The Elbow Normal and Basic Pathological Sonography 肘关节正常和基础病理超声表现 Elbow anatomy 肘关节解剖 Systemic scan technique and sonographic anatomy 系统扫查技术以及超声下解剖 Ba

Standardized scan elbow normal & basic pathology 肘关节标准扫描 正常和基础病理超声表现 APLAR Pre-congress Course 2016 Shanghai Dr Carrel Ka-lung Yu 余嘉龙博士 Hong Kong Society of Rheumatology 香港风湿学会

The Elbow Normal and Basic Pathological Sonography 肘关节正常和基础病理超声表现 Elbow anatomy 肘关节解剖 Systemic scan technique and sonographic anatomy 系统扫查技术以及超声下解剖 Basic pathology findings 基础病理表现

Anatomy of Elbow 肘关节解剖

肱骨 内上髁 冠突窝 肱骨小头 外上髁 桡骨头 肱骨滑车 环状隐窝 冠突 内侧 桡骨 尺骨 外侧

肱骨 内上髁 肱桡关节 肱骨小头 桡骨头 肱骨滑车 外上髁 肱尺关节 环状隐窝 近端桡尺关节 内侧 桡骨 尺骨 外侧

肱骨 鹰嘴窝 内上髁 外上髁 鹰嘴 外侧 尺骨 桡骨 内侧

肱骨 肱骨小头 鹰嘴 桡骨头 尺骨 桡骨 后方 前方

肱骨 鹰嘴窝 外上髁 鹰嘴 滑车 前方 桡骨 尺骨 后方

肱肌 肱肌 肱桡肌

肱二头肌 短头长头 长头 短头 肱二头肌肌腱 桡骨结节

肱三头肌 外侧和长头表浅短头深在, 内侧 长头 外侧头 短头 肌腱 近端尺骨鹰嘴

屈肌总腱 桡侧腕屈肌掌长肌尺侧腕屈肌 肱骨远端 内上髁 屈肌总腱 指浅屈肌

肱骨远端 伸肌总腱 桡侧腕短伸肌 外上髁 指伸肌小指伸肌尺侧腕伸肌 伸肌总腱

肘管 尺神经 肱骨 肱三头肌 内上髁 尺骨鹰嘴与肱骨内上髁之间的空隙 奥斯本筋膜 尺骨鹰嘴 尺侧腕屈肌

Systemic scan technique and sonographic anatomy 系统扫查技术以及超声下解剖

Technical Requirement 技术需求 A linear transducer with a frequency of at least 7.5 MHz is recommended for examining the elbow joint 检查肘关节推荐不低于 7.5MHz 的线阵探头 For superficial lying lesions a higher frequency transducer is useful,e.g. 10-20 MHz 检查表浅病变时, 频率更高的探头更实用, 例如 10-20MHz

General Principal in Scanning of the Elbow 扫查肘关节的基本原则 Static exam (Picture) 静态检查 ( 图片 ) Patient sitting in front/ next to examiner Arm supported, relaxed 患者在检查者前方或旁边坐下上臂用支撑物垫起, 放松 Linear transducer >7.5 MHz > 7.5 Mhz 的线阵探头 Minimal pressure 施予最小的压力 Dynamic exam (Video) 动态检查 ( 录像 )

Indication of US of the elbow 肘关节超声的指征 1. Effusion 渗出 2. Synovial proliferation 滑膜增生 3. Bursitis 滑囊炎 4. Bony lesions (erosions) 骨病变 ( 侵蚀 ) 5. Osteophytes ( 骨赘形成 ) 6. Loose joint bodies ( 关节游离体 ) 7. Differentiation between gout tophus and rheumatoid nodule 鉴别痛风石与类风湿结节 8. Tendinitis at the medial or lateral epicondyle 内上髁或外上髁肌腱炎 9. Calcinosis 钙化 10. Tendon rupture (distal biceps tendon) 肌腱撕裂 ( 远端肱二头肌 )

Standard views of the elbow 肘关节标准检查位置图 Anterior humero-radial long 前肱桡纵向 Posterior long 后方纵向 Anterior humero-ulnar long 前肱尺纵向 Lateral humero-radial long 外侧肱桡纵向 Posterior trans 后方横断面 Anterior transverse scan 前方横断面扫描 Medial humero-ulnar long 内侧肱尺纵向 Posterior long 后方纵向

Standard scans of the elbow 肘关节标准扫查步骤 1. Anterior humero-radial longitudinal scan 前肱桡纵向 2. Anterior humero-ulnar longitudinal scan 前肱尺纵向 3. Anterior transverse scan over the trochlea 滑车前方横断面 4. Anterior transverse scan over the radial head 桡骨头前方横断面 5. Posterior longitudinal scan (90 flexion / 180 extension) 后方纵向 (90 屈曲 / 180 伸展 ) 6. Posterior transverse scan (90 flexion / 180 extension) 后方横断面 (90 屈曲 / 180 伸展 ) 7. Posterior longitudinal scan (distal from the olecranon) 后方纵向 ( 鹰嘴远端 ) 8. Lateral humero-radial longitudinal scan (along lateral epicondyle) 肱桡外侧纵向 ( 沿外上髁 ) 9. Medial humero-ulnar longitudinal scan (along medial epicondyle) 肱尺内侧纵向 ( 沿内上髁 ) 10. Longitudinal scan along sulcus ulnaris 沿尺神经沟纵向 11. Transverse scan along sulcus ulnaris 沿尺神经沟横断面

Longitudinal scan of the anterior humeroradial recess 前肱桡隐窝纵向扫描 Brachioradialis m. 肱桡肌 Radial fossa 桡窝 Humeral capitellum 肱骨小头 Radial head 桡骨头 Proximal 近端 Distal 远端

Longitudinal scan of anterior humuroulnar recess 前肱尺隐窝纵向扫描 Brachialis 肱肌 Pronator teres 旋前圆肌 Humeral trochlea 肱骨滑车 Proximal 近端 Ulnar coronoid process 尺骨冠突 Distal 远端

Transverse scan of anterior synovial recess 前滑膜隐窝横断面扫描 Brachialis 肱肌 Humeral Capitellum 肱骨小头 Humeral Trochlea 肱骨滑车

Anterior transverse scan over radial head 桡骨头前方横断面扫描 Radial head 桡骨头

Medial Humero-ulnar Longitudinal Scan Common Flexor Tendon 内侧肱尺纵向扫描屈肌总腱 Medial Epicondyle 内上髁 Common flexor 屈肌总腱 Ulnar 尺骨 Proximal 近端 Distal 远端

Lateral Humero-radial Longitudinal Scan Common Extensor Tendon 外侧肱桡纵向扫描伸肌总腱 Lateral Epicondyle 外上髁 Common extensor 伸肌总腱 Radial head 桡骨头 Proximal 近端 Distal 远端

Posterior Joint Recess 后关节隐窝 Triceps tendon 肱三头肌腱 Triceps muscle 肱三头肌 Olecranon 鹰嘴 Olecranon fossa 鹰嘴窝 Proximal 近端 Distal 远端

Triceps Tendon 肱三头肌腱 Triceps tendon 肱三头肌腱 Olecranon 鹰嘴 Proximal 近端 Distal 远端

Posterior transverse scan 后方横断面扫描 Medial Epicondyle of humerus 肱骨内上髁 Lateral Epicondyle of humerus 肱骨外上髁 Medial 内侧 Lateral 外侧

Posterior longitudinal scan 后方纵向扫描 Olecranon 鹰嘴 Ulnar 尺骨 Proximal 近端 Distal 远端

Transverse & longitudinal Scan of the Ulnar Nerve 尺神经横断面和纵向扫描 Ulnar nerve 尺神经 Medial Epicondyle 内上髁 Medial 内侧 Olecranon 鹰嘴 Lateral 外侧 Proximal 近端 Distal 远端 Ulnar nerve 尺神经 Distal 远端

Basic Pathology of Elbow 肘关节基础病理

Elbow swelling 肘关节肿胀 smaller effusions may not be palpable 少量积液可能不能被手法检查出来 synovitis or effusion, or to another cause 滑膜炎 渗出或其他原因

Effusion 渗出 anechoic or hypo-echoic, compressible and displaceable, not exhibiting color signals 等回声或低回声区, 可被压缩, 不能移动, 无血流信号 smaller effusions typically localize in the radial groove or the coronoid fossa, because or the lowest pressure of the joint capsule in this region 少量积液常常出现在桡窝或冠突窝, 因为关节囊中该部位压力最低 large effusions can fill the olecranon fossa, small effusions can only be visualized by flexing and extending the elbow. 大量积液可以填充鹰嘴窝, 少量积液只在屈伸肘关节时可以观察到

Synovitis 滑膜炎 hypo-echoic, poorly compressible, not displaceable, perhaps exhibiting color signals 低回声区, 不易被压缩, 不能移动, 可能呈现出血流信号

Enthesiopathy 肌腱端病 occurs most commonly at the lateral aspects of the humeral epicondyle, followed by the medial humeral epicondyle and the triceps tendon 最常出现在肱骨外上髁, 其次是肱骨内上髁和肱三头肌腱 The tendons become hypo-echoic, inhomogeneus and thickened in case of enthesiopathy 肌腱端病中肌腱呈现低回声, 不均匀及增厚的特点 Acute enthesitis Doppler signals 急性肌腱端炎 - 多普勒信号 Chronic enthesiopathy calcifications 慢性肌腱端病 - 钙化

Bursitis 滑囊炎 Fluid is anechoic and easily compressible 液体为无回声, 容易被压缩 Septic bursitis often contains fluctuating particles 化脓性滑囊炎囊内常常漂浮游移的颗粒 Gouty tophi occur as hyper-echoic, cloudy structures with partial or complete posterior shadowing 痛风石表现为高回声, 云雾状结构, 后带部分或完全声影 Rheumatoid nodules are hypo-echoic, usually with rather clear borders and no or only few color signals 类风湿结节常常表现为低回声, 边界清晰, 不伴有或仅伴有少量血流信号

Nerve pathology 神经病变 hypoechoic swelling of the nerve 神经呈现出低回声 肿胀的特点 nerve entrapment due to synovitis, effusion, tumors or bony spurs 神经由于滑膜炎 渗出 肿瘤或骨赘而卡压

Elbow Synovial Proliferation 肘关节滑膜增生 Brachioradialis 肱桡肌 Brachialis 肱肌 Synovial proliferation 滑膜增生 Synovial proliferation 滑膜增生 Capitellum 肱骨小头 Radial head 桡骨头 Capitellum 肱骨小头 Trochlea 滑车

Elbow Synovitis 肘关节滑膜炎 Capitellum 肱骨小头 Radial head 桡骨头 Capitellum 肱骨小头 Radial head 桡骨头

Elbow Effusion 肘关节渗出 Triceps Brachii 肱三头肌 Olecranon 鹰嘴 Synovial thickening 滑膜增厚 Effusion 渗出 Olecranon fossa 鹰嘴窝

Elbow Synovial Proliferation with Effusion 肘关节滑膜增生伴渗出 Trochlear 滑车 Synovial proliferation 滑膜增生 Ulna 尺骨

Elbow Erosion 肘关节骨侵蚀 Capitellum 肱骨小头 erosion 骨侵蚀 Radial head 桡骨头 Radial head 桡骨头 erosion 骨侵蚀 Longitudinal Scan 纵向扫描 Transverse Scan 横断面扫描

Elbow Lateral Epicondylitis 肘外上髁炎 Lateral Epicondyle 外上髁 Common extensor 伸肌总腱 Radial head 桡骨头

Other pathology of elbow 肘关节其他病变 Rupture bicep tendon 肱二头肌腱撕裂 Olecrenon bursitis 鹰嘴窝滑囊炎 Effusion and synovial thickening 渗出和滑膜增厚 Osteoarthritis with loose body 骨关节炎游离体 Coronoid fossa 冠突窝

Live Demo of Elbow Ultrasound 肘关节扫查现场演示