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Soft Tissue Rheumatism

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Musculoskeletal Ultrasonography in Rheumatic Diseases

Abstract

Soft tissue imaging is a peculiar area where musculoskeletal ultrasonography is not only handy but also outstanding with its valuable findings. In addition to being of significant importance, soft tissue imaging has displayed diversity in musculoskeletal ultrasonography. We are therefore of the opinion that soft tissue examination is one of the most important applications of musculoskeletal ultrasonography.

Both the real-time examination method and dynamic capabilities make ultrasonographic studies unique. Ultrasonography is superior to all scanning modalities in tendon studies. High axial resolution together with the newer higher frequency transducers on high-grade machines can show minute details in soft tissue structures.

Soft tissue imaging utilizes all the possible conventional viewing processes of grayscale and power Doppler ultrasound, as well as recent modalities like elastography. Not only the operator should be well aware of the sonoanatomy, but he/she should also be familiar with the machine settings. Soft tissue scanning needs special transducer handling, proper knowledge of the different software settings and enhancements, and needs a customized scan for each patient with an expert examiner. Most of these structures are located superficially, and require the highest possible frequency.

This chapter describes the major soft tissue components, and their major pathologies.

The term “soft tissue rheumatism” refers to a wide range of musculoskeletal disorders. Local soft tissue rheumatism includes tendon, tendon sheath, muscle, ligament, bursa, fascia, and subcutaneous tissue pathology.

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References

  1. Álvarez-Nemegyei J, Canoso JJ. Name and classification of soft-tissue rheumatism. Reumatol Clín. 2007;3(4):151–2.

    Article  PubMed  Google Scholar 

  2. Toprak H, Kilic E, Serter A, Kocakoc E, Ozgocmen S. Ultrasound and Doppler US in evaluation of superficial soft-tissue lesions. J Clin Imag Sci. 2014;4:12.

    Article  Google Scholar 

  3. Katz JN, Buchbinder R. Soft tissue syndromes. Bailliere’s Clin Rheumatol. 1995;9(3):585–98.

    Article  CAS  Google Scholar 

  4. Cawston TE, Riley GP, Hazleman BL. Tendon lesions and soft tissue rheumatism—great outback or great opportunity? Ann Rheum Dis. 1996;55(1):1–3.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  5. Zamorani MP, Valle M. Muscle and tendon. In: Bianchi S, Martinoli C, editors. Ultrasound of the musculoskeletal system. 1st ed. Berlin: Springer; 2007. p. 45–96.

    Chapter  Google Scholar 

  6. Gaitini D. Shoulder ultrasonography: performance and common findings. J Clin Imag Sci. 2012;2:38.

    Article  Google Scholar 

  7. Möller I, Bong D, de Miguel Mendieta E. Soft tissue rheumatism. In: Wakefield RJ, D´Agostino MA, editors. Essential applications of musculoskeletal ultrasound in rheumatology. 1st ed. Philadelphia: Saunders, Elsevier; 2010. p. 219–35.

    Google Scholar 

  8. Brasseur JL. The biceps tendons: from the top and from the bottom. J Ultrasound. 2012;15(1):29–38.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Bianchi S, Martinoli C, de Gautard R, Gaignot C. Ultrasound of the digital flexor system: Normal and pathological findings(). J Ultrasound. 2007;10(2):85–92.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Fantino O, Borne J, Bordet B. Conflicts, snapping and instability of the tendons. Pictorial essay. J Ultrasound. 2012;15(1):42–9.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Pratt RK, Hoy GA, Bass Franzcr C. Extensor carpi ulnaris subluxation or dislocation? Ultrasound measurement of tendon excursion and normal values. Hand Surg: Int J Devoted H and Upper Limb Surg Related Res: J Asia-Pacific Fed Soc Surg Hand. 2004;9(2):137–43.

    CAS  Google Scholar 

  12. Lee KS, Ablove RH, Singh S, De Smet AA, Haaland B, Fine JP. Ultrasound imaging of normal displacement of the extensor carpi ulnaris tendon within the ulnar groove in 12 forearm-wrist positions. AJR Am J Roentgenol. 2009;193(3):651–5.

    Article  PubMed  Google Scholar 

  13. Raikin SM, Elias I, Nazarian LN. Intrasheath subluxation of the peroneal tendons. J Bone Joint Surg Am Vol. 2008;90(5):992–9.

    Article  PubMed  Google Scholar 

  14. Kaux JF, Forthomme B, Goff CL, Crielaard JM, Croisier JL. Current opinions on tendinopathy. J Sports Sci Med. 2011;10(2):238–53.

    PubMed Central  PubMed  Google Scholar 

  15. Smith J, Maida E. Musculoskeletal ultrasound of tendons. Oper Tech Orthop. 2013;23(2):50–5.

    Article  Google Scholar 

  16. Lew HL, Chen CP, Wang TG, Chew KT. Introduction to musculoskeletal diagnostic ultrasound: examination of the upper limb. Am J Phys Med Rehabil/Assoc Acad Physiatr. 2007;86(4):310–21.

    Article  Google Scholar 

  17. Chew K, Stevens KJ, Wang TG, Fredericson M, Lew HL. Introduction to diagnostic musculoskeletal ultrasound: part 2: examination of the lower limb. Am J Phys Med Rehabil/Assoc Acad Physiatr. 2008;87(3):238–48.

    Article  Google Scholar 

  18. Mathieson JR, Connell DG, Cooperberg PL, Lloyd-Smith DR. Sonography of the Achilles tendon and adjacent bursae. AJR Am J Roentgenol. 1988;151(1):127–31.

    Article  CAS  PubMed  Google Scholar 

  19. Vuillemin V, Guerini H, Bard H, Morvan G. Stenosing tenosynovitis. J Ultrasound. 2012;15(1):20–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Guerini H, Pessis E, Theumann N, Le Quintrec JS, Campagna R, Chevrot A, et al. Sonographic appearance of trigger fingers. J Ultrasound Med: Off J Am Inst Ultrasound Med. 2008;27(10):1407–13.

    Google Scholar 

  21. Wakefield RJ, Balint PV, Szkudlarek M, Filippucci E, Backhaus M, D’Agostino MA, et al. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol. 2005;32(12):2485–7.

    PubMed  Google Scholar 

  22. Cohen M. US imaging in operated tendons. J Ultrasound. 2012;15(1):69–75.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  23. Adler RS, Johnson KM, Fealy S, Maderazo A, Gallo RA, Gamradt SC, et al. Contrast-enhanced sonographic characterization of the vascularity of the repaired rotator cuff: utility of maximum intensity projection imaging. J Ultrasound Med: Off J Am Inst Ultrasound Med. 2011;30(8):1103–9.

    Google Scholar 

  24. Waitches GM, Rockett M, Brage M, Sudakoff G. Ultrasonographic-surgical correlation of ankle tendon tears. J Ultrasound Med: Off J Am Inst Ultrasound Med. 1998;17(4):249–56.

    CAS  Google Scholar 

  25. Blankstein A, Israeli A, Dudkiewicz I, Chechik A, Ganel A. Percutaneous Achilles tendon repair combined with real-time sonography. Isr Med Assoc J. 2007;9(2):83–5.

    PubMed  Google Scholar 

  26. Ooi CC, Malliaras P, Schneider ME, Connell DA. “Soft, hard, or just right?” Applications and limitations of axial-strain sonoelastography and shear-wave elastography in the assessment of tendon injuries. Skelet Radiol. 2014;43(1):1–12.

    Article  CAS  Google Scholar 

  27. Vera-Pérez E, Ventura-Ríos L, Gallegos-Nava S, Bernal A, Hernández-Díaz C, Pineda C. Son las Lesiones Musculares Adecuadamente Diagnosticadas por Ultrasonografía? Rev Chil Reumatol. 2013;29(4):226–31.

    Google Scholar 

  28. Woodhouse JB, McNally EG. Ultrasound of skeletal muscle injury: an update. Semin Ultrasound, CT, MR. 2011;32(2):91–100.

    Article  Google Scholar 

  29. Campbell RSD, Wood J. Ultrasound of muscle. Imaging. 2002;14(3):229–40.

    Article  Google Scholar 

  30. Koh ES, McNally EG. Ultrasound of skeletal muscle injury. Sem Musculoskelet Radiol. 2007;11(2):162–73.

    Article  Google Scholar 

  31. Abate M, Salini V, Rimondi E, Errani C, Alberghini M, Mercuri M, et al. Post traumatic myositis ossificans: sonographic findings. J Clin Ultrasound. 2011;39(3):135–40.

    Article  PubMed  Google Scholar 

  32. Campbell SE, Adler R, Sofka CM. Ultrasound of muscle abnormalities. Ultrasound Q. 2005;21(2):87–94; quiz 150, 3–4.

    PubMed  Google Scholar 

  33. Botar-Jid C, Damian L, Dudea SM, Vasilescu D, Rednic S, Badea R. The contribution of ultrasonography and sonoelastography in assessment of myositis. Med Ultrasonogr. 2010;12(2):120–6.

    Google Scholar 

  34. Michelin P, Delarue Y, Duparc F, Dacher JN. Thickening of the inferior glenohumeral capsule: an ultrasound sign for shoulder capsular contracture. Eur Radiol. 2013;23(10):2802–6.

    Article  PubMed  Google Scholar 

  35. Homsi C, Bordalo-Rodrigues M, da Silva JJ, Stump XM. Ultrasound in adhesive capsulitis of the shoulder: is assessment of the coracohumeral ligament a valuable diagnostic tool? Skelet Radiol. 2006;35(9):673–8.

    Article  Google Scholar 

  36. Teixeira PA, Omoumi P, Trudell DJ, Ward SR, Lecocq S, Blum A, et al. Ultrasound assessment of the lateral collateral ligamentous complex of the elbow: imaging aspects in cadavers and normal volunteers. Eur Radiol. 2011;21(7):1492–8.

    Article  PubMed  Google Scholar 

  37. Merolla G, Del Sordo S, Paladini P, Porcellini G. Elbow ulnar collateral ligament reconstruction: clinical, radiographic, and ultrasound outcomes at a mean 3-year follow-up. Musculoskelet Surg. 2014; 98(Suppl 1):S87–S93

    Google Scholar 

  38. Moraux A, Vandenbussche L, Demondion X, Gheno R, Pansini V, Cotten A. Anatomical study of the pisotriquetral joint ligaments using ultrasonography. Skelet Radiol. 2012;41(3):321–8.

    Article  Google Scholar 

  39. Renoux J, Zeitoun-Eiss D, Brasseur JL. Ultrasonographic study of wrist ligaments: review and new perspectives. Semin Musculoskelet Radiol. 2009;13(1):55–65.

    Article  PubMed  Google Scholar 

  40. De Maeseneer M, Marcelis S, Boulet C, Kichouh M, Shahabpour M, de Mey J, et al. Ultrasound of the knee with emphasis on the detailed anatomy of anterior, medial, and lateral structures. Skelet Radiol. 2014;43(8):1025–39.

    Google Scholar 

  41. Kleinbaum Y, Blankstein A. Mild to moderate medial collateral ligament (Mcl) injuries of the knee: sonographic findings and sonographic valgus stress test. J Musculoskelet Res. 2008;11(01):9–14.

    Article  Google Scholar 

  42. De Maeseneer M, Marcelis S, Jager T, Shahabpour M, Van Roy P, Weaver J, et al. Sonography of the normal ankle: a target approach using skeletal reference points. AJR Am J Roentgenol. 2009;192(2):487–95.

    Article  PubMed  Google Scholar 

  43. Mansour R, Teh J, Sharp RJ, Ostlere S. Ultrasound assessment of the spring ligament complex. Eur Radiol. 2008;18(11):2670–5.

    Article  PubMed  Google Scholar 

  44. Mansour R, Jibri Z, Kamath S, Mukherjee K, Ostlere S. Persistent ankle pain following a sprain: a review of imaging. Emerg Radiol. 2011;18(3):211–25.

    Article  PubMed  Google Scholar 

  45. Holsbeeck MTv, Introcaso JH. Ecografía de las bolsas articulares. In: Holsbeeck MTv, Introcaso JH, editors. Ecografia musculoesqueletica. 2nd ed. Madrid: Marban Libros; 2002. p. 131–69.

    Google Scholar 

  46. Blankstein A, Ganel A, Givon U, Mirovski Y, Chechick A. Ultrasonographic findings in patients with olecranon bursitis. Ultraschall Med. 2006;27(6):568–71.

    Article  CAS  PubMed  Google Scholar 

  47. Hirji Z, Hunjun JS, Choudur HN. Imaging of the bursae. J Clin Imag Sci. 2011;1(1):22.

    Article  Google Scholar 

  48. Girish G, Finlay K, Landry D, O’Neill J, Popowich T, Jacobson J, et al. Musculoskeletal disorders of the lower limb—ultrasound and magnetic resonance imaging correlation. Can Assoc Radiol J. 2007;58(3):152–66.

    PubMed  Google Scholar 

  49. Wortsman X, Carreño L, Morales C. Inflammatory diseases of the skin. In: Wortsman X, Jemec GBE, editors. Dermatologic ultrasound with clinical and ultrasound correlations. New York: Springer; 2013. p. 73–117.

    Chapter  Google Scholar 

  50. Turecki MB, Taljanovic MS, Stubbs AY, Graham AR, Holden DA, Hunter TB, et al. Imaging of musculoskeletal soft tissue infections. Skelet Radiol. 2010;39(10):957–71.

    Article  Google Scholar 

  51. Chau CL, Griffith JF. Musculoskeletal infections: ultrasound appearances. Clin Radiol. 2005;60(2):149–59.

    Article  CAS  PubMed  Google Scholar 

  52. Cardinal E, Bureau N, Chem RK. Masas del Tejido Blando: Un Enfoque Algorítmico. In: Cardinal E, Chem RK, editors. Ecografía Musculoesquelética: Pautas y gamuts. Buenos Aires: Ediciones Journal; 1999.

    Google Scholar 

  53. Hung EH, Griffith JF. Pitfalls in ultrasonography of soft tissue tumors. Semin Musculoskelet Radiol. 2014;18(1):79–85.

    Article  PubMed  Google Scholar 

  54. Verdugo M. Ultrasonido en el estudio de tumores de partes blandas. Rev Chil Radiol. 2009;15:5–18.

    Google Scholar 

  55. Beaman FD, Peterson JJ. MR imaging of cysts, ganglia, and bursae about the knee. Radiol Clin N Am. 2007;45(6):969–82, vi.

    Article  PubMed  Google Scholar 

  56. Wang G, Jacobson JA, Feng FY, Girish G, Caoili EM, Brandon C. Sonography of wrist ganglion cysts: variable and noncystic appearances. J Ultrasound Med: Off J Am Inst Ultrasound Med. 2007;26(10):1323–8; quiz 30–1.

    Google Scholar 

  57. Cardinal E, Buckwalter KA, Braunstein EM, Mih AD. Occult dorsal carpal ganglion: comparison of US and MR imaging. Radiology. 1994;193(1):259–62.

    Article  CAS  PubMed  Google Scholar 

  58. Vargas B, Wildhaber B, La Scala G. Late migration of a foreign body in the foot 5 years after initial trauma. Pediatr Emerg Care. 2011;27(6):535–6.

    Article  PubMed  Google Scholar 

  59. Leung A, Patton A, Navoy J, Cummings RJ. Intraoperative sonography-guided removal of radiolucent foreign bodies. J Pediatr Orthop. 1998;18(2):259–61.

    CAS  PubMed  Google Scholar 

  60. Gibbs TS. The use of sonography in the identification, localization, and removal of soft tissue foreign bodies. J Diagn Med Sonogr. 2006;22(1):5–21.

    Article  Google Scholar 

  61. Mohammadi A, Ghasemi-Rad M, Khodabakhsh M. Non-opaque soft tissue foreign body: sonographic findings. BMC Med Imag. 2011;11:9.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. New Kasr El Aini Teaching Hospital, Cairo University, Cairo, Egypt

    Adham Aboul Fotouh Khalil MD, MSc

  2. Laboratorio de Ultrasonido Musculoesquelético y Articular, Instituto Nacional de Rehabilitación, Mexico City, Mexico

    Cristina Hernández-Díaz MD, MS

Authors
  1. Adham Aboul Fotouh Khalil MD, MSc
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  2. Cristina Hernández-Díaz MD, MS
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Correspondence to Adham Aboul Fotouh Khalil MD, MSc .

Editor information

Editors and Affiliations

  1. Department of Rheumatology, Darent Valley Hospital, Dartford, United Kingdom

    Yasser El Miedany

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Khalil, A., Hernández-Díaz, C. (2015). Soft Tissue Rheumatism. In: El Miedany, Y. (eds) Musculoskeletal Ultrasonography in Rheumatic Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-15723-8_11

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  • DOI: https://doi.org/10.1007/978-3-319-15723-8_11

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