<p begin="00:00:07.605" end="00:00:09.307" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:09.307" end="00:00:11.398" style="s2">with a musculoskeletal exam type</p>
<p begin="00:00:11.398" end="00:00:13.825" style="s2">is used to perform an<br />ultrasound examination</p>
<p begin="00:00:13.825" end="00:00:16.575" style="s2">of the posterior groove of the shoulder.</p>
<p begin="00:00:16.575" end="00:00:18.571" style="s2">The patient is in a sitting position</p>
<p begin="00:00:18.571" end="00:00:21.772" style="s2">with the arm flexed<br />and internally rotated.</p>
<p begin="00:00:21.772" end="00:00:24.076" style="s2">The examiner is positioned<br />behind the patient</p>
<p begin="00:00:24.076" end="00:00:27.586" style="s2">and the transducer is placed<br />posteriorly over the shoulder</p>
<p begin="00:00:27.586" end="00:00:31.172" style="s2">with the orientation marker<br />to the patient's left side.</p>
<p begin="00:00:31.172" end="00:00:34.451" style="s2">The posterior labrum is seen<br />as a triangular structure</p>
<p begin="00:00:34.451" end="00:00:36.711" style="s2">between the bright, hyperechoic glenoid</p>
<p begin="00:00:36.711" end="00:00:38.235" style="s2">and the humeral head.</p>
<p begin="00:00:38.235" end="00:00:41.577" style="s2">The arm is slowly externally<br />and internally rotated</p>
<p begin="00:00:41.577" end="00:00:44.052" style="s2">to evaluate the ball and socket motion</p>
<p begin="00:00:44.052" end="00:00:45.907" style="s2">of the glenohumeral joint.</p>
<p begin="00:00:45.907" end="00:00:48.612" style="s2">The fibrillar pattern of<br />the infraspinatus muscle</p>
<p begin="00:00:48.612" end="00:00:50.029" style="s2">is also apparent.</p>
<p begin="00:00:50.900" end="00:00:53.980" style="s2">The transducer is moved slightly medially</p>
<p begin="00:00:53.980" end="00:00:55.591" style="s2">to identify the groove between</p>
<p begin="00:00:55.591" end="00:00:58.149" style="s2">the spine of the scapula and the glenoid</p>
<p begin="00:00:58.149" end="00:00:59.943" style="s2">where the neurovascular bundle</p>
<p begin="00:00:59.943" end="00:01:03.333" style="s2">containing the suprascapular<br />nerve is located.</p>
<p begin="00:01:03.333" end="00:01:05.134" style="s2">Color Doppler should be used to confirm</p>
<p begin="00:01:05.134" end="00:01:09.301" style="s2">the location of the artery<br />with the accompanying nerve.</p>

<p begin="00:00:07.475" end="00:00:09.192" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:09.192" end="00:00:11.437" style="s2">with a musculoskeletal exam<br />type is used to perform</p>
<p begin="00:00:11.437" end="00:00:14.536" style="s2">an ultrasound examination of the medial</p>
<p begin="00:00:14.536" end="00:00:16.451" style="s2">and lateral meniscus.</p>
<p begin="00:00:16.451" end="00:00:18.503" style="s2">The patient is in a supine position</p>
<p begin="00:00:18.503" end="00:00:21.065" style="s2">with the knee flexed 90 degrees.</p>
<p begin="00:00:21.065" end="00:00:23.363" style="s2">The transducer is placed longitudinally</p>
<p begin="00:00:23.363" end="00:00:25.976" style="s2">just proximal to the fibular head</p>
<p begin="00:00:25.976" end="00:00:29.305" style="s2">with the orientation marker<br />directed to the patient's head.</p>
<p begin="00:00:29.305" end="00:00:32.353" style="s2">The lateral meniscus is<br />seen as a triangular-shaped</p>
<p begin="00:00:32.353" end="00:00:35.081" style="s2">object between the bright<br />hyperechoic signatures</p>
<p begin="00:00:35.081" end="00:00:37.628" style="s2">of the tibia and distal femur.</p>
<p begin="00:00:37.628" end="00:00:39.898" style="s2">The fibrillar lateral collateral ligament</p>
<p begin="00:00:39.898" end="00:00:42.227" style="s2">is superficial to the lateral meniscus</p>
<p begin="00:00:42.227" end="00:00:44.535" style="s2">and runs from the lateral<br />condyle of the femur</p>
<p begin="00:00:44.535" end="00:00:46.535" style="s2">to the fibular head.</p>
<p begin="00:00:46.535" end="00:00:48.768" style="s2">The meniscus should have a uniform pattern</p>
<p begin="00:00:48.768" end="00:00:51.208" style="s2">without surrounding anechoic fluid.</p>
<p begin="00:00:51.208" end="00:00:54.560" style="s2">Color Doppler can be used<br />to exclude hypervascularity,</p>
<p begin="00:00:54.560" end="00:00:58.096" style="s2">sometimes seen with inflammation<br />or significant trauma.</p>
<p begin="00:00:58.096" end="00:01:00.977" style="s2">To examine the medial meniscus,<br />the transducer is placed</p>
<p begin="00:01:00.977" end="00:01:04.011" style="s2">longitudinally over the medial joint space</p>
<p begin="00:01:04.011" end="00:01:05.699" style="s2">with the orientation marker directed</p>
<p begin="00:01:05.699" end="00:01:07.268" style="s2">toward the patient's head.</p>
<p begin="00:01:07.268" end="00:01:09.928" style="s2">The medial meniscus is<br />a wedge-shaped structure</p>
<p begin="00:01:09.928" end="00:01:12.677" style="s2">located between the bright<br />hyperechoic signature</p>
<p begin="00:01:12.677" end="00:01:15.213" style="s2">of the distal femur and proximal tibia.</p>
<p begin="00:01:15.213" end="00:01:17.680" style="s2">The medial collateral ligament overlies</p>
<p begin="00:01:17.680" end="00:01:20.824" style="s2">the medial meniscus and<br />has a fibrillar pattern.</p>
<p begin="00:01:20.824" end="00:01:23.205" style="s2">The meniscus should have a uniform pattern</p>
<p begin="00:01:23.205" end="00:01:26.922" style="s2">without surrounding anechoic<br />fluid, tracks or cysts,</p>
<p begin="00:01:26.922" end="00:01:29.326" style="s2">which indicate a meniscal tear.</p>
<p begin="00:01:29.326" end="00:01:32.536" style="s2">Color Doppler can be used<br />to exclude hypervascularity,</p>
<p begin="00:01:32.536" end="00:01:36.703" style="s2">sometimes seen with inflammation<br />or significant trauma.</p>

<p begin="00:00:07.243" end="00:00:09.095" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:09.095" end="00:00:11.275" style="s2">with a musculoskeletal exam type</p>
<p begin="00:00:11.275" end="00:00:13.852" style="s2">is used to perform an<br />ultrasound examination</p>
<p begin="00:00:13.852" end="00:00:16.319" style="s2">of median nerve entrapment.</p>
<p begin="00:00:16.319" end="00:00:18.503" style="s2">The patient is in a sitting position</p>
<p begin="00:00:18.503" end="00:00:22.215" style="s2">with the arm flexed and the<br />hand externally rotated.</p>
<p begin="00:00:22.215" end="00:00:24.654" style="s2">The transducer is placed transversely</p>
<p begin="00:00:24.654" end="00:00:26.535" style="s2">over the proximal wrist crease,</p>
<p begin="00:00:26.535" end="00:00:30.067" style="s2">with the orientation marker<br />directed to the patient's right.</p>
<p begin="00:00:30.067" end="00:00:33.060" style="s2">The flexor retinaculum<br />spans the wrist structures,</p>
<p begin="00:00:33.060" end="00:00:36.004" style="s2">and is seen as a band-like structure.</p>
<p begin="00:00:36.004" end="00:00:38.844" style="s2">The bright, hyperechoic<br />surface of the lunate</p>
<p begin="00:00:38.844" end="00:00:42.500" style="s2">forms the most posterior<br />boundary of the volar wrist.</p>
<p begin="00:00:42.500" end="00:00:45.318" style="s2">The superficial and deep<br />tendons of the wrist</p>
<p begin="00:00:45.318" end="00:00:48.142" style="s2">can be seen as light gray oval structures,</p>
<p begin="00:00:48.142" end="00:00:51.306" style="s2">which are highly subject to anisotropy.</p>
<p begin="00:00:51.306" end="00:00:54.871" style="s2">The ulnar artery and nerve<br />can be seen in Guyon's canal</p>
<p begin="00:00:54.871" end="00:00:58.516" style="s2">superficially and on the<br />medial surface of the wrist.</p>
<p begin="00:00:58.516" end="00:01:00.908" style="s2">The median nerve is a dark, hyperechoic,</p>
<p begin="00:01:00.908" end="00:01:04.292" style="s2">elliptical shaped, honeycombed,<br />fascicular structure</p>
<p begin="00:01:04.292" end="00:01:07.821" style="s2">just ulnar to the flexor<br />carpi radialis tendon,</p>
<p begin="00:01:07.821" end="00:01:10.415" style="s2">in line with the three carpal bones.</p>
<p begin="00:01:10.415" end="00:01:12.711" style="s2">The nerve can be<br />distinguished from the tendons</p>
<p begin="00:01:12.711" end="00:01:15.351" style="s2">by the fact it is less<br />subject to anisotropy,</p>
<p begin="00:01:15.351" end="00:01:17.120" style="s2">and it remains in constant position</p>
<p begin="00:01:17.120" end="00:01:19.478" style="s2">with transducer translation.</p>
<p begin="00:01:19.478" end="00:01:21.803" style="s2">The nerve should remain<br />a constant diameter</p>
<p begin="00:01:21.803" end="00:01:25.059" style="s2">with movement of the transducer<br />distally in the hand.</p>
<p begin="00:01:25.059" end="00:01:27.714" style="s2">The transducer should be<br />centered over the median nerve</p>
<p begin="00:01:27.714" end="00:01:30.909" style="s2">and rotated 90 degrees clockwise.</p>
<p begin="00:01:30.909" end="00:01:34.020" style="s2">The median nerve will appear<br />as a fascicular structure</p>
<p begin="00:01:34.020" end="00:01:37.893" style="s2">which lies on top of the<br />similar-appearing flexor tendons.</p>
<p begin="00:01:37.893" end="00:01:39.670" style="s2">The patient can be instructed to flex</p>
<p begin="00:01:39.670" end="00:01:41.494" style="s2">their third and fourth finger</p>
<p begin="00:01:41.494" end="00:01:43.197" style="s2">to cause movement in the tendons,</p>
<p begin="00:01:43.197" end="00:01:46.058" style="s2">to distinguish them from<br />the overlying nerve.</p>
<p begin="00:01:46.058" end="00:01:49.049" style="s2">The median nerve should be<br />evaluated for any edema,</p>
<p begin="00:01:49.049" end="00:01:51.426" style="s2">which will make the<br />nerve more hyperechoic,</p>
<p begin="00:01:51.426" end="00:01:55.593" style="s2">or swelling, which may<br />occur distal to entrapment.</p>

<p begin="00:00:07.393" end="00:00:09.023" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:09.023" end="00:00:11.914" style="s2">with the musculoskeletal<br />exam type is used to perform</p>
<p begin="00:00:11.914" end="00:00:15.626" style="s2">an ultrasound examination of<br />the medial collateral ligament</p>
<p begin="00:00:15.626" end="00:00:16.752" style="s2">of the knee.</p>
<p begin="00:00:16.752" end="00:00:18.666" style="s2">The patient is in a supine position,</p>
<p begin="00:00:18.666" end="00:00:21.420" style="s2">with the knee flexed 90 degrees.</p>
<p begin="00:00:21.420" end="00:00:24.672" style="s2">The transducer is placed<br />longitudinally over the inner knee</p>
<p begin="00:00:24.672" end="00:00:27.541" style="s2">at the joint space, with the<br />orientation marker directed</p>
<p begin="00:00:27.541" end="00:00:29.498" style="s2">to the patient's head.</p>
<p begin="00:00:29.498" end="00:00:31.804" style="s2">The medial collateral<br />ligament can be seen as</p>
<p begin="00:00:31.804" end="00:00:34.336" style="s2">a compact, fibrillar patterned structure,</p>
<p begin="00:00:34.336" end="00:00:37.058" style="s2">superficial to the bright<br />hyperechoic distal femur</p>
<p begin="00:00:37.058" end="00:00:39.061" style="s2">and proximal tibia.</p>
<p begin="00:00:39.061" end="00:00:41.334" style="s2">The medial meniscus is<br />a triangular-shaped,</p>
<p begin="00:00:41.334" end="00:00:44.520" style="s2">hyperechoic structure<br />between the two bones.</p>
<p begin="00:00:44.520" end="00:00:47.454" style="s2">The medial collateral<br />ligament has a superficial</p>
<p begin="00:00:47.454" end="00:00:50.053" style="s2">and deep layer that should<br />be scanned from insertion</p>
<p begin="00:00:50.053" end="00:00:53.227" style="s2">on the femoral condyle down<br />to the darker, hyperechoic</p>
<p begin="00:00:53.227" end="00:00:55.566" style="s2">pes anserine tendon complex.</p>
<p begin="00:00:55.566" end="00:01:00.054" style="s2">The transducer is then rotated<br />90 degrees counterclockwise</p>
<p begin="00:01:00.054" end="00:01:02.259" style="s2">to obtain a short axis view.</p>
<p begin="00:01:02.259" end="00:01:05.175" style="s2">The medial collateral ligament<br />appears as a bilaminate,</p>
<p begin="00:01:05.175" end="00:01:09.156" style="s2">sheet-like structure, with<br />a darker, hypoechoic middle.</p>
<p begin="00:01:09.156" end="00:01:12.171" style="s2">The ligament should be scanned<br />from its proximal origin</p>
<p begin="00:01:12.171" end="00:01:16.338" style="s2">to its distal insertion to<br />complete the examination.</p>

<p begin="00:00:07.292" end="00:00:08.981" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:08.981" end="00:00:11.121" style="s2">with a musculoskeletal examine type</p>
<p begin="00:00:11.121" end="00:00:13.777" style="s2">is used to perform an<br />ultrasound guided injection</p>
<p begin="00:00:13.777" end="00:00:16.673" style="s2">of the knee using a lateral approach.</p>
<p begin="00:00:16.673" end="00:00:18.782" style="s2">The patient is in a supine position</p>
<p begin="00:00:18.782" end="00:00:20.520" style="s2">with the leg extended.</p>
<p begin="00:00:20.520" end="00:00:23.616" style="s2">The transducer is placed<br />just proximal to the patella</p>
<p begin="00:00:23.616" end="00:00:25.906" style="s2">in a long-axis fashion.</p>
<p begin="00:00:25.906" end="00:00:28.317" style="s2">The fibular pattern of<br />the quadriceps tendon</p>
<p begin="00:00:28.317" end="00:00:31.276" style="s2">in seen above the rounded,<br />bright hyperechoic surface</p>
<p begin="00:00:31.276" end="00:00:33.983" style="s2">of the distal femur and patella.</p>
<p begin="00:00:33.983" end="00:00:36.301" style="s2">The suprapatellar fat-pad and the darker</p>
<p begin="00:00:36.301" end="00:00:38.897" style="s2">hypoechoic suprapatellar bursa</p>
<p begin="00:00:38.897" end="00:00:40.829" style="s2">can be seen in this image.</p>
<p begin="00:00:40.829" end="00:00:43.760" style="s2">The transducer is rotated<br />90 degrees clockwise</p>
<p begin="00:00:43.760" end="00:00:46.149" style="s2">for a short-axis view of the bursa,</p>
<p begin="00:00:46.149" end="00:00:47.922" style="s2">which lies below the patellar tendon</p>
<p begin="00:00:47.922" end="00:00:50.137" style="s2">and above the bony cortex.</p>
<p begin="00:00:50.137" end="00:00:52.601" style="s2">The transducer is<br />adjusted so it is centered</p>
<p begin="00:00:52.601" end="00:00:55.199" style="s2">over the superapatellar bursa.</p>
<p begin="00:00:55.199" end="00:00:56.947" style="s2">The needle is inserted in the skin</p>
<p begin="00:00:56.947" end="00:00:58.889" style="s2">just proximal to the transducer,</p>
<p begin="00:00:58.889" end="00:01:01.243" style="s2">opposite the orientation marker.</p>
<p begin="00:01:01.243" end="00:01:03.766" style="s2">The needle is slowly<br />advanced to lie in-plane</p>
<p begin="00:01:03.766" end="00:01:06.557" style="s2">to the transducer beam,<br />and is seen as a bright,</p>
<p begin="00:01:06.557" end="00:01:09.116" style="s2">hyperechoic, linear structure.</p>
<p begin="00:01:09.116" end="00:01:11.776" style="s2">The needle is slowly advanced<br />under direct ultrasound</p>
<p begin="00:01:11.776" end="00:01:13.807" style="s2">visualization until the tip is seen</p>
<p begin="00:01:13.807" end="00:01:15.380" style="s2">to lie within the bursa,</p>
<p begin="00:01:15.380" end="00:01:19.297" style="s2">where the injection or<br />aspiration can be done.</p>

<p begin="00:00:07.188" end="00:00:08.845" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:08.845" end="00:00:11.064" style="s2">with a musculoskeletal exam type</p>
<p begin="00:00:11.064" end="00:00:13.476" style="s2">is used to perform an<br />ultrasound examination</p>
<p begin="00:00:13.476" end="00:00:15.738" style="s2">of the infrapatellar tendon.</p>
<p begin="00:00:15.738" end="00:00:17.577" style="s2">The patient is in a supine position</p>
<p begin="00:00:17.577" end="00:00:20.176" style="s2">with the knee flexed 90 degrees.</p>
<p begin="00:00:20.176" end="00:00:22.815" style="s2">The transducer is placed longitudinally</p>
<p begin="00:00:22.815" end="00:00:25.613" style="s2">just inferior to the<br />patella in the mid-line</p>
<p begin="00:00:25.613" end="00:00:26.858" style="s2">with the orientation marker</p>
<p begin="00:00:26.858" end="00:00:29.102" style="s2">directed to the patient's head.</p>
<p begin="00:00:29.102" end="00:00:31.030" style="s2">The bright hyperechoic patella</p>
<p begin="00:00:31.030" end="00:00:33.007" style="s2">is seen on the left of the image.</p>
<p begin="00:00:33.007" end="00:00:34.572" style="s2">The infrapatellar tendon</p>
<p begin="00:00:34.572" end="00:00:38.046" style="s2">is seen as a compact<br />fibrillar pattern structure</p>
<p begin="00:00:38.046" end="00:00:40.679" style="s2">which extends from the<br />patellar insertion distally</p>
<p begin="00:00:40.679" end="00:00:43.517" style="s2">to the anterior tibial tuberosity.</p>
<p begin="00:00:43.517" end="00:00:45.316" style="s2">The long axis examination</p>
<p begin="00:00:45.316" end="00:00:47.519" style="s2">is repeated medially and laterally</p>
<p begin="00:00:47.519" end="00:00:49.785" style="s2">to fully evaluate the tendon.</p>
<p begin="00:00:49.785" end="00:00:53.546" style="s2">The transducer is then rotated<br />90 degrees counter clockwise</p>
<p begin="00:00:53.546" end="00:00:55.964" style="s2">to obtain a short axis view.</p>
<p begin="00:00:55.964" end="00:00:59.087" style="s2">The infrapatellar tendon is<br />seen as a speckled pattern,</p>
<p begin="00:00:59.087" end="00:01:01.662" style="s2">elliptical structure distal to the patella</p>
<p begin="00:01:01.662" end="00:01:03.829" style="s2">and anterior to the tibia.</p>
<p begin="00:01:04.822" end="00:01:07.231" style="s2">The transducer is slowly moved distally</p>
<p begin="00:01:07.231" end="00:01:08.992" style="s2">as the tendon gradually thins</p>
<p begin="00:01:08.992" end="00:01:11.992" style="s2">to insert on the tibial tuberosity.</p>

<p begin="00:00:07.273" end="00:00:09.017" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:09.017" end="00:00:11.153" style="s2">with a musculoskeletal exam type</p>
<p begin="00:00:11.153" end="00:00:13.575" style="s2">is used to perform an<br />ultrasound examination</p>
<p begin="00:00:13.575" end="00:00:15.684" style="s2">of the glenohumeral joint.</p>
<p begin="00:00:15.684" end="00:00:17.552" style="s2">The patient is in a sitting position</p>
<p begin="00:00:17.552" end="00:00:19.569" style="s2">with the hand placed across the body,</p>
<p begin="00:00:19.569" end="00:00:21.954" style="s2">and grasping the opposite shoulder.</p>
<p begin="00:00:21.954" end="00:00:24.814" style="s2">The examiner is positioned<br />in front of the patient,</p>
<p begin="00:00:24.814" end="00:00:28.175" style="s2">and the transducer is placed<br />posteriorly over the shoulder,</p>
<p begin="00:00:28.175" end="00:00:32.518" style="s2">with the orientation marker<br />directed to the patient's right.</p>
<p begin="00:00:32.518" end="00:00:35.898" style="s2">The posterior labrum is seen<br />as a triangular structure</p>
<p begin="00:00:35.898" end="00:00:38.769" style="s2">between the bright,<br />hyperechoic glenoid fossa</p>
<p begin="00:00:38.769" end="00:00:40.309" style="s2">and the humeral head.</p>
<p begin="00:00:40.309" end="00:00:43.298" style="s2">The anechoic black cartilage<br />of the glenohumeral joint</p>
<p begin="00:00:43.298" end="00:00:45.418" style="s2">can be seen in this view.</p>
<p begin="00:00:45.418" end="00:00:48.819" style="s2">The arm is slowly externally<br />and internally rotated</p>
<p begin="00:00:48.819" end="00:00:51.152" style="s2">to evaluate the ball-and-socket motion</p>
<p begin="00:00:51.152" end="00:00:53.273" style="s2">of the glenohumeral joint.</p>
<p begin="00:00:53.273" end="00:00:55.895" style="s2">The fibrillar pattern of<br />the infraspinatous muscle</p>
<p begin="00:00:55.895" end="00:00:57.312" style="s2">is also apparent.</p>

<p begin="00:00:07.468" end="00:00:08.913" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:08.913" end="00:00:10.790" style="s2">with a musculos-skeletal exam type is used</p>
<p begin="00:00:10.790" end="00:00:14.145" style="s2">to perform an ultra sound<br />guided kneed injection.</p>
<p begin="00:00:14.145" end="00:00:15.682" style="s2">Using a medial approach.</p>
<p begin="00:00:15.682" end="00:00:19.428" style="s2">The patient is in a supine<br />position, with the leg extended.</p>
<p begin="00:00:19.428" end="00:00:23.144" style="s2">The transducer is placed<br />just proximal to the patella.</p>
<p begin="00:00:23.144" end="00:00:26.950" style="s2">In a long axis fashion, the<br />fibular pattern of the patellar</p>
<p begin="00:00:26.950" end="00:00:28.902" style="s2">tendon is seen above the rounded bright</p>
<p begin="00:00:28.902" end="00:00:32.923" style="s2">hyperechoic surface of the<br />distal femur and patella.</p>
<p begin="00:00:32.923" end="00:00:36.218" style="s2">The supra patellar fat pad<br />and the darker hyperechoic</p>
<p begin="00:00:36.218" end="00:00:39.746" style="s2">supra patellar versa can<br />be seen in this image.</p>
<p begin="00:00:39.746" end="00:00:43.687" style="s2">This versa may not be visible<br />in the absence of an infusion.</p>
<p begin="00:00:43.687" end="00:00:47.323" style="s2">The transducer is rotated<br />90 degrees clockwise</p>
<p begin="00:00:47.323" end="00:00:49.557" style="s2">for a short access view of the versa</p>
<p begin="00:00:49.557" end="00:00:52.314" style="s2">which lies below the patellar tendon.</p>
<p begin="00:00:52.314" end="00:00:55.459" style="s2">And above the bony cortex,<br />the transducer is adjusted.</p>
<p begin="00:00:55.459" end="00:00:59.185" style="s2">So it is centered over the<br />anechoic supra patellar versa.</p>
<p begin="00:00:59.185" end="00:01:01.457" style="s2">The needle is inserted in the skin,</p>
<p begin="00:01:01.457" end="00:01:03.366" style="s2">just proximal to the transducer.</p>
<p begin="00:01:03.366" end="00:01:05.224" style="s2">The needle is slowly advanced</p>
<p begin="00:01:05.224" end="00:01:07.961" style="s2">to lie in plane to the transducer beam.</p>
<p begin="00:01:07.961" end="00:01:11.207" style="s2">And is seen as a bright<br />hyperechoic linear structure.</p>
<p begin="00:01:11.207" end="00:01:12.807" style="s2">The needle is slowly advanced</p>
<p begin="00:01:12.807" end="00:01:15.253" style="s2">under direct ultrasound visualization.</p>
<p begin="00:01:15.253" end="00:01:17.750" style="s2">Until the tip is seen to lie in the versa,</p>
<p begin="00:01:17.750" end="00:01:21.500" style="s2">where an injection or<br />aspiration can be done.</p>

<p begin="00:00:07.374" end="00:00:09.089" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:09.089" end="00:00:12.017" style="s2">with a musculoskeletal exam<br />type is used to perform</p>
<p begin="00:00:12.017" end="00:00:14.388" style="s2">an ultrasound examination of the Lateral</p>
<p begin="00:00:14.388" end="00:00:16.672" style="s2">Collateral Ligament of the Knee.</p>
<p begin="00:00:16.672" end="00:00:18.568" style="s2">The patient is in a supine position</p>
<p begin="00:00:18.568" end="00:00:21.341" style="s2">with the knee flexed 90 degrees.</p>
<p begin="00:00:21.341" end="00:00:23.742" style="s2">The transducer is placed longitudinally</p>
<p begin="00:00:23.742" end="00:00:25.916" style="s2">over the outer knee at the joint space</p>
<p begin="00:00:25.916" end="00:00:27.753" style="s2">with the orientation marker directed</p>
<p begin="00:00:27.753" end="00:00:29.563" style="s2">to the patient's head.</p>
<p begin="00:00:29.563" end="00:00:32.682" style="s2">The fibular head is a<br />bright, hyperechoic structure</p>
<p begin="00:00:32.682" end="00:00:35.641" style="s2">where the biceps femoris muscle attaches.</p>
<p begin="00:00:35.641" end="00:00:37.553" style="s2">The transducer should be translated</p>
<p begin="00:00:37.553" end="00:00:39.726" style="s2">in a windshield wiper type maneuver</p>
<p begin="00:00:39.726" end="00:00:42.375" style="s2">to connect the fibula<br />and the femoral condyle</p>
<p begin="00:00:42.375" end="00:00:45.671" style="s2">to identify the Lateral<br />Collateral Ligament.</p>
<p begin="00:00:45.671" end="00:00:47.588" style="s2">The ligament can be seen as a packed,</p>
<p begin="00:00:47.588" end="00:00:50.143" style="s2">fibular patterned, tight,<br />elliptical structure</p>
<p begin="00:00:50.143" end="00:00:52.167" style="s2">arising from the lateral condyle,</p>
<p begin="00:00:52.167" end="00:00:54.630" style="s2">and inserting on the fibular head.</p>
<p begin="00:00:54.630" end="00:00:57.277" style="s2">The transducer is then rotated 90 degrees</p>
<p begin="00:00:57.277" end="00:01:00.799" style="s2">counterclockwise to<br />obtain a short-axis view.</p>
<p begin="00:01:00.799" end="00:01:02.914" style="s2">The Lateral Collateral Ligament appears</p>
<p begin="00:01:02.914" end="00:01:05.520" style="s2">as a sheet-like structure,<br />which should be scanned</p>
<p begin="00:01:05.520" end="00:01:07.742" style="s2">from its proximal to distal insertion</p>
<p begin="00:01:07.742" end="00:01:10.159" style="s2">to complete the examination.</p>

<p begin="00:00:07.590" end="00:00:09.232" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:09.232" end="00:00:11.400" style="s2">with a musculoskeletal exam type</p>
<p begin="00:00:11.400" end="00:00:13.944" style="s2">is used to perform an<br />ultrasound examination</p>
<p begin="00:00:13.944" end="00:00:16.266" style="s2">of the acromioclavicular joint.</p>
<p begin="00:00:16.266" end="00:00:18.252" style="s2">The patient is in a sitting position,</p>
<p begin="00:00:18.252" end="00:00:21.021" style="s2">with the hand resting<br />palm up on the thigh.</p>
<p begin="00:00:21.021" end="00:00:23.733" style="s2">The transducer is placed longitudinally</p>
<p begin="00:00:23.733" end="00:00:25.973" style="s2">over the acromioclavicular area,</p>
<p begin="00:00:25.973" end="00:00:29.385" style="s2">with the orientation marker<br />directed to the patient's right.</p>
<p begin="00:00:29.385" end="00:00:31.893" style="s2">The acromioclavicular<br />joint is seen between</p>
<p begin="00:00:31.893" end="00:00:34.142" style="s2">the bright, hyperechoic acromion,</p>
<p begin="00:00:34.142" end="00:00:36.498" style="s2">and the distal clavicle.</p>
<p begin="00:00:36.498" end="00:00:40.181" style="s2">The supraspinatous muscle<br />is lateral to the acromion.</p>
<p begin="00:00:40.181" end="00:00:42.884" style="s2">The acromioclavicular<br />joint should be scanned</p>
<p begin="00:00:42.884" end="00:00:45.338" style="s2">in an anterior to posterior direction</p>
<p begin="00:00:45.338" end="00:00:47.883" style="s2">to evaluate the entire joint area.</p>
<p begin="00:00:47.883" end="00:00:50.773" style="s2">The patient can move their<br />arm in a cross-chest fashion</p>
<p begin="00:00:50.773" end="00:00:53.799" style="s2">to further evaluate the<br />integrity of the joint.</p>
<p begin="00:00:53.799" end="00:00:56.268" style="s2">Movement of the acromioclavicular joint</p>
<p begin="00:00:56.268" end="00:00:59.351" style="s2">should be minimal with this maneuver.</p>