The ankle & foot 足踝关节 Anterior aspect Medial aspect Lateral aspect Posterior & plantar aspect 前面内侧外侧后方 & 跖侧

Standardized scan and basic pathology: ankle and foot 足踝关节标准扫描和基础病理超声表现 Peter Mandl MD, PhD Division of Rheumatology, 3rd Department of Internal Medicine Medical University of Vienna, Vienna, Austria China Rheumatology Association & The Hong Kong Society of Rheumatology Basic MSUS Course Shanghai, China 24-26 September 2016

Anterior aspect 前方

Tibiotalar joint, dorsal longitudinal scan 胫距关节, 背侧纵向扫描 Ti Ti F Ta F: fat pad, 脂肪垫, Ta: talus, 距骨, Ti: tibia 胫骨

Tibiotalar joint, dorsal transverse scan 胫距关节, 背侧纵向扫描 EDLT EHLT TAT Ti Medial 内侧 Lateral 外侧 EDLT: extensor digitorum longus tendon, 趾长伸肌腱,EHLT: extensor hallucis longus tendon, 拇长伸肌腱 TAT : tibialis anterior tendon, 胫骨前肌腱,Ti: tibia 胫骨

Talonavicular joint, dorsal longitudinal scan 距舟关节, 背侧纵向扫描 TAT Ta S N Ta: talus, 距骨,N: navicular, 舟骨,TAT : tibialis anterior tendon, 胫骨前肌腱,S: sesamoid bone, 籽骨

Talonavicular joint, dorsal transverse scan 距舟关节, 背侧横断面 TAT Ta Ta: talus, 距骨,TAT : tibialis anterior tendon, 胫骨前肌腱

Cuneonavicular joint, dorsal longitudinal scan 舟楔关节, 背侧纵向扫描 N Cu Cu: cuneiform, 楔骨,N navicular, 舟骨

Tarsometatarsal joint, dorsal longitudinal scan 跗跖关节, 背侧纵向扫描 Cu MT Cu: cuneiform, 楔骨,MT : metatarsal, 跖骨

C: cartilage, 软骨,EDLT : extensor digitorum longus tendon, 趾长伸肌腱,F: fat pad, 脂肪垫, M: metatarsal head, 跖骨头,P: phalangeal base, 趾骨底 Metatarsophalangeal joint, dorsal longitudinal scan 跖趾关节, 背侧纵向扫描 EDLT F C C M P

Tibiotalar joint, dorsal longitudinal scan 胫距关节, 背侧纵向扫描 Synovial effusion in tibiotalar joint 胫距关节滑膜渗出

Tibiotalar joint, dorsal longitudinal scan 胫距关节, 背侧纵向扫描 Synovial effusion & hypertrophy in tibiotalar joint 胫距关节滑膜渗出 & 增生

Talonavicular joint 距舟关节 Synovial effusion in talonavicular joint 距舟关节滑膜渗出

Talonavicular joint, dorsal longitudinal scan 距舟关节, 背侧纵向扫描 Synovitis in talonavicular joint 距舟关节滑膜炎

Cuneonavicular joint, dorsal longitudinal scan 舟楔关节, 背侧纵向扫描 Synovial effusion in talonavicular & cuneonavicular joint 距舟和舟楔关节滑膜渗出

Cuneonavicular joint, dorsal longitudinal scan 舟楔关节, 背侧纵向扫描 Synovitis in talonavicular & cuneonavicular joint 距舟和舟楔关节滑膜炎

Tibiotalar joint, dorsal transverse scan 胫距关节, 背侧横断面扫描 synovial effusion in tibiotalar joint 胫距关节滑膜渗出 tibialis anterior tenosynovitis 胫骨前肌腱腱鞘炎

Tibialis anterior 胫骨前肌 tenosynovitis of tibialis anterior tendon 胫骨前肌腱腱鞘炎

Extensor digitorum longus 趾长伸肌 tenosynovitis of extensor digitorum longus 趾长伸肌腱腱鞘炎

MTP1 joint 第 1 跖趾关节 synovitis 滑膜炎

MTP2 joint 第 2 跖趾关节 synovitis 滑膜炎

MTP1 joint 第 1 跖趾关节 synovitis in gout 痛风中的滑膜炎

Medial aspect 内侧

Medial malleolus, oblique transverse scan 内踝, 斜向横断面扫描 FDLT: flexor digitorum longus tendon, 趾长屈肌腱,FHLT : flexor hallucis longus tendon, 踇长屈肌腱 NVB: neurovascular bundle, 神经血管束,TN: tibial nerve, 胫神经,TPT: tibialis posterior tendon 胫骨后肌腱

Medial malleolus, oblique transverse scan 内踝, 斜向横断面扫描

Tenosynovitis of tibialis posterior tendon 胫骨后肌腱鞘炎

Tenosynovitis of flexor digitorum longus & tib. post 趾长屈肌腱 & 胫骨后肌腱鞘炎

Tenosynovitis of flexor digitorum longus 趾长屈肌腱鞘炎 tenosynovitis of flexor digitorum longus 趾长屈肌腱鞘炎

Medial ankle, bony landmarks 内踝, 骨性标记内踝舟骨距骨后距下关节跟骨前距下关节载距突 Courtesy of Moller I and Bong D

Anterior subtalar joint 前距下关节胫骨后肌内踝三角韧带载距突距骨胫距关节

Anterior subtalar joint 前距下关节

Synovitis of the anterior subtalar & tibiotalar joints 前距下关节 & 胫距关节滑膜炎

Synovitis of the anterior subtalar & tibiotalar joints 前距下关节 & 胫距关节滑膜炎前距下关节和胫距关节滑膜炎

Courtesy of Moller I and Bong D Anterior subtalar joint spring ligament 前距下关节跳跃韧带 From the starting position distal aspect of the transducer remains fixed over the sustantaculum tali while the proximal portion is rotated anteriorly toward the navicular 从起始位置开始, 探头远端固定在载距突上, 近端部分转向前方的舟骨

Anterior subtalar joint spring ligament 前距下关节跳跃韧带胫骨后肌趾长屈肌跳跃韧带距骨载距突胫距关节

Anterior subtalar joint spring ligament 前距下关节跳跃韧带

Posterior subtalar joint 后距下关节 From the starting position, slide the probe toward the plantar aspect of the foot to visualize the FHL tendon under the sustentaculum tali (*) while dynamically plantar and dorsiflexing the great toe. Once the FHL is in the center of the screen, rotate the probe along the long axis of the FHL. 从起始位置, 朝向足跖侧滑动探头, 当动态跖屈或背屈大足趾时可观察到载距突下方的踇长屈肌腱当踇长屈肌腱在屏幕中央时, 沿踇长屈肌腱长轴旋转探头

Posterior subtalar joint 后距下关节踇长屈肌距骨跟骨胫距关节

Posterior subtalar joint 后距下关节 tenosynovitis of the flexor hallucis longus 踇长屈肌腱鞘炎

Tenosynovitis/ganglion cyst of FHL tendon 踇长屈肌腱腱鞘炎 / 腱鞘囊肿后距下关节

Lateraal aspect 外侧

Peronei, transverse view 腓骨肌, 横断面观 PB: peroneus brevis tendon, 腓骨短肌腱,PL: peroneus longus tendon 腓骨长肌腱

Peronei, longitudinal view 腓骨肌, 纵向观 Ca: calcaneus, 跟骨,Fi : fibula, 腓骨,

Peronei, transverse view 腓骨肌, 横断面观 tenosynovitis of the peronei 腓骨肌腱腱鞘炎

Peronei, longitudinal view 腓骨肌, 纵向观 tenosynovitis of the peronei 腓骨肌腱腱鞘炎

Posterior subtalar joint from lateral 外侧后距下关节 Parallel to the leg over the lateral malleolus, the proximal pole of the transducer positioned slightly anterior to the malleolus, and the distal pole oriented slightly oblique-anterior resting on the calcaneus 在外踝上方, 沿着小腿方向, 探头近端放置在踝骨稍前方, 探头远端放置在跟骨稍斜前方

Posterior subtalar joint 后距下关节腓骨腓骨短肌距腓关节距骨跟骨

Posterior subtalar joint 后距下关节

Sinus tarsi 跗骨窦

Synovitis of the posterior subtalar joint from lateral 外侧距下关节滑膜炎

Calcaneocuboid joint, lateral longitudinal scan 跟骰关节, 外侧纵向扫描 Ca : calcaneus, 跟骨,Cu : cuboid, 骰骨,PLT : peroneus longus tendon, 腓骨长肌腱

Posterior and plantar aspect 后方和跖侧

Achilles enthesis, longitudinal view 跟腱附着点, 纵向扫描 At : Achilles tendon, 跟腱 Ca : calcaneus, 跟骨 K : Kager s fat pad, 脂肪垫 RB : retrocalcaneal bursa 跟后滑囊

Achilles enthesis, longitudinal view 跟腱附着点, 纵向扫描 Achilles enthesitis 跟腱附着点炎

Achilles enthesis 跟腱附着点 Achilles enthesitis 跟腱附着点炎

Posterior subtalar joint 后距下关节跟腱 Kager 脂肪垫踇长屈肌胫距关节后距下关节

Achilles enthesitis/tibiotalar joint effusion (post. recess) 跟腱附着点炎 / 胫距关节渗出 ( 后隐窝 ) 胫距关节

Tibiotalar joint effusion (post. recess) 跟腱附着点炎 / 胫距关节渗出 ( 后隐窝 ) 胫距关节后距下关节

Effusion in the tibiotalar joint and posterior subtalar joint 胫距关节和后距下关节渗出

Conclusion 总结 US is very useful for diagnosing and detecting pathology in the foot and ankle 超声在诊断和探查足踝关节病变时非常实用 Tenosynovitis vs. synovitis 腱鞘炎与滑膜炎 Unexpected involvement (e.g. talonavicular) 未预料到的病变 ( 如距舟关节 ) Clinically difficult joints (e.g. subtalar) 临床有难度关节 ( 如距下关节 ) Pitfalls: mechanical issues, effusions,osteoarthrosis 缺陷 : 超声机器问题, 渗出, 骨关节炎