Stefaan Marcelis

Spectrum of Normal and Pathologic Findings in the Region of the First Extensor Compartment of the Wrist: Sonographic Findings and Correlations With Dissections

Objective. The purpose of this presentation is to review pathologic conditions that lead to pain at the radial aspect of the distal radius and to address anatomic variations of the first extensor compartment that exist and may have diagnostic and therapeutic implications. Methods. Our presentation is based on a review of cases from teaching files and observations made in anatomic specimens. Results. The discussed conditions include de Quervain tenosynovitis, intersection syndrome, and Wartenberg syndrome. Sonographic diagnosis of these conditions is addressed, and correlations are provided with anatomic specimens. Conclusions. Sonography is able to depict and differentiate between these conditions.

Sonography of the Normal Ankle: A Target Approach Using Skeletal Reference Points

OBJECTIVE Sonographic examination of the ankle depends on exact knowledge of the specific probe positions to acquire the best images. CONCLUSION In this article, we discuss these positions and illustrate them with drawings, anatomic slices or dissection, and sonograms. Positions studied include those for best imaging of the anterior tibiotalar joint, anterior tibiofibular ligament, anterior talofibular ligament, calcaneofibular ligament, peroneal tendons, Achilles tendon, flexor hallucis longus, posterior deltoid ligament, anterior deltoid ligament, and posterior medial tendons.

Ultrasound of the knee with emphasis on the detailed anatomy of anterior, medial, and lateral structures

ObjectiveTo describe the detailed ultrasound anatomy of the anterior, medial, and lateral aspects of the knee and present the ultrasound examination technique used.Materials and MethodsWe present ultrasound using images of patients, volunteer subjects, and cadaveric specimens. We correlate ultrasound images with images of anatomical sections and dissections.ResultsThe distal quadriceps tendon is made up of different laminas that can be seen with ultrasound. One to five laminas may be observed. The medial retinaculum is made up of three anatomical layers: the fascia, an intermediate layer, and the capsular layer. At the level of the medial patellofemoral ligament (MPFL) one to three layers may be observed with ultrasound. The medial supporting structures are made up of the medial collateral ligament and posterior oblique ligament. At the level of the medial collateral ligament (MCL), the superficial band, as well as the deeper meniscofemoral and meniscotibial bands can be discerned with ultrasound. The posterior part, corresponding to the posterior oblique ligament (POL), also can be visualized. Along the posteromedial aspect of the knee the semimembranosus tendon has several insertions including an anterior arm, direct arm, and oblique popliteal arm. These arms can be differentiated with ultrasound. Along the lateral aspect of the knee the iliotibial band and adjacent joint recesses can be assessed. The fibular collateral ligament is encircled by the anterior arms of the distal biceps tendon. Along the posterolateral corner, the fabellofibular, popliteofibular, and arcuate ligaments can be visualized.ConclusionThe anatomy of the anterior, medial, and lateral supporting structures of the knee is more complex than is usually thought. Ultrasound, with its exquisite resolution, allows an accurate assessment of anatomical detail. Knowledge of detailed anatomy and a systematic technique are prerequisites for a successful ultrasound examination of the knee.

Ultrasound during dissection of cadaveric specimens: a new method for obtaining ultrasound–anatomic correlations in musculoskeletal radiology

We report a new technique for ultrasound–anatomic correlations consisting of dissection of embalmed specimens during ultrasound examination. Our method consists of performing ultrasound during the different stages of dissection. The technique was developed by making observations of selected structures in two embalmed and two non-embalmed cadaver hands. The image quality was subjectively graded by consensus of two investigators, before and after denudation of the selected structures of the hand. As an example, the technique is demonstrated for the flexors at the metacarpophalangeal joint level, the extensor complex at the level of the proximal phalanx, and the dorsal hood of the second to fourth fingers. Before dissection the image quality in fresh specimens was graded moderate, and in embalmed specimens good. After dissection the image quality was good in fresh specimens and excellent in embalmed specimens. Our method is simple and does not require sophisticated material. Our results indicate that embalmed specimens could be better than non-embalmed specimens, because of the presence of artefacts in the non-embalmed specimens (gas deposits). The described methodology can yield excellent results regarding precise identification of different interfaces and structures, as observed at ultrasound.

Improved visualization of the radial insertion of the biceps tendon at ultrasound with a lateral approach

We report a new lateral approach for ultrasound visualization of the distal biceps tendon. A cadaver specimen was dissected to study distal biceps anatomy relevant to this approach. Sonograms obtained in volunteers and patients are provided to illustrate this alternative method.

Functional anatomy of the dorsal hood or the hand: correlation of ultrasound and MR findings with cadaveric dissection

The main aim of this study was to provide an overview of the anatomy of the dorsal hood (DH) based on the dissection of sixteen cadaver hands, correlated with magnetic resonance (MR) and ultrasound findings. A secondary aim was to assess the function of components of the DH. Sixteen embalmed hands were evaluated by MRI and ultrasound before being dissected. Each hand was photographed during each stage of dissection. Secondly we evaluated the role of the different structures of the DH in the stability of the extensor tendon by transection of the different components alternatively at the ulnar and radial sides. MR, ultrasound, and dissection showed that the extensor tendon (ET) is stabilized by the sagittal band (SB) at the level of the metacarpophalangeal (MCP) joint and more distally by the transverse and the oblique bands, respectively. Transection of the radial SB of the second finger leads systematically to ulnar dislocation of the ET. The transection of the ulnar DH does not lead to instability of the ET. The SB is the most important structure of the DH in the stability of the ET at the MCP level. Rupture of the radial SB of the second finger leads systematically to ulnar dislocation of the ET.

Sonography of the finger flexor and extensor system at the hand and wrist level: findings in volunteers and anatomical correlation in cadavers.

We present a review of sonography of the flexor and extensor system of the hand and wrist in volunteers and cadavers. CT tenography also was performed in cadaveric specimens. Anatomical structures of the extensor system that were assessed with sonography included the extensor tendons and insertions, retinaculum, and dorsal hood. On the flexor side, the variable relationship between the flexor superficialis and profundus could be appreciated. Volar plates, tendon insertions, and annular pulleys could also be investigated. Sonography can show details of the finger flexor and extensor system.

Ultrasound of the elbow: A systematic approach using bony landmarks

The use of bony landmarks can be helpful in performing an ultrasound study of the elbow. We discuss bony landmarks that can be used for evaluation of the common extensor tendon, ulnar collateral ligament and common flexor tendon, coronoid and olecranon fossa, ulnar nerve, and biceps tendon. We discuss bony landmarks for each of these structures.

Ultrasound of the sural nerve: normal anatomy on cadaveric dissection and case series.

The sural nerve is a small sensory nerve innervating the lateral aspect of the ankle and foot. Clinical symptoms of pathology may present as atypical sensory changes in this region. We present the normal anatomy and ultrasound technique for examination of the sural nerve based on an anatomical dissection, as well as imaging in a normal volunteer. We also present a case series (n=10) of different conditions of the sural nerve that we encountered based on a review of interesting cases from 4 institutions. The pathological conditions included neuropathy related to stripping or venous laser surgery, compression by abscess, Lyme disease, nerve tumors, traumatic transsection, and encasement by fibrous plaque and edema. Ultrasound with its exquisite resolution is the preferred imaging method for examining the sural nerve in patients with unexplained sensory changes at the lateral aspect of the ankle and foot.

Ultrasound findings in injuries of dorsal extensor hood: Correlation with MR and follow-up findings

OBJECTIVE The aim of this study was to use ultrasound to examine the dorsal hood in nine patients with a clinical suspicion of dorsal hood injuries. MATERIAL AND METHODS Clinical and imaging files from interesting case logbooks of nine patients were reviewed. Ultrasound was performed by one of the three radiologists experienced in musculoskeletal ultrasound. The examinations were also performed in flexion and in flexion with resistance. MR correlation was obtained in six patients. One patient underwent surgery. To obtain anatomical correlation of the normal dorsal hood 2 embalmed hand specimens were dissected. RESULTS The sagittal bands were easily depicted in the transverse plane on ultrasound images and presented as hypoechoic bands on both sides of the extensor communis tendons. Injuries of the sagittal bands were seen on ultrasound as hypoechoic thickening of the sagittal bands at the side of the extensor tendons. The normal shape of the sagittal bands was also no longer recognizable. Subluxations or dislocations of the extensor tendons were also seen. When the injuries were located in the fibrous slips between the extensor indicis and the extensor communis of the second finger, subluxations with an increased distance between these 2 tendons were seen, especially in flexion, or in flexion with resistance. CONCLUSION Ultrasound is a valuable tool for the assessment of the injuries of the dorsal hood and is an easily available method for the diagnosis of the fine soft tissue components of the dorsal hood region.