<p begin="00:00:07.711" end="00:00:09.526" style="s2">- [Voiceover] A<br />linear-array transducer with</p>
<p begin="00:00:09.526" end="00:00:12.155" style="s2">a musculoskeletal exam<br />type is used to perform</p>
<p begin="00:00:12.155" end="00:00:16.827" style="s2">an ultrasound examination of<br />the flexor tendon of the ankle.</p>
<p begin="00:00:16.827" end="00:00:19.167" style="s2">The patient is placed in a supine position</p>
<p begin="00:00:19.167" end="00:00:21.755" style="s2">with the foot rotated slightly laterally</p>
<p begin="00:00:21.755" end="00:00:24.852" style="s2">and a pillow under the lateral malleolus.</p>
<p begin="00:00:24.852" end="00:00:27.174" style="s2">The transducer is placed obliquely behind</p>
<p begin="00:00:27.174" end="00:00:30.348" style="s2">the medial malleolus with<br />the orientation marker</p>
<p begin="00:00:30.348" end="00:00:32.705" style="s2">directed toward the patient's right.</p>
<p begin="00:00:32.705" end="00:00:34.588" style="s2">The medial melleolus is seen as</p>
<p begin="00:00:34.588" end="00:00:37.115" style="s2">a bright, hyperechoic structure.</p>
<p begin="00:00:37.115" end="00:00:40.118" style="s2">The tibialis posterior<br />tendon can be seen as</p>
<p begin="00:00:40.118" end="00:00:43.352" style="s2">a hyperechoic, compact fibular structure</p>
<p begin="00:00:43.352" end="00:00:46.051" style="s2">posterior to the malleolus.</p>
<p begin="00:00:46.051" end="00:00:48.861" style="s2">The flexor digitorum<br />longus tendon appears as</p>
<p begin="00:00:48.861" end="00:00:52.096" style="s2">a rounded, hyperechoic<br />structure immediately lateral</p>
<p begin="00:00:52.096" end="00:00:54.308" style="s2">to the tibialis tendon.</p>
<p begin="00:00:54.308" end="00:00:57.044" style="s2">Compressible posterior<br />tibial veins can be seen</p>
<p begin="00:00:57.044" end="00:01:00.621" style="s2">as dark, round, hypoechoic areas.</p>
<p begin="00:01:00.621" end="00:01:03.238" style="s2">The posterior tibial artery can be seen</p>
<p begin="00:01:03.238" end="00:01:06.293" style="s2">as a rounded, pulsatile structure.</p>
<p begin="00:01:06.293" end="00:01:08.347" style="s2">The flexor retinaculum is seen as</p>
<p begin="00:01:08.347" end="00:01:11.449" style="s2">a linear, hyperechoic<br />band which is superficial</p>
<p begin="00:01:11.449" end="00:01:14.782" style="s2">to these structures in the medial ankle.</p>

<p begin="00:00:07.306" end="00:00:09.048" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:09.048" end="00:00:11.915" style="s2">with a musculoskeletal exam<br />type, is used to perform</p>
<p begin="00:00:11.915" end="00:00:14.431" style="s2">an ultrasound examination of the extensor</p>
<p begin="00:00:14.431" end="00:00:16.473" style="s2">tendon of the ankle.</p>
<p begin="00:00:16.473" end="00:00:19.238" style="s2">The patient is placed in a<br />supine position with the knee</p>
<p begin="00:00:19.238" end="00:00:21.811" style="s2">flexed, and the foot on the bed.</p>
<p begin="00:00:21.811" end="00:00:24.280" style="s2">The transducer is placed<br />over the ankle joint,</p>
<p begin="00:00:24.280" end="00:00:27.182" style="s2">in a transverse fashion<br />with the orientation marker</p>
<p begin="00:00:27.182" end="00:00:29.648" style="s2">directed toward the patient's right.</p>
<p begin="00:00:29.648" end="00:00:33.811" style="s2">The talus is seen as a<br />bright, hyperechoic line.</p>
<p begin="00:00:33.811" end="00:00:37.412" style="s2">The three extensor tendons are<br />seen as elliptical, compact,</p>
<p begin="00:00:37.412" end="00:00:40.852" style="s2">fibular structures, anterior to the tibia.</p>
<p begin="00:00:40.852" end="00:00:44.349" style="s2">The anterior tibial tendon is most medial.</p>
<p begin="00:00:44.349" end="00:00:46.911" style="s2">The extensor hallucis longus tendon,</p>
<p begin="00:00:46.911" end="00:00:49.662" style="s2">is next to the tibial tendon.</p>
<p begin="00:00:49.662" end="00:00:52.920" style="s2">The extensor digitorum longus<br />tendon, is the most lateral</p>
<p begin="00:00:52.920" end="00:00:54.860" style="s2">tendon in the group.</p>
<p begin="00:00:54.860" end="00:00:58.379" style="s2">The tendons should be scanned<br />superiorly, and inferiorly,</p>
<p begin="00:00:58.379" end="00:01:02.266" style="s2">to evaluate for tears, or tendinopathy.</p>
<p begin="00:01:02.266" end="00:01:05.642" style="s2">The transducers is centered<br />on the anterior tibial tendon,</p>
<p begin="00:01:05.642" end="00:01:09.070" style="s2">and rotated 90 degrees clockwise.</p>
<p begin="00:01:09.070" end="00:01:12.120" style="s2">The fibular pattern of the<br />tendon is identified anterior</p>
<p begin="00:01:12.120" end="00:01:13.892" style="s2">to the ankle joint.</p>
<p begin="00:01:13.892" end="00:01:16.678" style="s2">The tendon should be scanned<br />medially, and laterally,</p>
<p begin="00:01:16.678" end="00:01:20.275" style="s2">to evaluate for tear, or tendinopathy.</p>
<p begin="00:01:20.275" end="00:01:23.698" style="s2">The transducer is rotated<br />90 degrees counterclockwise,</p>
<p begin="00:01:23.698" end="00:01:27.253" style="s2">and centered on the extensor<br />hallucis longus tendon,</p>
<p begin="00:01:27.253" end="00:01:30.489" style="s2">just posterior to the anterior<br />tibial tendon, that should</p>
<p begin="00:01:30.489" end="00:01:34.379" style="s2">be scanned in a transverse,<br />and longitudinal fashion.</p>
<p begin="00:01:34.379" end="00:01:37.751" style="s2">The transducer is then returned<br />to a transverse orientation,</p>
<p begin="00:01:37.751" end="00:01:41.039" style="s2">to scan the extensor digitorum<br />longus tendon, in a similar</p>
<p begin="00:01:41.039" end="00:01:44.122" style="s2">fashion, to complete the examination.</p>

<p begin="00:00:07.432" end="00:00:09.095" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:09.095" end="00:00:11.235" style="s2">with a musculoskeletal exam type</p>
<p begin="00:00:11.235" end="00:00:13.676" style="s2">is used to perform an<br />ultrasound examination</p>
<p begin="00:00:13.676" end="00:00:15.475" style="s2">of the biceps tendon.</p>
<p begin="00:00:15.475" end="00:00:17.318" style="s2">The patient is in a sitting position</p>
<p begin="00:00:17.318" end="00:00:20.061" style="s2">with the hand placed palm up on the knee.</p>
<p begin="00:00:20.061" end="00:00:22.230" style="s2">The transducer is placed transversely</p>
<p begin="00:00:22.230" end="00:00:23.766" style="s2">over the head of the humerus</p>
<p begin="00:00:23.766" end="00:00:28.067" style="s2">with the orientation marker<br />directed to the patient's right.</p>
<p begin="00:00:28.067" end="00:00:29.698" style="s2">The deltoid muscle is seen as</p>
<p begin="00:00:29.698" end="00:00:32.001" style="s2">the most superficial structure.</p>
<p begin="00:00:32.001" end="00:00:35.322" style="s2">The bright hyperechoic greater<br />and lesser tuberosities</p>
<p begin="00:00:35.322" end="00:00:38.758" style="s2">of the humerus surround the<br />oval-shaped biceps tendon.</p>
<p begin="00:00:38.758" end="00:00:40.408" style="s2">The transverse humeral ligament,</p>
<p begin="00:00:40.408" end="00:00:42.151" style="s2">which covers the biceps tendon,</p>
<p begin="00:00:42.151" end="00:00:44.621" style="s2">can be seen as a thin, bright line.</p>
<p begin="00:00:44.621" end="00:00:48.055" style="s2">The biceps tendon is seen<br />in the bicipital groove</p>
<p begin="00:00:48.055" end="00:00:51.014" style="s2">and can appear artificially bright or dark</p>
<p begin="00:00:51.014" end="00:00:53.628" style="s2">due to anisotropy, which<br />occurs if the transducer</p>
<p begin="00:00:53.628" end="00:00:55.700" style="s2">is rocked over the tendon.</p>
<p begin="00:00:55.700" end="00:00:57.933" style="s2">The transducer should<br />be moved down the arm</p>
<p begin="00:00:57.933" end="00:01:01.182" style="s2">to evaluate the tendon to<br />its musculotendinous junction</p>
<p begin="00:01:01.182" end="00:01:04.277" style="s2">and the insertion of the<br />pectoralis major tendon.</p>
<p begin="00:01:04.277" end="00:01:07.211" style="s2">The transducer is returned<br />to the starting position</p>
<p begin="00:01:07.211" end="00:01:10.990" style="s2">at the bicipital groove and<br />rotated 90 degrees clockwise</p>
<p begin="00:01:10.990" end="00:01:14.008" style="s2">to obtain a long axis view of the tendon.</p>
<p begin="00:01:14.008" end="00:01:15.976" style="s2">The fibular tendon should be scanned</p>
<p begin="00:01:15.976" end="00:01:20.143" style="s2">from proximal to distal to<br />the musculotendinous junction.</p>