Extremities Nonvascular & Superficial Soft Tissue Structures

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Last updated 1:15 AM on 6/17/26

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11 Terms

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muskuloskeletal structures

equipment: linear array transducer
must place transducer parallel to tendon to avoid anisotropy (artifact)
image symptomatic and asymptomatic areas for comparison
evaluate in its entirety in SAG and TRV planes

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MSK structure: tendons

bundles of connective tissue that attach muscle to bone
proximal attachment is called the origin, and distal attachment is the insertion
portion of the attachment to the muscle is called the musculotendinous junction
point of attachment to the bone is the osteotendinous junction
SONO: hypo-hyperechoic fibillary appearance; surrounded by thin, echogenic peritoneum

<ul><li><p>bundles of connective tissue that attach <span style="color: yellow;">muscle to bone</span></p></li><li><p>proximal attachment is called the <strong><em>origin</em></strong>, and distal attachment is the <strong><em>insertion</em></strong></p></li><li><p>portion of the attachment to the muscle is called the <strong><em>musculotendinous junction</em></strong></p></li><li><p>point of attachment to the bone is the <strong><em>osteotendinous junction</em></strong></p></li><li><p>SONO: hypo-hyperechoic fibillary appearance; surrounded by thin, echogenic peritoneum</p></li></ul><p></p>

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MSK structure: achilles tendon

MC injured ankle tendon
connects the calf muscle to the calcaneus (posterior surface of the feel)

<ul><li><p>MC injured ankle tendon</p></li><li><p>connects the calf muscle to the calcaneus (posterior surface of the feel)</p></li></ul><p></p>

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how to image achilles tendon

start high, then go downwards towards heel

look for breaks, thickening, fluid, etc. on the way down

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MSK structure: ligaments

connective tissue that attach bone to bone
types: collagenous, not flexible, or elastic
elastic ligaments can stretch and recoil as the bone moves
SONO: echogenic fibrillar appearance; not easily seen because they contain less cartilage

<ul><li><p>connective tissue that attach <span style="color: yellow;">bone to bone</span></p></li><li><p>types: collagenous, not flexible, or elastic</p></li><li><p>elastic ligaments can stretch and recoil as the bone moves</p></li><li><p>SONO: echogenic fibrillar appearance; not easily seen because they contain less cartilage</p></li></ul><p></p>

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MSK structure: muscles

muscles are voluntary or involuntary (controlled by Autonomic Nervous System)
3 types: skeletal; smooth; cardiac
- skeletal: controlled through the nervous system; attached to bones
- cardiac: smooth muscle involving the heart; involuntary
- smooth: attached to internal organs and muscles surrounding the blood vessels
SONO:
- hypoechoic with linear, echogenic strands/striations when imaged SAG
- speckled “starry night” appearance when imaged TRV

<ul><li><p>muscles are voluntary or involuntary (controlled by Autonomic Nervous System)</p></li><li><p>3 types: skeletal; smooth; cardiac</p><ul><li><p>skeletal: controlled through the nervous system; attached to bones</p></li><li><p>cardiac: smooth muscle involving the heart; involuntary</p></li><li><p>smooth: attached to internal organs and muscles surrounding the blood vessels</p></li></ul></li><li><p>SONO: </p><ul><li><p>hypoechoic with linear, echogenic strands/striations when imaged SAG</p></li><li><p>speckled “starry night” appearance when imaged TRV</p></li></ul></li></ul><p></p>

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tendonitis

inflammation of the tendon
S/S: pain, swelling
SONO:
- thickened and hypoechoic tendon (diffuse) or enlarged hypoechoic area within tendon (local)
- possible hyperechoic flow within the tendon

<ul><li><p>inflammation of the tendon</p></li><li><p>S/S: pain, swelling</p></li><li><p>SONO: </p><ul><li><p><span style="color: yellow;">thickened and hypoechoic</span> tendon (diffuse) or enlarged hypoechoic area within tendon (local)</p></li><li><p>possible <span style="color: yellow;">hyperechoic</span> flow within the tendon</p></li></ul></li></ul><p></p>

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tendon rupture

aka “tear”
S/S: significant pain; edema; fluid accumulation
SONO:
- partial tear=focal hypoechoic area within tendon
- complete tear=anechoic or heterogeneous area within the tendon, indicative of hematoma
  - complete ruptures also show shadowing in area of the separated tendon, with fat, a hematoma, or granulomatous material filling the gap created by the tear

**MRI is gold standard

<ul><li><p>aka “tear”</p></li><li><p>S/S: significant pain; edema; fluid accumulation</p></li><li><p>SONO:</p><ul><li><p>partial tear=focal hypoechoic area within tendon </p></li><li><p>complete tear=anechoic or heterogeneous area within the tendon, indicative of hematoma</p><ul><li><p>complete ruptures also show shadowing in area of the separated tendon, with fat, a hematoma, or granulomatous material filling the gap created by the tear</p></li></ul></li></ul></li></ul><p>**MRI is gold standard</p><p></p>

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achilles rupture

S/S: posterior ankle pain
transducer is placed misline above the heel; light touch; ample amount of gel; dorsiflexion (foot lifted towards the chin)
thompson to determine complete or partial tear (can’t flex if theres a complete tear)
- pt. prone, squeeze calf → foot should plantar flex when a complete tear is not present

<ul><li><p>S/S: posterior ankle pain</p></li><li><p>transducer is placed misline above the heel; light touch; ample amount of gel; dorsiflexion (foot lifted towards the chin)</p></li><li><p>thompson to determine complete or partial tear (can’t flex if theres a complete tear)</p><ul><li><p>pt. prone, squeeze calf → foot should plantar flex when a complete tear is not present </p></li></ul></li></ul><p></p>

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