OBJECTIVES:To 1) determine the types and frequency of complications within 3 months following ultrasound-guided surgical procedures, and 2) identify any patient demographics, co-morbidities, or procedural characteristics that were associated with an increased risk of complications. METHODS:A retrospective chart review was performed at six Sports Medicine clinics across the United States. The Clavien-Dindo classification was used to categorize procedural complications on a 5-point scale from 1, representing any deviation in post-procedure care without requiring pharmacological or invasive treatment to 5, representing death. Generalized Estimating Equations for binomial outcomes with a logit link were used to estimate the overall and procedure-specific 3-month complication rates. RESULTS:Among 1902 patients, 8.1% (n = 154) had diabetes and 6.3% (n = 119) were current smokers. The analysis included 2,369 procedures, which were performed in either the upper extremity (44.1%, n = 1045) or lower extremity (55.2%, n = 1308) regions. The most common procedure was ultrasound-guided tenotomy (69.9%, n = 1655). Additional procedures included, trigger finger release (13.1%, n = 310), tendon scraping (8.0%, n = 189), carpal tunnel release (5.4%, n = 128), soft tissue release (2.1%, n = 50), and compartment fasciotomy (1.6%, n = 37). Overall, there was a complication rate of 1.2% (n = 29 complications; 95% CI: 0.8-1.7%). Individual procedures had complication rates that ranged from 0 to 2.7%. There were 13 Grade I complications in 13 patients, 12 Grade II complications in 10 patients, 4 Grade III complications in 4 patients, and 0 Grade IV or V complications. No associations between complication risk and any patient demographics (age, sex, BMI), co-morbidities (diabetes, smoker), or procedure characteristics (type, region) were identified. CONCLUSION:This retrospective review provides an evidence-based estimate supporting the low level of risk associated with ultrasound-guided surgical procedures for patients from a variety of geographical settings who are seeking care at private and academic-affiliated clinics.

Ultrasound is an excellent modality for the routine assessment of foot and ankle pathologies. In this chapter, a systematic approach to the sonographic evaluation of the ankle is presented. A subsequent chapter will detail the US of the foot.

The word "oedema" was changed to "edema" throughout the chapter for consistency.4. In the first line of the section "6.2 Avascular Necrosis," the abbreviation "AVN" was expanded to "Avascular necrosis."5. The word "parosteal" was changed to "periosteal" in the sentence "This is typically surrounded by avid bone marrow edema…."6.The term "Morton's neuroma" was changed to "interdigital neuroma" throughout the chapter for consistency.

Pain that arises from the second to fourth rays and interspaces is termed lesser metatarsalgia (LM). While the pain is commonly located at the plantar aspect of metatarsophalangeal joints (MTP), it can also be experienced more diffusely in the forefoot, including dorsally in some individuals. In this chapter, we review the forefoot anatomy and outline a systematic approach to the sonographic and MRI evaluation of LM. Both common and less common causes of LM will be discussed.

BACKGROUND:The thumb annular pulley system is unique from the other digits and is integral to normal thumb function. Injuries to this pulley system can present a diagnostic challenge. No prior study has evaluated the ability of ultrasound (US) to evaluate all four thumb pulleys.OBJECTIVE:To validate the sonographic visualization of all four thumb pulleys.DESIGN:Prospective cadaveric laboratory investigation.SETTING:Academic center procedural skills laboratory.PARTICIPANTS:Twelve unembalmed cadaveric hands from seven adult male donors ages 78-89 years with body mass index 21.9-26.6 kg/m2 .INTERVENTIONS:Based on anatomic descriptions, a single examiner used a standardized protocol and high-frequency linear transducers to identify the A1, variable (Av), oblique (Ao), and A2 pulleys of the thumb in 10 cadaveric hands. As part of the validation process, the presumed Ao pulley was injected with diluted colored latex using US guidance. Two additional cadaveric specimens were dissected for detailed study of the thumb pulley system.MAIN OUTCOME MEASURES:Correlation between the four anatomic pulleys as revealed by dissection and the US findings, including identification of latex location with respect to the Ao pulley.RESULTS:US correctly identified all four thumb pulleys as distinct anatomic structures and the sonographic appearance of the pulleys correlated with the dissection in all 10 specimens. Latex was observed in the Ao pulley in 100% of the cadavers.CONCLUSIONS:Ultrasound can be used to accurately identify all four thumb pulleys, including distinct Ao and Av pulleys, and should be considered in the evaluation of thumb pulley injuries. This is the first study to validate the US visualization of the annular pulley system of the thumb.

The current lack of agreement regarding standardised terminology in musculoskeletal and sports ultrasound presents challenges in education, clinical practice and research. This consensus was developed to provide a reference to improve clarity and consistency in communication. A multidisciplinary expert panel was convened consisting of 18 members representing multiple specialty societies identified as key stakeholders in musculoskeletal and sports ultrasound. A Delphi process was used to reach consensus, which was defined as group level agreement of >80%. Content was organised into seven general topics including: (1) general definitions, (2) equipment and transducer manipulation, (3) anatomical and descriptive terminology, (4) pathology, (5) procedural terminology, (6) image labelling and (7) documentation. Terms and definitions which reached consensus agreement are presented herein. The historic use of multiple similar terms in the absence of precise definitions has led to confusion when conveying information between colleagues, patients and third-party payers. This multidisciplinary expert consensus addresses multiple areas of variability in diagnostic ultrasound imaging and ultrasound-guided procedures related to musculoskeletal and sports medicine.

Sports ultrasound is commonly used by sports medicine physicians to enhance diagnostic and procedural accuracy. This expert consensus statement serves as an update to the 2015 American Medical Society for Sports Medicine recommended sports ultrasound curriculum for sports medicine fellowships. Although written in the context of the American sports medicine fellowship training model, we present a stepwise progression in both diagnostic and interventional sports ultrasound that may be applicable to the broader sports medicine community. The curriculum is divided into 12 units with each unit including didactic instructional sessions, practical hands-on instruction, independent scanning practice sessions and mentored clinical experience. To assist with prioritisation of learning, we have organised relevant pathology and procedures as essential, desirable and optional. The expanded content can serve as an outline for continuing education postfellowship or for any physician to further advance their sports ultrasound knowledge and skill. We also provide updated scanning protocols, sample milestones and a sample objective structured clinical examination to aid fellowships with implementation of the curriculum and ongoing assessment of fellow progress.

The most common etiology of carpal tunnel syndrome (CTS) is idiopathic. However, secondary causes of CTS should be considered when symptoms are unilateral, or electrodiagnostic studies are discrepant with the clinical presentation. Imaging of the carpal tunnel should be performed when secondary causes of CTS are suspected. An ultrasound evaluation of the carpal tunnel can assess for pathologic changes of the median nerve, detect secondary causes of CTS, and aid in surgical planning.

Gluteus minimus disorders are a potential source of greater trochanteric or anterior hip pain. Disorders of the gluteus minimus tendon most commonly occur in conjunction with gluteus medius tendon abnormalities but can also occur in isolation. Understanding the sonoanatomy of the gluteus minimus muscle-tendon unit is a prerequisite for recognizing and characterizing gluteus minimus tendon disorders, which, in turn, guides treatment for patients with greater trochanteric or anterior hip pain syndromes.

PM&RVolume 11, Issue 11 p. 1248-1249 Images Sonographic Identification of an Atypical Palmar Cutaneous Branch of the Median Nerve Amanda Honsvall Hoefler MD, Amanda Honsvall Hoefler MD orcid.org/0000-0002-7548-8982 Department of Family Medicine and Community Health, University of Minnesota Methodist Hospital Family Medicine Residency Program, St. Louis Park, MNDisclosure: noneSearch for more papers by this authorJay Smith MD, Jay Smith MD Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, MNDisclosures outside this publication: Tenex Health LLC, License, Royalties, Stock; Sonex Health LLC, License, Royalties, Stock, Founder, Board of Governors; other, Associate section editor - Journal of Ultrasound in Medicine.Search for more papers by this authorDouglas Hoffman MD, Corresponding Author Douglas Hoffman MD douglas.hoffman@essentiahealth.org Department of Radiology and Orthopedics, Essentia Health, Duluth, MNDisclosure: noneAddress correspondence to: D. F. H., Department of Radiology and Orthopedics, Essentia Health, 400 E. Third Street, Duluth, MN 55805. e-mail: douglas.hoffman@essentiahealth.orgSearch for more papers by this author Amanda Honsvall Hoefler MD, Amanda Honsvall Hoefler MD orcid.org/0000-0002-7548-8982 Department of Family Medicine and Community Health, University of Minnesota Methodist Hospital Family Medicine Residency Program, St. Louis Park, MNDisclosure: noneSearch for more papers by this authorJay Smith MD, Jay Smith MD Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, MNDisclosures outside this publication: Tenex Health LLC, License, Royalties, Stock; Sonex Health LLC, License, Royalties, Stock, Founder, Board of Governors; other, Associate section editor - Journal of Ultrasound in Medicine.Search for more papers by this authorDouglas Hoffman MD, Corresponding Author Douglas Hoffman MD douglas.hoffman@essentiahealth.org Department of Radiology and Orthopedics, Essentia Health, Duluth, MNDisclosure: noneAddress correspondence to: D. F. H., Department of Radiology and Orthopedics, Essentia Health, 400 E. Third Street, Duluth, MN 55805. e-mail: douglas.hoffman@essentiahealth.orgSearch for more papers by this author First published: 13 May 2019 https://doi.org/10.1002/pmrj.12188 Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume11, Issue11November 2019Pages 1248-1249 This article also appears in:Ultrasound RelatedInformation

Background: The importance of meniscal preservation has become widely accepted, and meniscal repair techniques have evolved over recent years. With new techniques come new complications, which are critical to recognize. Purpose: To describe a new complication of foreign body reaction from a nonabsorbable suture anchor associated with improper placement of the all-inside meniscal device. Study Design: Case series; Level of evidence, 4. Methods: This study was a retrospective review of 3 patients who developed pain associated with a foreign body reaction from a misplaced all-inside meniscal device. Results: All patients had a delayed diagnosis (6 months to 8 years) and negative magnetic resonance imaging (MRI). Diagnostic ultrasound identified the misplaced suture with foreign body reaction and was used to guide a diagnostic injection of local anesthetic prior to surgical intervention. Intraoperative ultrasound guidance was utilized to precisely localize and excise the suture material and associated reactive tissue. Conclusion: Foreign body reaction from a misplaced all-inside meniscal device is a previously unreported complication. Diagnosis is challenging as MRI and arthroscopy can be unrevealing. Diagnostic ultrasound was able to identify the foreign body reaction, confirm the diagnosis by facilitating diagnostic local anesthetic injection, and guide surgical excision. Sonographic evaluation should be considered in patients presenting with ongoing knee pain after all-inside meniscus repair.

BACKGROUND:The importance of meniscal preservation has become widely accepted, and meniscal repair techniques have evolved over recent years. With new techniques come new complications, which are critical to recognize.PURPOSE:To describe a new complication of foreign body reaction from a nonabsorbable suture anchor associated with improper placement of the all-inside meniscal device.STUDY DESIGN:Case series; Level of evidence, 4.METHODS:This study was a retrospective review of 3 patients who developed pain associated with a foreign body reaction from a misplaced all-inside meniscal device.RESULTS:All patients had a delayed diagnosis (6 months to 8 years) and negative magnetic resonance imaging (MRI). Diagnostic ultrasound identified the misplaced suture with foreign body reaction and was used to guide a diagnostic injection of local anesthetic prior to surgical intervention. Intraoperative ultrasound guidance was utilized to precisely localize and excise the suture material and associated reactive tissue.CONCLUSION:Foreign body reaction from a misplaced all-inside meniscal device is a previously unreported complication. Diagnosis is challenging as MRI and arthroscopy can be unrevealing. Diagnostic ultrasound was able to identify the foreign body reaction, confirm the diagnosis by facilitating diagnostic local anesthetic injection, and guide surgical excision. Sonographic evaluation should be considered in patients presenting with ongoing knee pain after all-inside meniscus repair.

Greater trochanteric pain syndrome is a common clinical entity that most often results from disorders of the gluteus medius tendon. There are two distinct bands of the gluteus medius tendon, and abnormalities may affect the anterior or posterior band in isolation or simultaneously. Although abnormalities of the anterior band are more common, awareness and sonographic detection of posterior band abnormalities is essential to guide treatment in the setting of greater trochanteric pain syndrome.

High-resolution ultrasound is emerging as an important imaging modality in fracture assessment due to its availability, ease of use and multiplanar capabilities. Its usefulness includes injury assessment for the presence of a fracture when obtaining radiographs is not immediately available, detecting occult fractures not revealed on radiographs, and diagnosing bone stress injury before radiographic changes. Sonographic evaluation of bone, however, has limitations and should always be coupled with radiographs and possibly advanced imaging modalities such as CT and MR when clinically indicated.

The objective of this study was to raise awareness of the diagnosis of enthesopathy of the lateral cord of the plantar fascia (LCPF) and describe its sonographic findings. We conducted a retrospective case series of 13 sonographic examinations with the diagnosis of LCPF enthesopathy. Two cadaver dissections of the plantar foot were performed for anatomic correlation. Sonographic findings of LCPF enthesopathy included generalized or focal hypoechoic thickening, loss of the normal fibrillar echo texture, cortical irregularity of the fifth metatarsal tuberosity, and vascularity on color Doppler imaging. Anatomic dissections of the plantar foot detailed the course of the LCPF and served as a guide for optimal sonographic imaging. Enthesopathy of the LCPF is an important etiology of nontraumatic pain at the base of the fifth metatarsal. Sonographic evaluation can readily show the characteristic findings of LCPF enthesopathy.

Plantar hindfoot and midfoot pain is a common orthopedic condition. Plantar fasciopathy is the most common cause of plantar foot pain, and sonographic evaluation can easily show the characteristic pathologic changes. In addition, sonography is well suited to evaluate other potential causes of plantar foot pain. We present a review of the sonographic findings of plantar fasciopathy and other potential causes of plantar hindfoot and midfoot pain.

Finger injuries are one of the most common traumatic sports injuries. During the care for such injuries, it is important for the clinician to come to the correct diagnosis and initiate appropriate treatment to avoid complications of deformity and dysfunction. In addition, the clinician must have a good understanding of finger anatomy and knowledge of the mechanism of injury. Initial evaluation should include a clinical musculoskeletal examination as well as radiography.

To present the ultrasound appearance of talocalcaneal coalitions (TCC).