-axis scans over the insertion
of the tibialis posterior.
mine the flexor digitorum longus tendon down to reach the sustentaculum tali. Look
e flexor retinaculum, the posterior tibial vessels and the tibial nerve with its divisional
ches (medial and lateral plantar nerves). Compression may help to assess whether
veins are patent.
%% %%&'( &'(
)*+&
!;7!(15?<<:(1!<+156*6!(1<:;#:
Legend: a, tibialis posterior artery; MM, medial malleolus; v, posterior tibial ve
digitorum longus tendon; white arrowheads, flexor retinaculum; white arrows,
on long-
of the tib
9
Examine the flexor digitorum longus tendon down to reach
at the flexor retinaculum, the posterior tibial vessels and th
branches (medial and lateral plantar nerves). Compression
the veins are patent.
%% &'(
5!;7!(15?<<:(1!<+156*6!(1<:;#:
5
own to reach the sustentaculum tali. Look
ssels and the tibial nerve with its divisional
Compression may help to assess whether
%%
&'(
)*+&
entaculum tali. Look
rve with its divisional
p to assess whether
&'(
)*+&
Con Compresión
45. • TIBIONAVICULAR.
• TIBIOCALCÁNEO.
• TIBIOTALAR
(ANTERIOR Y
POSTERIOR).
LIGAMENTO DELTOIDEO
profundo11,39,41,42
. Los ligamentos que componen el plano
superficial cruzan dos articulaciones, la del tobillo y la sub-
Golanó P, et al. Anatomía
Figura 8. Representación esquemática de los componentes constantes
del ligamento colateral medial descritos por Milner y Soames41
. 1. Li-
gamento tibiospring. 2. Ligamento tibionavicular. 3. Ligamento tibiota-
lar posterior profundo. 4. Ligamento calcaneonavicular superomedial.
46. • Capa superficial.
• El ligamento tibionavicular se origina del borde
anterior del colículo del maléolo medial y se
inserta en el aspecto dorsomedial del hueso
navicular.
47. of the medial malleolus and inserts on the dorsomedial aspect of the navicular. (a) Schematic drawing of the
tibionavicular ligament anatomic structure. (b) Probe positioning on the medial ankle. (c) US scan of the tibi-
onavicular ligament (arrowheads). N = navicular, Ta = talus, Ti = tibia.
tendons superficially.This is an indirect sign of
continuity of the CFL. If displacement is absent
of the deltoid ligament act as a unit prov
support to the ankle. Insufficiency of th
collateral ligament may lead to osteoarth
the ankle joint (51).
Lesions of the deltoid ligament occur
severe eversion injuries and are usually a
ated with fractures of the lateral malleol
with lateral displacement of the talus. L
monly, deltoid ligament injuries are obs
in association with avulsion fractures of
medial malleolus at the site of attachme
superficial portion. Rupture of the delto
of
sup
col
the
sev
ate
LIGAMENTO TIBIONAVICULAR
48. • El ligamento tibiocalcáneo se origina del
aspecto medial del colículo anterior del
maléolo medial, desciende verticalmente y se
inserta en el borde medial del sustentaculum
tali.
49. l ligament.
om the me-
colliculus of
cends verti-
edial border
a) Schematic
eal ligament
be position-
(c) US scan
ment (arrow-
= posterior
ament.The tibionavicular
rted to be present in ap-
general population (52).
ment connects the ante-
us to the superior border
ortion of the spring liga-
gament originates from
e anterior colliculus of the
ular
ap-
52).
nte-
rder
iga-
om
of the
LIGAMENTO TIBIOCALCÁNEO
50. RG • Volume 35 Number 1
Figure
the tib
portion
echotex
ligamen
with so
The dis
homog
51. • Capa profunda.
• El ligamento anterior tibiotalar. Es muy delgado.
Se origina de la punta del colículo anterior y la
parte anterior del surco intercolicular del maléolo
medial y se inserta en la superficie medial del
tálus.
52. Figure 13. Anterior tibiotalar ligament.
This ligament originates from the tip of the
anterior colliculus and the anterior part of
the intercollicular groove of the medial mal-
leolus and inserts on the medial surface of
the talus just distal to the anterior part of the
medial talar articular surface. (a) Schematic
drawing of the anterior tibiotalar ligament
anatomic structure. (b) Probe positioning
on the medial ankle. (c) US scan of the an-
terior tibiotalar ligament (arrowheads). Ta =
talus, Ti = tibia.
The distal insertion of the ligament is also in-
homogeneous and hypoechoic (**).
Figure 13. Anterior tibiotalar ligament.
This ligament originates from the tip of the
anterior colliculus and the anterior part of
the intercollicular groove of the medial mal-
leolus and inserts on the medial surface of
the talus just distal to the anterior part of the
medial talar articular surface. (a) Schematic
drawing of the anterior tibiotalar ligament
anatomic structure. (b) Probe positioning
on the medial ankle. (c) US scan of the an-
terior tibiotalar ligament (arrowheads). Ta =
talus, Ti = tibia.
Figure 13. Ante
This ligament orig
anterior colliculus
the intercollicular g
leolus and inserts
the talus just distal
medial talar articul
drawing of the an
anatomic structure
on the medial ank
terior tibiotalar liga
talus, Ti = tibia.
LIGAMENTO TIBIOTALAR ANTERIOR
53. • El ligamento tibiotalar posterior es el más grueso
de los ligamentos de la región medial. Este
ligamento se origina en el segmento superior de la
superficie posterior del colículo anterior, y se
inserta en la superficie medial del tálus por debajo
de la faceta articular.
54. ligament (arrowheads). PTT = posterior tibial tendon, Ta = ta
Figure 15. Dorsal calcaneocuboid liga-
t. This ligament originates from the upper seg-
rior colliculus, the intercollicular groove, and the
of the medial malleolus. The fibers insert on the
l of the articular facet, up to the posteromedial
the posterior tibiotalar ligament anatomic struc-
ial ankle. (c) US scan of the posterior tibiotalar
ibial tendon, Ta = talus, Ti = tibia.
radiographics.rsna.org
per seg-
and the
rt on the
romedial
mic struc-
tibiotalar
55. • REGIÓN POSTERIOR
• Tendón de Aquiles.
• Grasa de Kagger.
• Bursa PA Y RA.
• Fascia Plantar.
56. TENDÓN DE AQUÍLESOn a prone position, let the foot hanging out of the examination
table. Look clinically to the position of the foot, comparing both sid-
es to see any differences that can lead to the diagnosis of Achilles
tendon full-thickness tear. Then, examine the Achilles tendon from
its myotendinous junction to its calcanear insertion by means of
transverse and longitudinal planes. While scanning the Achilles
tendon on short-axis planes, tilt the probe on each side of the tend-
on to assess the peritendinous envelope. Measure the size of the
Achilles tendon only on transverse planes. The Achilles tendon has
to be followed down to its calcanear insertion. Check the retroachil-
les and the retrocalcanear bursae.
Legend: arrowheads, Achilles tendon; asterisk, anisotropy; fhl, flexor
hallucis longus muscle
soleus
fhl
Kager Calcaneus
*
!
"
#
$
Check the plantaris tendon. In cases of complete Achilles tendon tear, the plantaris may
mimic residual intact fibers of the Achilles. Dynamic scanning during passive dorsal and
plantar flexion help to distinguish partial from complete Achilles tendon tears.
On a prone position, let the foot hanging out of the examination
table. Look clinically to the position of the foot, comparing both sid-
es to see any differences that can lead to the diagnosis of Achilles
tendon full-thickness tear. Then, examine the Achilles tendon from
its myotendinous junction to its calcanear insertion by means of
transverse and longitudinal planes. While scanning the Achilles
tendon on short-axis planes, tilt the probe on each side of the tend-
on to assess the peritendinous envelope. Measure the size of the
Achilles tendon only on transverse planes. The Achilles tendon has
to be followed down to its calcanear insertion. Check the retroachil-
les and the retrocalcanear bursae.
Legend: arrowheads, Achilles tendon; asterisk, anisotropy; fhl, flexor
hallucis longus muscle
soleus
fhl
Kager Calcaneus
*
!
"
#
$
Check the plantaris tendon. In cases of complete Achilles tendon tear, the plantaris may
mimic residual intact fibers of the Achilles. Dynamic scanning during passive dorsal and
plantar flexion help to distinguish partial from complete Achilles tendon tears.
57. BURSA PREAQUÍLEA
e este paciente se apreciaba en el examen lon-
tudinal (Figura 1) un tendón moderadamente
El estudio dinámico es una de las ventajas
aporta la ecografía y precisamente a travé
GURA 1. Realizando un corte longitudinal del tendón de Aquiles
aprecia en el interior una imagen anecoica que corresponde a
na rotura parcial (r). Además en la parte profunda del tendón se
precia la ocupación de la bursa preaquílea (B)
FIGURA 2. El examen longitudinal realizado sobre el tendó
aquileo con el pie en posición neutra permite observar la b
preaquilea por debajo del tendón (B)
Rotura Parcial
del T.Aquiles.
alizando un corte longitudinal del tendón de Aquiles
el interior una imagen anecoica que corresponde a
cial (r). Además en la parte profunda del tendón se
pación de la bursa preaquílea (B)
FIGURA 2. El examen longitudinal realizado sobre el tendón
aquileo con el pie en posición neutra permite observar la bursa
preaquilea por debajo del tendón (B)
este otro corte en eje largo al realizar la flexión
, la bursa cambia su posición interponiéndose
eo y el tendón
FIGURA 4. El corte axial del tendón de Aquiles permite ver la
zona anecoica de la rotura en el interior del tendón (r) y la ocu-
pación de la bursa (B) por debajo del mismo