Medial ankle and heel: ultrasound evaluation and sonographic appearances of conditions causing symptoms.

The complex anatomy of the medial ankle and hindfoot can make clinical assessment of medial ankle and heel pain challenging. Ultrasound is an accessible, relatively inexpensive modality, and modern high-resolution probes allow eloquent demonstration of the main structures that are implicated as potential causes of medial ankle pain. In this work we review highlights the clinically relevant anatomy and normal sonographic appearances of structures around the medial ankle and heel and discuss key techniques to allow optimal ultrasound assessment. The conditions that cause medial-sided ankle and heel symptoms are discussed with their characteristic sonographic appearances.

Sonography of the anterior oblique ligament of the trapeziometacarpal joint: a study of cadavers and asymptomatic volunteers.

OBJECTIVE: The purpose of this study was to evaluate the ability of ultrasound to identify and characterize the anterior oblique ligament of the thumb in cadavers and asymptomatic volunteers. SUBJECTS AND METHODS: The anterior oblique ligaments of four cadaveric hands were imaged with a high-resolution transducer. The ligaments were then injected with 0.1% methylene blue using ultrasound guidance. To confirm identification of the ligament, the base of the thumb was immediately dissected, revealing the exact location of the dye. The bilateral ligaments in 40 asymptomatic adult volunteers were imaged. RESULTS: Surgical dissection confirmed injection of methylene blue into all cadaveric ligaments. The proximal attachment of the anterior oblique ligament was well defined in all the hands, and the distal attachment was well defined in 94% of the hands. The mean thickness of the anterior oblique ligament at the metacarpal attachment (0.7 mm), midportion (0.98 mm), and trapezial attachment (0.65 mm) did not differ significantly with respect to sex, right and left side, or hand dominance and was weakly correlated with weight, height, body mass index, and age. The length of the ligament was statistically significantly different between the dominant (10.6 mm) and nondominant (9.6 mm) hands. The volar metacarpal translation with palmar abduction stress did not differ significantly between the dominant (0.7 mm) and nondominant (0.8 mm) hands. There was no association between the degree of translation and the biologic characteristics (weight, height, body mass index, and age). CONCLUSION: High-resolution ultrasound can be used to identify and measure the thickness of the anterior oblique ligament. Dynamic ultrasound imaging can depict volar translation of the metacarpal, which may facilitate diagnosis of ligamentous injury.

Sonography of the lateral ulnar collateral ligament of the elbow: study of cadavers and healthy volunteers.

OBJECTIVE: The purpose of this study was to assess the utility of high-resolution sonography in identification and characterization of the size and echogenicity of the lateral ulnar collateral ligament of the elbow in cadavers and healthy volunteers. SUBJECTS AND METHODS: The lateral ulnar collateral ligaments of four cadaveric elbows were imaged with a high-resolution linear-array ultrasound transducer. On localization, the ligaments were injected with 0.1% methylene blue under sonographic guidance. For confirmation of identification of the ligaments, the elbows were immediately dissected to reveal the exact location of the stain. The ligaments of both elbows of 35 healthy adult volunteers were imaged. RESULTS: Surgical dissection confirmed injection of methylene blue into all four cadaveric ligaments. The lateral ulnar collateral ligament was identified bilaterally over the radial head in all 35 volunteers. The mean thickness of the ligament at this point was 1.2 mm in women and men. The proximal attachment of the ligament to the humerus was well visualized bilaterally in 94.3% of volunteers. The mean thickness at this point was 1.7 mm in women and 1.6 mm in men. The distal attachment on the ulna was well visualized in 90% of elbows. The ligament was hyperechoic in relation to muscle in all volunteers. Differences in ligament measurements with regard to sex and hand dominance were not significant. Ligament thickness correlated weakly with volunteer weight, height, body mass index, and age. CONCLUSION: High-resolution ultrasound imaging is accurate for identification and measurement of normal lateral ulnar collateral ligaments. Therefore, ultrasound may prove valuable in assessment of abnormal lateral ulnar collateral ligaments.

Comparison of sonography and magnetic resonance imaging for spring ligament abnormalities: preliminary study.

OBJECTIVE: The purpose of this study was to determine whether sonography is as accurate as magnetic resonance (MR) imaging for depicting abnormalities of the spring ligament in patients with symptomatic posterior tibial tendon (PTT) dysfunction. METHODS: Sixteen patients (18 ligaments) with symptomatic PTT dysfunction were prospectively evaluated with sonography and MR imaging. RESULTS: Magnetic resonance imaging showed spring ligament tears in 8 of 18 feet, including 6 incomplete tears and 2 complete tears. Sonography showed spring ligament tears in 7 of 18 feet, including 6 incomplete tears and 1 complete tear. The findings of sonography and MR imaging were concordant in 17 of 18 feet (94%). Six of the 8 spring ligament tears on MR imaging were associated with posterior tibial tendinosis or tears. CONCLUSIONS: Sonography is an effective imaging option in assessing spring ligament abnormalities in patients with symptomatic PTT dysfunction.

Musculoskeletal disorders of the lower limb--ultrasound and magnetic resonance imaging correlation.

The purpose of this paper is to familiarize general radiologists and specialists with the sonographic and corresponding magnetic resonance imaging (MRI) appearance of various musculoskeletal disorders of the lower limb. Technologists and radiologists should be familiar with all imaging techniques for the investigation and evaluation of musculoskeletal abnormalities. The role of high-resolution ultrasound (US) is highlighted, as well as the complementary relation between both imaging modalities. We also discuss some of the advantages of US over MRI in the investigation of musculoskeletal disorders of the lower limb. The MRI and US appearances of various articular, periarticular, and soft tissue pathologies of the lower limb are compared and reviewed, and where possible, the advantages of each modality are identified.

Sonography of the superomedial part of the spring ligament complex of the foot: a study of cadavers and asymptomatic volunteers.

OBJECTIVE: To evaluate the ability of high-resolution sonography for assessing the thickness and echogenicity of the superomedial part of the normal spring ligament in the foot in cadavers and asymptomatic volunteers. MATERIALS AND METHODS: The superomedial part of the normal spring ligament of four cadaveric feet was imaged with a high-resolution linear array transducer. Upon localization, the ligament was injected with 0.1% methylene blue with sonographic guidance. A posteromedial approach was used to dissect the feet immediately following injection to confirm accurate identification of the ligament. The bilateral ligaments in 40 asymptomatic adult volunteers were subsequently imaged. RESULTS: Surgical dissection confirmed the accurate injection of methylene blue into all four cadaveric ligaments. The superomedial part of the normal spring ligament was identified bilaterally in all of the 40 asymptomatic volunteers, with a mean thickness of 3 mm in longitudinal short axes. The ligament was echogenic relative to surrounding fat, and it was thinner in women. Differences in ligament measurements with respect to age, sex, side (left vs. right) and foot dominance were not significant. The volunteers' height, weight and body mass index had a weakly positive correlation with ligament thickness. CONCLUSION: High-resolution ultrasound can be used to identify and measure the thickness of the superomedial part of the normal spring ligament. The provided baseline measurements for the normal ligament could prove valuable when assessing the abnormal ligament.

Sonography of full-thickness supraspinatus tears: comparison of patient positioning technique with surgical correlation.

OBJECTIVE: Sonography has become a popular technique for the assessment of musculoskeletal disorders. Patient positioning is crucial to a thorough and accurate assessment of rotator cuff tendons. Two positions, the Crass and modified Crass, have been routinely used in the research and clinical settings to examine the supraspinatus tendon. Our study was a prospective trial to determine whether the Crass or the modified Crass position affords the most accurate measure of supraspinatus tears when compared with surgical findings. SUBJECTS AND METHODS: Twenty-one patients with full-thickness supraspinatus tears underwent shoulder sonography in both the Crass and the modified Crass positions. Measurements of supraspinatus tears were performed in the sagittal and transverse dimensions. Patients subsequently underwent either arthroscopic or open supraspinatus repair. Intraoperative measurements were made in two dimensions and were compared with sonographic findings. RESULTS: Sonography had 100% specificity in detecting full-thickness supraspinatus tears. No statistically significant difference was seen between the size of supraspinatus tears in the Crass and modified Crass positions and surgical findings in the transverse plane (p = 0.55 and 0.61, respectively). In the sagittal dimension, no statistically significant difference was seen between surgical findings and the Crass position (p = 0.14); however, a difference existed when the modified Crass position was used (p = 0.03). CONCLUSION: Sonography reliably detects and quantifies supraspinatus tears. Both the Crass and the modified Crass positions reflected the true size of supraspinatus tears in the transverse plane. In the sagittal plane, the Crass position is the more useful to quantify supraspinatus tears because the modified Crass position overestimates the size of such tears.