Musculoskeletal structures

image of Musculoskeletal structures
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Ultrasonography is an established method for the detection of muscle and tendon pathology. The ultrasonographic evaluation of joints and associated ligaments can also be performed in dogs and cats but is more technically challenging. Indications for ultrasonographic examination of musculoskeletal structures include: atrophy of muscle; palpable thickening of a tendon; abnormal range of movement of a joint; pain on manipulation of a joint; and discharging sinus tract. This chapter explains the value of ultrasonography compared with radiography and advanced imaging techniques. Imaging technique for muscles, tendons, bones, articular ligaments and joints is presented.

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Image of 20.1
20.1 Probe position for scanning of the supraspinatus insertion site on the major tubercle of the humerus in a longitudinal plane. Longitudinal image of the normal supraspinatus muscle. Note the normal echotexture of the muscle; hypoechoic with hyperechoic stipples throughout. The short tendon (arrowed) is the hypoechoic structure above the hyperechoic, concave surface of the major tubercle (with acoustic shadowing).
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20.2 Infraspinatus muscle rupture. Note the complete rupture of the muscle (thin arrows represent the muscle stump) with small hyperechoic structures representing the avulsed bone at the lateral aspect of the humerus (open arrow). The muscle has a complex, heterogeneous appearance at the rupture site.
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20.3 Longitudinal image of the quadriceps muscle. Cellulitis is present in this dog, seen as a characteristic complex pattern of hypoechoic areas between hyperechoic bands of tissue.
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20.4 Longitudinal image in the region of the perineal musculature. An adenocarcinoma (hypoechoic, heterogeneous mass with well defined margins) was diagnosed. Power Doppler ultrasonography shows the irregular tortuous pattern of the vessels, which raises the suspicion of malignancy.
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20.5 Longitudinal image of the quadriceps muscle. An abscess (well delineated, hypoechoic fluid pocket) with a hyperechoic foreign body (arrowed) is present. Plant material was diagnosed.
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20.6 Transverse image of the biceps tendon within the intertubercular sulcus. The tendon (between the arrows) has a somewhat elliptical shape, is homogeneous and hyperechoic with a thin hypoechoic rim surrounding it.
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20.7 Biceps muscle and tendon. The probe is positioned to scan the origin of the biceps brachii muscle over the supraglenoid tubercle. Longitudinal scan of the origin of the normal biceps brachii muscle at the supraglenoid tubercle of the shoulder (thin arrow represents proximal humerus). The normal echotexture of the biceps tendon is seen. Note the uniform and parallel tendon fibre alignment and homogeneity of the tendon structure (open arrows).
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20.8 Biceps brachii tenosynovitis caused by a partial tendon rupture. Transverse scan at the level of the intertubercular groove. The fluid-filled tendon sheath and the heterogeneous tendon are visible. A small piece of bone (arrowed) (from the supraglenoid tubercle) is visible as a hyperechoic structure with acoustic shadowing in the tendon sheath.
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20.9 Partial rupture (arrowed) of the biceps tendon. Transverse scan of the biceps brachii tendon over the intertubercular groove. Accumulation of anechoic fluid in the tendon sheath (open arrow) is consistent with chronic tenosynovitis and synovitis.
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20.10 The probe is positioned to scan the insertion region of the Achilles tendon over the calcaneus. Longitudinal scan of the normal insertion site of the Achilles tendon. The normal tendon echotexture of the deep and superficial parts of the Achilles tendon is clearly seen proximal to the hyperechoic surface of the calcaneus (C; acoustic shadowing behind the bony surface). The hypoechoic region in the area of the insertion of the deep part of the tendon to the calcaneus represents the bursa (arrowed).
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20.11 Achilles tendon rupture. There is complete interruption of the tendon echotexture. On the right side of the image a hypoechoic, irregular mass (haematoma) is visible. Longitudinal scan over the calcaneus (C) showing a chronic ruptured Achilles tendon (between the arrows). Heterogeneous, hypoechoic zones of tendon healing and small calcifications are visible and are indicative of the chronic nature of the disease.
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20.12 Longitudinal images showing fracture healing (grades 1–5) in a femur. Grade 1. A fracture gap is present with a sharply defined, linear, hyperechoic bone fragment. Note the homogeneous, hypoechoic to anechoic areas of haematoma formation adjacent to the bone fragment and in the fracture gap. Grade 2. Haematoma resorption is evident at the fracture site and heterogeneous tissue remains adjacent to the fracture. Note the margins of the fracture remain fairly sharp. Grade 3. Fracture margins are irregular and blunted due to resorption. The early, non-ossified callus has a heterogeneous appearance and irregular contours. (continues) Longitudinal images showing fracture healing (grades 1–5) in a femur. Grade 4. The callus is increasingly echogenic, continuous and laminar in appearance. The callus is still heterogeneous, which is consistent with immaturity and incomplete ossification. The callus surface is irregular. Grade 5. The fracture is completely healed and a continuous hyperechoic contour can be identified bridging the fracture.
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20.13 Longitudinal image of the dorsal bony surface of the distal radial metaphysis. An irregular bony surface with lysis and proliferation is seen. The soft tissue involvement is visible as a hypoechoic, heterogeneous area directly over the bone. The diagnosis was confirmed as osteosarcoma.
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20.14 Longitudinal image of a septic shoulder joint. Osteomyelitis and synovitis are present. The normally hyperechoic convex surface of the humeral head (H) is now irregular and interrupted. It is surrounded by hypoechoic tissue, representing the inflamed synovium (arrowed).
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20.15 Longitudinal image of the normal hip joint. The smooth rounded hyperechoic surface of the femoral head is shown (arrowed). The joint space appears as a thin hypoechoic rim adjacent to the hyperechoic bony surface of the femoral head. Longitudinal image of a hip joint with septic arthritis. Note the presence of heterogeneous, hypoechoic synovitis above the hyperechoic, convex line, which represents the bony surface of the femoral head (arrowed).
Image of 20.16
20.16 Infrapatellar view (transducer is rotated approximately 20 degrees laterally) of cruciate rupture. The ligament stump is seen as a small hyperechoic area with irregular margins (bottom arrow). The hypoechoic area around the stump represents the inflamed synovial tissue surrounding the ligament rupture. The top arrow indicates the area of the changed fatty body. PT = patellar ligament.

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