US OF LOWER EXTREMITY (ADVANCED)

US OF LOWER EXTREMITY (ADVANCED)

PIT PERAMI XI

Hip

Anterior approach:

1. Anterior joint recess

2. Rectus femoris dan iliopsoas tendon Posterior :

1. Pyriformis muscle

2. Sciatic nerve

Will be distended if there any joint effusion

Anterior hip joint recess

RadioGraphics 2018; 38:867–889

Anterior hip joint recess

Longitudinal oreintation

RadioGraphics 2018; 38:867–889

Joint effusion Labral tear with paralabral cyst

RadioGraphics 2018; 38:867–889

Rectus femoris dan iliopsoas tendon

Rectus femoris tendon

Iliopsoas tendon

Iliopsoas

Tendon

Iliopsoas Tendon

NORMAL ILIOPSOAS BURSITIS

RIGHT ILIOPSOAS TENDINOSIS

Rectus Femoris Tendon

Long axis

AIIS

IP RF

Rectus Femoris Tendon

Short axis

Rectus Femoris Tendon : Direct and Indirect Tendon

Enthesitis RF

Calcific tendinosis RF

Complete RF tendon tear with muscle retraction

PYRIFORMIS MUSCLE AND SCIATIC NERVE

PYRIFORMIS MUSCLE AND SCIATIC NERVE

PSIS, Posterior Superior Iliac Spine SH, Sacral Hiatus

GT, Greater Trochanter.

The anterior-posterior thickness of the piriformis muscle measured by ultrasound varied widely

between individuals: from 5.8 to 11.5 mm in males

and from 4.4 to 9.6 mm in females

Pyriformis Syndrome

The most common piriformis syndrome causes are:

• Inflammation (swelling) in the piriformis or the tissues around it

• Muscle spasms

• Scarring in the muscle

When hypertrophy, inflammation, injury or anatomical variation of

the piriformis muscle results in compression of the sciatic nerve as

they both exit the pelvis through the greater sciatic notch.

Knee

1. Medial and lateral patelar retinaculum

2. Iliotibial band friction syndrome

Knee : MPFL

Knee :

Iliotibial band friction

syndrome

Journal of Ultrasound (2020) 23:379–385

https://ankleandfootcentre.com.au/2018/12/case-study-11-iliotibial-band-friction-syndrome/

Ankle

1. Layers of deltoid lig : - tibiotalar ligamen

- tibiocalcaneal ligamen - tibionavicular ligamen 2. Plantar fascia

3. Morton neuroma

Layers of deltoid ligament

SUPERFICIAL LAYER :

- Tibionavicular ligament (TNL - Tibiospring ligament (TSL)

- Tibiocalcaneal ligament (TCL) All three of these fascicles

blend with the superomedial

portion of the spring ligament

complex (SL)

Layers of deltoid ligament

DEEP LAYER :

Tibiotalar ligament (TTL) :

a small and variable anterior

tibiotalar ligament (ATTL) and a

very strong posterior tibiotalar

ligament (PTTL)

Bony landmarks.

(1) Posterior colliculus of the medial malleolus, (2) anterior colliculus of the medial malleolus, (3) tubercle of the navicular,

(4) sustentaculum tali of the calcaneus^,

(5) posteromedial talar tubercle

Deltoid ligament

A rupture of the

tibionavicular ligament (black arrow heads) B,C Ruptures of all ligament components

: ligament rupture.

A rupture of the tibionavicular ligament (black arrow heads) D-E: Ruptures of all ligament components

(F) A rupture of the anterior section of the deep posterior tibiotalar ligament with an intact tibiocalcaneal ligament (white arrow heads).

: ligament rupture.

Tarsal tunnel and tibial nerve

Tarsal tunnel and tibial nerve

PTT

FDLT

PTV PTV

PTV PTA

TN

FHLT

RETINACULUM

Tarsal tunnel syndrome

Morton’s neuroma (MN) is considered a nerve

entrapment neuropathy, causing symptoms relating to impingement of the common plantar digital and

proper plantar digital nerves, such as burning, tingling or numbness

MORTON NEUROMA

MORTON NEUROMA

A: Clasping of the

forefoot in the short axis view;

B, C: Short axis views of the intermetatarsal space before (B) and after (C) squeezing the forefoot;

D: Clasping of the

forefoot in the long axis view;

E, F: Long axis views of the intermetatarsal space before (E) and after (F) squeezing the forefoot.

In all images, arrows indicate Morton’s neuroma.

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