Indeed all things that are echogenic are not necessarily calcification.

Yes indeed delimitation means the same as a longitudinal split tear of the tendon and when this occurs you often get that classic linear line of scar tissue.

I don’t think I can be perfect in always allocating the correct diagnosis to an echogenic area in a…[Read more]

I will record the carotid, renal arts, CVI, DVT and leg arts as I get time,

As always the great man Martin Necas deserves all the credit for my vascular ultrasound presentations.

He is the real master.

Steve

I think the main thing with ergonomics above all others is to prevent unsupported abduction of the shoulder.
If you can prevent this I think your scanning technique will be robust and safe for the long haul.

Steve

This is in the correct area for paratendinitis and rheumatoid is certainly going to be a predisposing factor for such synovial proliferation.
The unusual thing about this one is it is focal and localised, more like a rheumatoid nodule of synovial proliferation compared to the more common diffuse paratendinitis appearance.
I still think…[Read more]

Absolutely,

nice example,

You might even be able to extend the length of this longitudinal tear if you tilt the lateral edge of the transducer towards the flor. You will lose the biceps tendon but be in a more perfect long axis plane for the subscap fibres showing the full length of the delimitation.
The echogenic line may have some…[Read more]

These are lovely pictures,

You are doing them perfectly,

I think all cases are positive.

In a normal rotator cuff interval there should be no flow and you have significant flow in all cases which indicates some inflammation of the glenohumeral joint capsule which may be adhesive capsulitis or simple synovitis of the GH joint.
If it…[Read more]

Steve

Your question about PSV and ICA/CCA ratio is a good one and it can be answered with one small word ” or ”

It is only 2 letters but it gives you the answer.

I have attached a…[Read more]

It is just a basic overview style lecture but the knowledge is really useful when you are performing gynae ultrasound or renal ultrasound and some sort of prolapse is the likely problem.

Steve

I think you have made the correct measurements.

All abdominal hernias are more pronounced when the patient is standing. I have a tilting bed so I can put it at 60 degrees allowing for good gravitational pressure and a stable scanning position,

Steve

Steve

I have not seen the images and if you can upload some that would be brilliant.

I am thinking…[Read more]

Injecting small amounts of saline or lignocaine into areas of concern in the rotator cuff is something that many people do as a diagnostic test and it works very well.
You can also add a little gas to the injection by adgitating the liquid prior to injecting and use the…[Read more]

I think when we do this the transducer is placed slightly more to the ulnar side so you see the FCR tendon in long axis and the scaphoid and trapezium bones. To then show the 1st CMC you slide the…[Read more]

It may well be spigelian but also consider that it might be a ventral hernia through the linea alba where the linea alba is very wide due to the abdominal wall musculature weakness.
Ventral hernias through the linea alba are much more common than spigelian so I would bet on this one first . The fact that it is not in the…[Read more]

I have a few resources I will share with you,

From my perspective there are 3 types of TOS.

Neural, venous and arterial.

I am really only keen to scan for arterial TOS with ultrasound.

My technique is simple. Scan the affected subclavian artery from its origin to the axillary artery.

Follow it medially to where it disappears under…[Read more]

To be honest this probably doesn’t need an ultrasound at all,

If the uterus is prolapsed by such a degree it is a clinical diagnosis and the gynaecologist team can manage the patient medically and surgically as appropriate.

If you do a trans perineal scan I use a convex transducer like i use for imaging the liver etc. I put gel on the…[Read more]

It is just as important,

In pulse wave you should use the most appropriate Doppler frequency,

If you are using a higher frequency and getting better results with colour Doppler use the same trick with pulse wave and similarly if you are lowering your colour Doppler frequency to get the best result mirror this with the pulse…[Read more]

You will see this finding very commonly in this demographic.

Steve

The brachial plexus is a fascinating area to scan in terms of the anatomy but I am still skeptical about the use of ultrasound for diagnosing subtle neural oedema or adhesions etc.

This is a work in progress for me and has been for many years with to be honest not much progress being made!

I am still keen to earn more about…[Read more]

this is a great question with a long answer.

I have a nice post op shoulder lecture and I will record it into a webinar for the website as this will answer your questions plus other things that are important.

To answer your questions before the webinar is loaded up:

The long head of biceps tendon is often absent in the area of the…[Read more]

I think part of doing a good ultrasound is to convey some clinical presentation details to the reporting Doctor. I am not pretending to ge a Doctor myself as I am a sonographer so I don’t do formal tests like empty can etc but I am happy to make simple observations like the scapula-humeral rhythm and limited external rotation etc.
I…[Read more]

AC joints get degenerative change early in life so I think the age of the patient makes a difference after trauma.

If they are young, for example 25 and you are seeing these changes they are likely related to the trauma but in an older patient you are seeing normal for age AC point degenerative changes.
I use forward flexion and…[Read more]

Scale / PRF are the same thing and this should be set low to see slow flowing blood and higher for faster flowing blood.

The transducer frequency is a completely different thing and you should think about it the same way you do when doing b-mode ultrasound.
Colour Doppler and Pulse wave Doppler frequencies can be adjusted on some…[Read more]

I agree, they can be really easy and beautiful or really difficult!
I will answer your questions.

1: Yes, I think beam steering is overused and more beam steering should only be used when I can not heel and toe the transducer to keep my angle below 60 degrees.
In the carotid system anything less than 60 degrees is OK but I think if you…[Read more]

I think good sonographers look at the big picture including multiple points of reference and the clinical presentation before reaching their conclusions.

Nice one,

Steve

Good questions.

The first question is an age old debate and people have different views as to stay at 60 degrees or alternatively anything less than 60 is good. Personally I use the lowest angle correction I can as this gives the least mathematical error for every degree of angle correction error you are using. So I am happy to use…[Read more]

Steve

I do the same trick for my medial left elbows and ulnar nerve studies.

It makes it really ergonomic for everyone.

Steve

At first I thought it was too far removed from the dermis, but late in the video there is a hint of a punctum.

The other differential I would include would be an area of chronic fat necrosis as this part of the body is commonly traumatised.

It looks really benign whatever it proves to be.

Steve

I think taking a global objective assessment approach is better than any single measurement.

We always get snookered with numbers being important in reports, but I can’t help but think the best reports I read have a “specialist medical opinion” rather than a list of…[Read more]

Yes, I am not at all a numbers person and I think that is an advantage.

A global perspective works best I think.

With adhesive cap I look at a number of things clinically and sonographically.

Clinically I test them for external rotation range compared to the other side.
Then I stand behind them and dig a finger into the medial…[Read more]

Sometimes (like in the knee lump you posted it does not resolve completely and you…[Read more]

For left arm DVT I lay the patient supine with their head at the other end of the bed so the left side is close to me.

This makes it ergonomic when you get used to it.

I find you don’t have to lower the arm to fill the veins.

This is essential for a lower limb but in the upper limb it is not so essential.

I still cross my fingers…[Read more]

There are several methods described and to be honest I think they are all rubbish.

If you measure the length of the right lobe it is super variable with some people having a Riedels lobe, others having a big left liver and short right lobe so I think the natural variation destroys the test. Once again I look more globally. An enlarged…[Read more]

I have had a look for a few examples of dodgy subscaps,

I think ultrasound is not as sensitive as MRI for subscapularis injuries, especially in the superior part of the insertion. When I see a long head of biceps tendon which is drifting medially I suspect a subscap tear causing long head of biceps instability. Medial migration of the…[Read more]

Steve

you are getting it,
I think your picture sums it up well.

the term sub-periosteal may be a bit confusing but it just means that the enthesis has a pitted surface. The pitting forms like little caves if you like in the surface of the enthesis. On ultrasound we sound getting “into the bone” and echoes returning from just beneath where we…[Read more]