Musculoskeletal Ultrasound in Rheumatology Review

Foreword
Preface
	Organization
Acknowledgments
Contents
Contributors
1: Introduction: Musculoskeletal Ultrasound Indications and Fundamentals
	Introduction
	Indications for Ultrasound in Rheumatology
	Technical Fundamentals of Ultrasound
		Ultrasound Waves
		Ultrasound Energy
		Ultrasound Modes
	Ultrasound Equipment
	How to Use Ultrasound Equipment: “Knobology”
	How to Sit and Hold the Probe: Ultrasound Ergonomics
	How Anatomic Structures Appear on an Ultrasound Image
	Common Artifacts
		Anisotropy
		Posterior Acoustic Shadowing (Attenuation Artifact)
		Posterior Acoustic Enhancement
		Lateral Edge Shadowing
		Posterior Reverberation
		Mirror Image
	Conclusion
	References
2: Basic Sonopathology and Implementing Musculoskeletal Ultrasound into Clinical Practice
	Introduction
		Definitions
	Rheumatoid Arthritis
		Synovitis and Tenosynovitis
		Effusions
		Erosions
		RA Synovitis Scoring Systems
		Prognosis
	Osteoarthritis
		Osteophytes
		Articular Cartilage Damage
		Effusions and Baker’s Cysts
		Synovitis
	Spondyloarthropathies
		Tendon/Enthesis
		Ankylosing Spondylitis
		Psoriatic Arthritis
		Dactylitis
		Psoriasis of the Nails
		Scoring Systems for SpA
	Crystal Arthropathies: Gout and CPPD/Pseudogout
		Gout
		Asymptomatic Hyperuricemia and Early Gout
		Gout Vs. Calcium Pyrophosphate Dihydrate Deposition (Pseudogout)
		Ultrasound Vs. Other Imaging Modalities for  Diagnosis of Gout
		Chronic Tophaceous Gout
		Calcium Pyrophosphate Deposition Disease
		Systemic Sclerosis/Systemic Lupus Erythematosus
	Sjögren’s Syndrome
	Large Vessel Vasculitis and Polymyalgia Rheumatica
	Implementing Ultrasound into Clinical Practice
	Maintenance of Equipment
	Cleaning Guidelines
	Documentation and Billing
	Conclusion
	References
3: Ultrasound of the Hand and Wrist
	General Principles
	Dorsal Wrist
	Radial Wrist
	Ulnar Wrist
	Volar/Palmar Wrist
	Finger Joints
	Pathology
		Synovitis
		Erosions
		Tendon and Ligament Pathology
		Nodules
		Nerve Impingement
	Conclusion
	References
4: Ultrasound of the Elbow
	Introduction
	Ultrasound Examination Technique
		Anterior Elbow
		Lateral Elbow
		Medial Elbow
		Posterior Elbow
	Rheumatologic Elbow Pathology
		Synovial Pathology
		Bursal Pathology
		Tendon and Ligament Pathology
		Bony Pathology
		Soft Tissue Pathology
		Nerve Pathology
		Ultrasound-Guided Procedures at the Elbow
	Conclusion
	References
5: Ultrasound of the Shoulder
	Introduction
	Sonoanatomy
	Standard Scanning Protocol
		Anterior Transverse and Longitudinal Scans: Biceps Tendon and Subscapularis Tendon
		Superior Scan: Acromioclavicular Joint
		Posterior Longitudinal Scans in Internal and External Rotation: Infraspinatus Tendon, Posterior Glenohumeral Joint, and Posterior Labrum
		Anterior Longitudinal and Transverse Supraspinatus Tendon Scans: Supraspinatus Tendon and Subacromial Bursa
	Sonopathology
		Long Head Biceps Tendon
			Bicipital Tendon Sheath Effusion
			Biceps Tendon Tears
		Rotator Cuff
			Rotator Cuff Tears
			Rotator Cuff Calcifications
		Subacromial/Subdeltoid Bursitis
		Glenohumeral Effusion
	Inflammatory Arthritis
		Rheumatoid Arthritis
		Polymyalgia Rheumatica
	Conclusion
	References
6: Ultrasound of the Hip
	Introduction
	Technical Requirements
	Standard Views and Normal Ultrasound Findings
		Anterior Hip
		Lateral Hip
		Posterior Hip
	Pathology Relevant to the Hip
		Hip Joint Effusion and Synovitis
		Arthritis/Osteonecrosis of the Hip
		Labral Tears and Paralabral Cysts
		Prosthetic Joint
		Iliopsoas Bursitis
		Snapping Iliopsoas Tendon
		Greater Trochanteric Pain Syndrome
		Tensor Fasciae Latae Tendinopathy
		Piriformis Muscle Syndrome
	Ultrasound of the Hip Joint in Rheumatologic Diseases
		Polymyalgia Rheumatica
		Gout and Pseudogout
		Ultrasound-Guided Aspiration and Injection of the Hip Joint
		Ultrasound-Guided Injection of the Trochanteric Bursa/Gluteus Medius Peritendinous Space
		Common Pitfalls in Hip Ultrasonography
	Conclusion
	References
7: Ultrasound of the Knee
	Introduction
	Standard Views in the Normal Knee
	Anterior
		Suprapatellar
			Suprapatellar Longitudinal View
			Suprapatellar Transverse View
			Parapatellar Views (Nonstandard)
			Suprapatellar Transverse in Maximum Flexion View
		Infrapatellar
			Infrapatellar Longitudinal-Proximal
			Infrapatellar Longitudinal-Distal
			Infrapatellar Transverse
	Medial
		Medial Longitudinal
	Lateral
		Lateral Longitudinal
	Posterior
		Posterior Transverse
	General Pathology Definitions and Structures Specific to the Knee
	Disease-Specific Findings at the Knee
		Rheumatoid Arthritis
		Osteoarthritis
		Spondyloarthritis
		Crystalline Arthropathies
		Tendon and Ligament Injuries
		Bursitis
		Reliability and Scoring Systems
	Injections and Ultrasound Guidance at the Knee
	Conclusion
	References
8: Ultrasound of the Ankle and Foot
	Introduction
	Standard Views in the Normal Ankle
		Dorsal Ankle
			Dorsal Longitudinal
			Dorsal Transverse
		Lateral Ankle
			Lateral Transverse
		Lateral Longitudinal
			Lateral Inframalleolar Longitudinal
		Medial Ankle
			Medial Transverse
			Medial Longitudinal
			Medial Inframalleolar Longitudinal
		Posterior Ankle
			Posterior Longitudinal
			Posterior Transverse
	Standard Views of the Normal Foot
		Plantar Fascia
			Plantar Longitudinal
		Subtalar Joint
		Dorsal Midfoot
		Metatarsophalangeal Joints
			Dorsal Longitudinal View
			Medial and Lateral Longitudinal
			Transverse
			Plantar Longitudinal and Transverse
			Pathology
		Tibiotalar Joint
		Lateral and Medial Ankle
		Posterior Ankle
		Plantar Fascia
		Subtalar Joint
		Midfoot
		Metatarsophalangeal Joints
	Conclusion
	References
9: Ultrasound-Guided Injections
	Introduction
	Evidence-Based Support for US-Guided Musculoskeletal Procedures
	Arthrocentesis
	Accuracy of US-Guided Needle Placement in Musculoskeletal Structures
	Outcome and Cost-Effectiveness of US-Guided Procedures
	Diagnosis, Diagnostic Ultrasound, and US-Guided Procedures
	Patient Positioning
	Palpation and Identification of Local Anatomy
	Sterile Technique and Universal Precautions
	Antisepsis
	Ultrasound Gel
	Ultrasound Probe
	Universal Precautions
	Prevention of Injection Site Hematoma and Hemorrhage
	Prevention of Iatrogenic Corticosteroid Atrophy of Skin and Subcutaneous Fat
	Needle and Syringe Selection
	De-Bubbling the Syringe
	Relationship of the Needle to the US Beam and Probe
		In-Plane Approach
		Out-of-Plane Approach
		Needle Visualization
	Hydrodissection, Hydrodilation, Hydrodisplacement, Hydrolysis, and Hydrodisruption
	Common Musculoskeletal Ultrasound-Guided Interventions
	Knee Procedures
		Ultrasound-Guided Arthrocentesis and Injection of the Knee
		US-Guided Injection of the Knee
		US-Guided Pes Anserine Bursa Injection
		US-Guided Iliotibial Band Injection
		US-Guided Aspiration and Injection of Popliteal Cysts
	Shoulder Procedures
		US-Guided Glenohumeral Joint Injection
		Ultrasound-Guided Subacromial/Subdeltoid Bursa Injection
		US-Guided Acromioclavicular Joint Injection
		US-Guided Bicipital Tendon Sheath Injection
	Ultrasound-Guided Needle Tenotomy (or Barbotage) and Lavage for Calcific Tendinitis/Tendinopathy
		Ultrasound-Guided Needle Tenotomy, (or Barbotage)
		Lavage
	Elbow Procedures
		Ultrasound-Guided Elbow Joint Injection
		Ultrasound-Guided Lateral Epicondyle Injection
	Hand and Wrist Procedures
		Ultrasound-Guided Wrist (Radiocarpal) Joint Injection
		Ultrasound-Guided Carpal Tunnel Injection
		Ultrasound-Guided First Carpometacarpal (Metacarpotrapizium) Joint and Scaphotrapeziotrapezoid Joint Injections
		Ultrasound-Guided First Dorsal Wrist Compartment Injection for De Quervain’s Stenosing Tenosynovitis
		Ganglion Cysts and Periarticular Cysts
		Ultrasound-Guided Trigger Finger Injection for Digital Flexor Tenosynovitis with A1 Pulley Stenosis
	Ultrasound-Guided Small Joint Injections: Metacarpophalangeal (MCP), Interphalangeal Joints (IP), and Distal Interphalangeal (DIP) Cysts
	Hip Procedures
		Ultrasound-Guided Hip Joint Injection
		US-Guided Trochanteric Bursa Injections
		US-Guided Sacroiliac Joint Injections
	US-Guided Procedures of the Foot and Ankle
		Ultrasound-Guided Tibiotalar Ankle Joint Injection
		Ultrasound-Guided Injections of the Subtalar, Tarsonavicular, and Other Midfoot Joints
		Ultrasound-Guided Tarsal Tunnel Injection
		Ultrasound-Guided Peroneal Tendon Sheath Injection
		Ultrasound-Guided Achilles Tendon and Associated Bursae Injections
		Ultrasound-Guided Calcaneus and Plantar Fascia Injections
		Ultrasound-Guided Morton’s Neuroma Injection
		Ultrasound-Guided Injections of Metatarsophalangeal and Interphalangeal Joints
		US-Guided Percutaneous Biopsy
	Conclusion
	References
10: Pediatric Musculoskeletal Ultrasonography
	Introduction
	Technical Requirements
	Normal Ultrasound Anatomy in Children
		Joint
	Cartilage Assessment
		Tendon and Enthesis/Apophysis
		Ligaments
		Joint Capsule
		Doppler
	Traction Apophysitis
	Reactive Arthritis: Transient Synovitis of the Hip
	Juvenile Idiopathic Arthritis
		Synovitis
		Enthesitis
		Synovial Cysts
		Erosions
		Cartilage
	Point-of-Care US in Pediatric Rheumatology
	Interventions
	Conclusion
	References
Part I: Rheumatic Diseases
	11: Ultrasound in Rheumatoid Arthritis
		Introduction
		How to Obtain Good Images for Evaluation of Synovitis in Joints and Tendons
		Ultrasound Evaluation of Inflammation
			Doppler Ultrasound
			Optimization of Doppler Settings
			Scoring of Synovitis
			Semiquantitative Synovitis Scoring Systems
			Quantitative Synovitis Scoring
			Number of Joints to Be Examined
		Evaluation of Tenosynovitis
		Special Considerations When Performing Ultrasound of RA Patients
			Assessment of the Wrist
			Paratenonitis
			Intermetatarsal Bursitis
			Baker’s Cyst (Popliteal Cyst)
		Erosions
		Conclusion
		References
	12: Ultrasound in Psoriatic Arthritis
		Introduction
		Enthesitis
			Pathoanatomical Definitions of Entheses
			Sonopathology of Enthesitis
			Entheseal Indices and the Choice of Entheseal Sites
		Dactylitis
		Ultrasound of the Peripheral Joints in Psoriatic Arthritis
			Ultrasound Features of Joint Involvement in Psoriatic Arthritis
			Sonography and Diagnosis of PsA
			Sonographic Outcome Measures for Joint Involvement
		Conclusion
		References
	13: Ultrasound in Crystalline Diseases: Gout and Calcium-Associated Arthritis
		Introduction
		Calcium-Associated Arthritis: Basic Calcium Phosphate Disease and Calcium Pyrophosphate Deposition Disease
			Basic Calcium Phosphate
			Calcium Pyrophosphate Dihydrate
		GOUT
			Gout
				Double Contour Sign
				Tophus
				First Metatarsophalangeal Joint (MTP 1)
				Aggregates
				Erosions
			Comparison of Ultrasonography and Other Imaging Modalities in Gout
			Assessment of Treatment Response
		Conclusion
		References
	14: Ultrasound in Osteoarthritis
		Introduction
		Ultrasound Findings in Osteoarthritis
		Reliability of Ultrasound in Osteoarthritis
		Ultrasound Features by Joint in Osteoarthritis
			General
			Hand/Wrist
			Elbow
			Shoulder
			Hip
			Knee
			Foot/Ankle
		Image Modality Comparison
			Overview
			Knee
			Hip
			Hand
		Sonography of Osteoarthritis for Rheumatologists (SOAR)
		Summary
		References
	15: Ultrasound in Systemic Sclerosis and Systemic Lupus Erythematosus
		Ultrasound in Systemic Sclerosis
			Introduction
			Joint and Tendon Disease in Systemic Sclerosis
				Articular Disease in Systemic Sclerosis
				Tendinopathy in Systemic Sclerosis
			Vascular Disease and Associated Pathology in Systemic Sclerosis
				Raynaud’s Phenomena
				Ulnar Artery Occlusion and Finger Pulp Blood Flow
				Digital Ulcers
			Calcinosis
			Peripheral Neuropathy in SSc
			Skin Thickening in Systemic Sclerosis
			Lung Ultrasound in Systemic Sclerosis
		Ultrasound in Systemic Lupus Erythematosus
			Introduction
			Arthropathy in Systemic Lupus Erythematosus
				Asymptomatic Arthropathy
				Nondeforming, Nonerosive (NDNE) Arthropathy and Jaccoud’s Arthropathy
				Rhupus and Erosive Arthropathy
			Tendinopathy in Systemic Lupus Erythematosus
		Conclusion
		References
Part II: Beyond Musculoskeletal Ultrasound
	16: Ultrasound in Vasculitis
		Introduction
			General Considerations
			Evidence-Based Background for the Use of Ultrasound in Vasculitis
			Medium-Sized and Small Vessel Vasculitides
			Polymyalgia Rheumatica
		Ultrasound Adjustments for Vasculitis: Proper Equipment and Settings
			Proper Equipment, B-Mode, and Color Doppler Adjustments
				B-Mode Adjustments
				Color Doppler Adjustments
			Pitfalls
				Not Steering the Color Box
				Pseudohalo
				Blooming
				Hair
				Use of Power and Not Color Doppler
				Atherosclerosis
				The IMC Thickness Disappears with Treatment
				Inflammatory Changes Due to Other Diseases (Infection, Other Systemic Vasculitides, Amyloidosis, etc.)
		Normal Vascular Ultrasound Anatomy and Examination Techniques
			Temporal Artery
			Distal Facial Artery
			Carotid Artery
			Subclavian Artery
			Axillary Artery
			Abdominal Aorta
			Sonopathology in Large-Vessel Vasculitis
			Cranial Arteritis
				Temporal Arteritis
					Facial Arteritis
			Supraaortic Arteritis
				Carotid Arteritis
				Subclavian Arteritis
				Axillary Arteritis
			Abdominal Aortitis
		References
	17: Salivary Gland Ultrasound for Sjögren’s Syndrome
		Introduction
		Salivary Gland Anatomy
		Scanning Technique
		Ultrasonographic Features of the Normal Salivary Glands
		Ultrasonographic Features in Sjögren’s Syndrome
		Scoring and Diagnosis of Sjögren’s Syndrome
		Differential Diagnoses
			Noninflammatory/Nonmalignant Causes
			IgG4-Related Disease
			HIV-Associated Disease
				Sarcoidosis, Amyloidosis
		Ultrasound in Prognostication and Therapeutic Response
		Conclusion
		References
	18: Lung Ultrasound for Rheumatic Diseases
		Introduction
		Lung Involvement in Rheumatic Diseases
		Normal Lung Imaging
		The Abnormal Lung
		Pneumothorax
		Interstitial Syndrome
			B-Lines
		Consolidation
		Pleural Effusions
		Pleural Disease
		Lung Scanning Protocols
		Ultrasound Assessment for ILD and Pleural Disease in CTDs
		Ultrasound in Systemic Sclerosis Lung Disease
		Scanning Protocols and Scoring Systems for CTD-LUS
		Equipment Issues
		Conclusion
		References
	19: Advanced Ultrasound Applications: Elastography and Contrast-Enhanced Ultrasound
		Introduction to Elastography
		General Principles
		Strain Elastography (SE) [Also Known as Real-Time Elastography RTE)]
		Shear Wave Elastography (SWE)
		Basic Physics Measurements in Shear Wave EUS
		Achilles/Patellar Tendinopathy
		Psoriasis
		Rotator Cuff Tendinopathy
		Lateral Epicondylitis
		Plantar Fasciitis
		Sjögren’s Syndrome
		Systemic Sclerosis
		Hypermobility Spectrum Disorders
		Dupuytren’s Contracture
		Gouty Arthritis
		Myofascial Pain
		Median Nerve and Carpal Tunnel Syndrome
		Selected Topics in Pediatric Rheumatology
		Contrast-Enhanced Ultrasound (CEUS)
		Conclusion
		Appendix A: Physics of Elastography
		References
Index