Blog

Case 16: Boxer’s Knuckle

Boxer’s Knuckle Direct trauma to the dorsal aspect of the MCP joint of the fingers is a common occurrence in Boxers and Martial Artists. This injury to the extensor mechanism has been called a “Boxer’s knuckle” although this should not be confused with the term ‘Boxer’s knuckle’ used to describe a fracture of the 5th […]

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Case 15: The Wrist Joint – Injection

Case 15; The Wrist Joint – Injection Anatomical Considerations The radiocarpal joint is an ellipsoid joint formed by the radius and the articular disc proximally and the proximal row of carpal bones distally. The carpal bones on the ulnar side only make intermittent contact with the proximal side — the triquetrum only makes contact during ulnar abduction. […]

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Case 14: Weber ‘A’ Fracture

Case 14: Weber ‘A’ Fracture A 40-year old female patient was referred for an US of the lateral ligaments to include dynamic assessment with a long history of ankle instability and pain. Interestingly she could recall no significant trauma although did describe a long history of relatively mild inversion injuries. No imaging had been undertaken […]

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Case 13: Ruptured Flexor Carpi Radialis

Case 13: Ruptured Flexor Carpi Radialis Flexor Carpi Radialis originates on the medial epicondyle of the humerus and inserts on the anterior aspect of the base of the second metacarpal, and has small slips to both the third metacarpal and tuberosity of the trapezium. On the anterior aspect of the forearm, proximal to the wrist, flexor […]

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Physiotherapists who carry out Ultrasound Examinations: Do you need additional Insurance?

Physiotherapists who carry out Ultrasound Examinations: Do you need additional Insurance? It may be useful to consider additional Public Liability Insurance (PLI)  if you are a Physiotherapist who is working as a Sonographer. Public liability insurance is designed for professionals who interact with members of the public. It protects against claims of personal injury or property damage […]

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Case 12: Imaging the Distal Biceps Tendon

Case 12: Imaging the Distal Biceps Tendon The traditional way to view the distal biceps tendon and the way I have used and taught has been to fully extend and supinate the elbow. In this position it is possible to see the tendon but imaging is often sub-optimal as the tendon ‘dives’ away from the […]

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Case 11: Tear of the Fascia Cruris

Case 11: Tear of the Fascia Cruris The fascia cruris is a layer of connective tissue which encloses the posterior structures of the calf extending as far down as the ankle joint with connection directly to the Achilles tendon. The paratenon which takes the place of a true synovial sheath surrounds the posterior, lateral and medial Achilles and […]

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Case 10: Freiberg’s Disease

Case 10: Freiberg’s Disease Freiberg’s Disease (also known as Freiberg’s infarction) Most commonly seen in 12 to 18 year old patients. However if missed it may become apparent when the joint develops secondary osteoarthritis later in life. Commonly occurs in the 2nd metatarsal head (approx. 70% of cases). Female to male ratio 4:1. Caused when […]

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Case 9: Scapulothoracic Crepitus

 Case: 9 Scapulothoracic Crepitus Crepitus around the scapulothoracic region maybe due to a predisposing abnormal anatomy such as, Malunion of scapula or rib fractures A history of resection of 1st rib for thoracic outlet syndrome Superomedial hooking of the scapula – approximately 6% of scapulae It may also be due to, Overuse with normal anatomy […]

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Case 8: The Case of the missing Coracoid

Case 8: The Case of the missing Coracoid A 26 year old male patient was referred with ‘Shoulder impingement +/- injection’. The referral contained no other clinical information. On questioning the patient described surgery for previous shoulder dislocation but could give no other information. Of interest was the longitudinal scan of the subscapularis tendon and […]

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Case 7: Ultrasound and early detection of Stress Fracture in a runner

Case 7: Ultrasound and early detection of Stress Fracture in a runner Stress injuries are a common cause of lower limb pain in runners accounting for approximately 8% of all injuries in elite track and field athletes (1). Bone stress injuries often progress to stress fractures (2). Stress fractures are the result of accelerated physiologic […]

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Case 6: Occult Fracture of the 2nd Toe in a runner

Case 6: Occult Fracture of the 2nd Toe in a runner A 40 year old male runner presented to Ultrasound with a referral from their GP with pain in the forefoot. Problems had been present for 3 weeks. Onset had been gradual during a run. There was no reported trauma. The patient described not being […]

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Case 5 – Avulsion fracture of the Ulnar Collateral Ligament (UCL) of the thumb

Avulsion fracture of the Ulnar Collateral Ligament (UCL) of the thumb Following on from Case 4 this video demonstrates an example of an avulsion injury of the UCL of the thumb. The UCL appears significantly thickened and an avulsion fracture maybe seen to the left of the image at the base of the proximal phalanx. […]

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Case 4: Ulnar Collateral Ligament (UCL) injury (Skier’s or Gamekeepers Thumb)

Case 4: Ulnar Collateral Ligament (UCL) injury (Skier’s or Gamekeepers Thumb) The UCL is typically 4-8mm wide and 12-14mm long and gives lateral and dorsal stability to the metacarpophalangeal joint of the thumb. The ligament arises from the medial tubercle of the metacarpal and inserts into the base of the proximal phalanx distally. The UCL […]

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US Case 3: Subluxation of the Long Head of Biceps

US Case 3: Subluxation of the Long Head of Biceps A 52 year old male patient presented to clinic with intermittent catching and pain at the anterior aspect of the shoulder following a press overhead with a barbell. An MRI had demonstrated a well sited long head of biceps within the bicipital groove. Likewise static […]

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US Case 2: Posterior Interosseus Nerve (PIN) and the Arcade of Fröshe Entrapment

US Case 2: Posterior Interosseus Nerve (PIN) and the Arcade of Fröshe Entrapment Introduction: The PIN is a branch of the radial nerve that provides motor innervation to the extensor compartment of the forearm. It passes between the two heads of the supinator muscle through the arcade of Fröshe distal to the radial head. It […]

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APL tendon variations

An interesting article sent by Walter Hemelryck Osteopath and Sonographer from Belgium This follows up Case 1. The whole article can be found at  http://www.smj.org.sg/sites/default/files/5501/5501a4.pdf  

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NEW BOOK – Diagnostic Musculoskeletal Ultrasound & Guided Injection: A Practical Guide

Publication of new Book: For further details http://www.thieme.com/books-main/manual-medicine/product/4382-diagnostic-musculoskeletal-ultrasound-and-guided-injection The aim of this book is to provide a pragmatic and accessible guide in the use of ultrasound in both the diagnosis and management of musculoskeletal and sports pathologies. The book is aimed at clinicians from a wide variety of backgrounds including Chiropractic, Orthopaedics, Osteopathy, Physiotherapy, Rheumatology, Sonography […]

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US Case 1: Anatomical variations in Dorsal Compartment 1

US Case 1: Anatomical variations in Dorsal Compartment 1 (DC1) of the Wrist The tendon of abductor pollicis longus (APL) and extensor pollicis brevis (EPB) lie side by side within the first dorsal compartment of the wrist lateral to the radial styloid. APL is in the more volar position with EPB laying more dorsally. A […]

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