Ultrasound elastography is a widely used technique for assessing the mechanical characteristics of tissues. Although there are several ultrasound elastography techniques, strain elastography (SE) is currently the most widely used technique for visualizing an elastographic map in real time. Among its various indications, SE is especially useful in evaluating the musculoskeletal system. In this article, we review the SE techniques for clinical practice and describe the images produced by these techniques in the context of the musculoskeletal system. SE provides information about tissue stiffness and allows real-time visualization of the image; however, SE cannot completely replace gray-scale, color, or power Doppler ultrasonography. SE can increase diagnostic accuracy and may be useful for the follow-up of benign lesions.
Elasticity Imaging Techniques* ; Follow-Up Studies ; Musculoskeletal System* ; Soft Tissue Neoplasms ; Ultrasonography ; Ultrasonography, Doppler

The use of musculoskeletal ultrasound in rheumatology clinical practice has rapidly increased over the past decade. Ultrasound has enabled rheumatologists to diagnose, prognosticate and monitor disease outcome. Although international standardization remains a concern still, the use of ultrasound in rheumatology is expected to grow further as costs fall and the opportunity to train in the technique improves. We present a review of value of ultrasound, focusing on major applications of ultrasound in rheumatologic diseases.
Humans ; Magnetic Resonance Imaging ; Musculoskeletal System/ultrasonography ; Osteoarthritis/ultrasonography ; Rheumatic Diseases/*ultrasonography ; Sjogren's Syndrome/ultrasonography ; Spondylarthropathies/ultrasonography ; Synovitis/ultrasonography ; Tendinopathy/ultrasonography ; Vasculitis/ultrasonography

OBJECTIVE: The aim of this study is to know the usefulness of ultrasonographic evaluation in the musculoskeletal disease. METHOD: Thirty-nine cases with musculoskeletal pain were evaluated by physical examination, Cyriax selective tension technique, simple X-ray, electromyography, arthrography, Computed tomography, Magnetic resonance image and the high-resolution realtime ultrasonography to define the location of pain. The ultasonographic results were compared to other diagnostic methods. RESULTS: The ultrasonographic findings are as follow; 22 tendinitis, 7 entrapment neuropathies, 6 bursitis, 2 ligament injuries, and 2 rotator cuff injuries. Clinical diagnosis were matched with ultrasonographic findings in 30 cases out of 39. The most common ultrasonographic findings in 22 tendinitis cases were hypoechogenicity in affected tendon. Ultrasonographic findings in 7 entrapment neuropathies were 6 nerve swellings and 1 nerve flattening. CONCLUSION: The ultrasonography can provide detailed images of musculoskeletal system, including tendons, nerves and subcutaneous tissue. Therefore the ultrasonography is very useful in diagnosis and treatment of some musculoskeletal diseases such as tendinitis and entrapment neuropathy.
Arthrography ; Bursitis ; Diagnosis ; Electromyography ; Ligaments ; Musculoskeletal Diseases* ; Musculoskeletal Pain ; Musculoskeletal System ; Nerve Compression Syndromes ; Physical Examination ; Rotator Cuff ; Subcutaneous Tissue ; Tendinopathy ; Tendons ; Ultrasonography

Ultrasonography (US) is an inexpensive, convenient, and effective tool that can be used to evaluate the shoulder. It does not expose the patient to harmful radiation and can be used to evaluate the musculoskeletal system dynamically. Additionally, US is not subject to metal artifacts when evaluating patients with previously placed hardware. Over the years, US has been found to be reliable and accurate for diagnosing rotator cuff tears (RCTs), despite its operator-dependence. The usage of US for diagnosing RCTs in orthopedic practice varies depending on practitioners' familiarity with the exam and the availability of experienced technicians. The purpose of this article is to review the diagnostic accuracy of US for identifying RCTs.
Artifacts ; Diagnostic Imaging ; Humans ; Musculoskeletal System ; Orthopedics ; Recognition (Psychology) ; Rotator Cuff ; Shoulder ; Tears ; Ultrasonography

Shear wave elastography (SWE) is an emerging technology that provides information about the inherent elasticity of tissues by producing an acoustic radiofrequency force impulse, sometimes called an “acoustic wind,” which generates transversely-oriented shear waves that propagate through the surrounding tissue and provide biomechanical information about tissue quality. Although SWE has the potential to revolutionize bone and joint imaging, its clinical application has been hindered by technical and artifactual challenges. Many of the stumbling blocks encountered during musculoskeletal SWE imaging are readily recognizable and can be overcome, but progressive advances in technology and a better understanding of image acquisition are required before SWE can reliably be used in musculoskeletal imaging.
Acoustics ; Elasticity ; Elasticity Imaging Techniques* ; Joints ; Muscles ; Musculoskeletal System* ; Tendons ; Ultrasonography

Ultrasonography (US) is a very powerful diagnostic modality for the musculoskeletal system due to the ability to perform real-time dynamic high-resolution examinations with the Doppler technique. In addition to acquiring morphologic data, we can now obtain biomechanical information by quantifying the elasticity of the musculoskeletal structures with US elastography. The earlier diagnosis of degeneration and the ability to perform follow-up evaluations of healing and the effects of treatment are possible. US elastography enables a transition from US-based inspection to US-based palpation in order to diagnose the characteristics of tissue. Shear wave elastography is considered the most suitable type of US elastography for the musculoskeletal system. It is widely used for tendons, ligaments, and muscles. It is important to understand practice guidelines in order to enhance reproducibility. Incorporating viscoelasticity and overcoming inconsistencies among manufacturers are future tasks for improving the capabilities of US elastography.
Diagnosis ; Elasticity ; Elasticity Imaging Techniques* ; Follow-Up Studies ; Ligaments ; Muscles ; Musculoskeletal System ; Palpation ; Tendinopathy ; Tendons ; Ultrasonography

In order to accurately diagnose lesions of musculoskeletal tissue, evaluation not only of the abnormality of the bone, but the condition of soft tissue is important. Magnetic resonance imaging has been widely used in evaluation of the state of soft tissue, however, it has the disadvantage that testing is expensive and real-time scanning is not possible. In recent years, ultrasonography has been used for evaluation of musculoskeletal tissue and its usefulness has shown a gradual increase. The ultrasound image is determined by the tissue specific acoustic impedance and other factors. Highly reflective tissues such as bone, calcification, ligament, and tendon are expressed as hyperechoic images, and less reflective tissues such as muscle and nerve are expressed as hypoechoic images.
Acoustics ; Electric Impedance ; Ligaments ; Magnetic Resonance Imaging ; Muscles ; Musculoskeletal System ; Tendons ; Ultrasonography

The musculoskeletal system is mainly composed of the bones, muscles, tendons, and ligaments, in addition to nerves and blood vessels. The greatest difficulty in an ultrasonographic freeze-frame created by the examiner is recognition of the targeted structures without indicators, since an elephant's trunk may not be easily distinguished from its leg. It is not difficult to find descriptive ultrasonographic terms used for educational purposes, which help in distinguishing features of these structures either in a normal or abnormal anatomic condition. However, the terms sometimes create confusion when describing common objects, for example, in Western countries, pears have a triangular shape, but in Asia they are round. Skilled experts in musculoskeletal ultrasound have tried to express certain distinguishing features of anatomic landmarks using terms taken from everyday objects which may be reminiscent of that particular feature. This pictorial review introduces known signature patterns of distinguishing features in musculoskeletal ultrasound in a normal or abnormal condition, and may stir the beginners' interest to play a treasure-hunt game among unfamiliar images within a boundless ocean.
Anatomic Landmarks ; Anisotropy ; Asia ; Blood Vessels ; Education ; Leg ; Ligaments ; Muscles ; Musculoskeletal System ; Peripheral Nerves ; Pyrus ; Tendons ; Ultrasonography* ; Ultrasonography, Interventional

The musculoskeletal system is mainly composed of the bones, muscles, tendons, and ligaments, in addition to nerves and blood vessels. The greatest difficulty in an ultrasonographic freeze-frame created by the examiner is recognition of the targeted structures without indicators, since an elephant's trunk may not be easily distinguished from its leg. It is not difficult to find descriptive ultrasonographic terms used for educational purposes, which help in distinguishing features of these structures either in a normal or abnormal anatomic condition. However, the terms sometimes create confusion when describing common objects, for example, in Western countries, pears have a triangular shape, but in Asia they are round. Skilled experts in musculoskeletal ultrasound have tried to express certain distinguishing features of anatomic landmarks using terms taken from everyday objects which may be reminiscent of that particular feature. This pictorial review introduces known signature patterns of distinguishing features in musculoskeletal ultrasound in a normal or abnormal condition, and may stir the beginners' interest to play a treasure-hunt game among unfamiliar images within a boundless ocean.
Anatomic Landmarks ; Anisotropy ; Asia ; Blood Vessels ; Education ; Leg ; Ligaments ; Muscles ; Musculoskeletal System ; Peripheral Nerves ; Pyrus ; Tendons ; Ultrasonography* ; Ultrasonography, Interventional

OBJECTIVE: To determine the incidence and types of congenital anomalies and evaluate the efficiency of antenatal ultrasonography for detection of congenital anomalies METHODS: This was a retrospective study, undertaken on 157 cases with congenital anomalies among 5,554 delivered newborns at Chungnam National University Hospital from Jan. 1, 1998 to Dec. 31, 2002. For statistical evaluation, Chi-square test were used. RESULTS: Among the total 5,554 newborns, the overall incidence of congenital anomalies was 2.8%. The incidence of congenital anomalies in birth weights less than 2,500 gm was 9.2% which was 7.5 times higher than that of birth weights more than 2,500 gm. The incidence of congenital anomalies in stillbirth was 19.3% which was 8.2 times higher than that of the live birth. When classified according to the type of congenital anomalies, the incidence of congenital anomalies were 26.5%, 21.0%, 19.8%, 13.0%, 7.4%, 6.2%, 3.7%, and 2.5% respectively in urogenital system, central nervous system, digestive system, cardiopulmonary system, dermatologic system, musculoskeletal system, chromosomal anomaly syndrome, and fetal tumor. Among 157 cases of congenital anomaly babies, anomaly babies were detected antenatally by ultrasonographic examination in 122 cases, and then the rate of antenatal ultrasonographic detection was 77.7%. CONCLUSION: The overall incidence of congenital anomalies was 2.8%. The most common congenital anomalies were urogenital anomalies. The rate of antenatal ultrasonographic detection for congenital anomalies was 77.7%.
Birth Weight ; Central Nervous System ; Chungcheongnam-do ; Diagnosis* ; Digestive System ; Humans ; Incidence* ; Infant, Newborn ; Live Birth ; Musculoskeletal System ; Prenatal Diagnosis ; Retrospective Studies ; Stillbirth ; Ultrasonography* ; Urogenital System