Musculoskeletal ultrasound for traumatic and torsional alterations

Abstract

The sonographic appearance of soft tissue can be altered by trauma and positional change with torsional stress. This creates challenges for ultrasonographic interpretation, because most descriptive literature and standard instructional references are displayed in anatomically neutral or other conventional positions. Knowledge of anatomic alteration and changes in sonographic appearance with torsional stress is essential for accurately assessing soft tissue abnormalities in conditions of spasticity, traumatic and post-surgical changes, and other conditions that distort musculoskeletal relationships. A systematic scanning approach to these alterations is needed for accurate diagnostic interpretation, optimizing electrode placement for electrodiagnostic techniques, effective needle placement for therapeutic ultrasound-guided procedures, and even planning for restorative surgery. This review describes expected positional changes of normal structures with torsional alteration, as well as sonographic recognition of scars, burns, hematomas, fat layer fracture, Morel-Lavallee lesions, abscesses, foreign bodies, myotendinous lesions, muscle injury and denervation, and traumatic peripheral nerve injury.

Ultrasonographic and Histological Correlation after Experimental Reconstruction of a Volumetric Muscle Loss Injury with Adipose Tissue

“…Ultrasound is an extremely important tool in the assessment of both normal and pathological skeletal muscle structure. Ultrasound studies are mainly focused on the diagnosis and follow-up of neuromuscular diseases [1][2][3][4] and traumatic injuries [5,6]. In these cases, the fundamental aim of the aforementioned studies is to analyze changes in muscle histoarchitecture caused by degenerative and regenerative processes, changes in the size of the muscle fibers, formation of edema, replacement by fibrous and/or adipose tissue, changes in vascularization, etc., all of which translate into changes in ultrasound patterns [7].…”