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Ultrasound Imaging of the Musculoskeletal System


Examination of the Knee


Examination of the Shoulder

Using Point of Care Ultrasound to Augment Acquisition of Physical Exam Skills: Knee and Shoulder

Source: Joseph H. Donroe, Rachel Liu; Yale School of Medicine, USA

Point of Care Ultrasound or POCUS is easy to use, has enhanced mobility due to the smaller equipment needed, and may be carried out in a variety of settings. It is also far safer and cheaper than imaging techniques like computer tomography.

POCUS can be helpful when certain physical exam findings are difficult to appreciate by palpation, percussion, or auscultation and can facilitate learning elements of the cardiac, pulmonary, abdominal, musculoskeletal, and vascular exams.

With ultrasound, the anatomy of the knee and shoulder are easily visualized, thus allowing a better understanding of the anatomic basis for many exam maneuvers.  Ultrasound allows for the detection of tendons, ligaments, and muscle injury, the presence of fluid, structural abnormalities, and bone fractures in the musculoskeletal region.

In the case of the knee, ultrasound is helpful in the detection of injuries of the quadriceps and patellar tendons; injuries of the medial and lateral collateral ligaments; meniscal tears; effusions; degenerative changes; bursitis of the suprapatellar, prepatellar, infrapatellar, and pes anserine bursae; and other similar diseases. On the other hand, in the shoulder, ultrasound can be useful in the diagnosis of rotator cuff disease, biceps brachii injury, and acromioclavicular joint disease, among other shoulder pathologies.

Ultrasound is also a dynamic imaging modality that can highlight the movement of joints and muscles in real-time. Therefore, it can lead to the improved acquisition of exam skills when performed in conjunction with the specific maneuvers. For example, shoulder impingement syndrome can be better understood by learners of the physical exam by seeing the anatomy and dynamic movements under ultrasound.

Examination of the musculoskeletal system is a particularly difficult skill to acquire, involving the integration of the technical skills to perform specific maneuvers with the relevant clinical anatomy and physiology of joints. Overall, the integration of ultrasound with other clinical skills results in improved confidence and accuracy in the performance of the physical exam. In this video, we will demonstrate how to use POCUS to facilitate learning the examination of the knee and shoulder.

1. A Brief Orientation to Ultrasound Imaging of the Musculoskeletal System

  1. For most musculoskeletal examinations, the linear probe and a musculoskeletal preset should be selected.
  2. The probe indicator, in most instances, is oriented proximally or medially.
  3. Common structures that are visualized using ultrasound include bones, tendons, ligaments, and muscles.
  4. Bones are hyperechoic and create shadow artifacts posteriorly.
  5. Tendons and ligaments are hyperechoic and have a fib

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