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Joint ultrasound indications are rapidly expanding because of the technological improvements of modern equipments, high availability, and low cost compared with sophisticated imaging techniques.
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Proper operator skills and high-resolution transducers are demanded.
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Color and power Doppler examinations are recommended in every joint study; static imaging of joints should be followed by a dynamic examination.
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Ultrasound is limited in the diagnosis of intra-articular anatomy and pathologic processes
Joint Ultrasound
Section snippets
Key points
Ultrasound technology
Broadband high-resolution linear array transducers (7–15 MHz) provide enough penetration for the examination of large joints with an excellent resolution. A 3- to 9-MHz frequency is needed for a deeper penetration in a larger patient, at the expense of lower resolution.6, 7, 8 Small field of view hockey stick–shaped transducers are ideal for evaluating small superficial joints and performing dynamic maneuvers.
Spatial compound sonography obtains information from several different angles of
Scanning technique
Examination technique depends on the different joints, but as a rule of thumb, a 4-side B-mode scan is recommended, covering the joint from anterior, lateral, medial, and posterior sides. Color and power Doppler imaging are useful for showing the vascular anatomy. Dynamic maneuvers are functional tests to visualize joints during real-time examination.
Normal anatomy
Joint anatomy is adapted to specific functional requirements and varies among joints. Synovial joints are the most commonly examined with ultrasound. They are composed of the articulating bone surfaces covered by hyaline articular cartilage and the joint capsule, inserting marginally into the cortical bone and periosteum. The articular cartilage is seen as a hypoechoic smooth linear band over a regular hyperechoic line corresponding to the subchondral bone. Cartilage thickness may be accurately
Joint Effusion
Ultrasound is highly sensitive, although not specific, in detecting joint fluid that may indicate a joint problem. Different types of synovial effusion (traumatic, inflammatory, infectious, or neoplastic) are not definitively differentiated based on their ultrasound appearance (Fig. 3). Noninfectious nonhemorrhagic fluid is anechoic or may contain scattered echoes caused by proteins, fibrin, crystals, or cellular debris. Synovial inflammation or infection may appear as an irregularly thickened
Ultrasound-guided procedures
Interventional procedures under ultrasound guidance related to joints, both for diagnostic and therapeutic purposes, range from simple and commonly performed ones, such as fluid aspiration and steroid injection in joints or para-articular tissues, to more complex ones, such as needle biopsy of space-occupying lesions and removal of foreign bodies.27, 28, 29 Patients are required to sign an informed consent after being informed of the procedure steps, benefits, and risks. Ultrasound examination
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