<p begin="00:00:07.495" end="00:00:09.368" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:09.368" end="00:00:11.564" style="s2">with a musculoskeletal exam type</p>
<p begin="00:00:11.564" end="00:00:13.107" style="s2">is used to perform an ultrasound</p>
<p begin="00:00:13.107" end="00:00:16.103" style="s2">examination of the quadriceps tendon.</p>
<p begin="00:00:16.103" end="00:00:18.355" style="s2">The patient is in a supine position</p>
<p begin="00:00:18.355" end="00:00:20.929" style="s2">with the knee flexed 90 degrees.</p>
<p begin="00:00:20.929" end="00:00:24.345" style="s2">The transducer is placed<br />longitudinally just proximal</p>
<p begin="00:00:24.345" end="00:00:26.962" style="s2">to the patella with the<br />orientation marker directed</p>
<p begin="00:00:26.962" end="00:00:28.933" style="s2">to the patient's head.</p>
<p begin="00:00:28.933" end="00:00:32.297" style="s2">The compact fibrillar pattern<br />of the quadriceps tendon</p>
<p begin="00:00:32.297" end="00:00:35.012" style="s2">is seen superficial to the<br />bright hyperechoic signal</p>
<p begin="00:00:35.012" end="00:00:37.124" style="s2">of the distal femur.</p>
<p begin="00:00:37.124" end="00:00:39.177" style="s2">The bright hyperechoic patella is seen</p>
<p begin="00:00:39.177" end="00:00:41.050" style="s2">on the right of the image.</p>
<p begin="00:00:41.050" end="00:00:44.090" style="s2">The suprapatellar fat pad<br />can be seen as a triangular,</p>
<p begin="00:00:44.090" end="00:00:47.089" style="s2">bright hyperechoic<br />structure just superficial</p>
<p begin="00:00:47.089" end="00:00:49.755" style="s2">to the suprapatellar bursa.</p>
<p begin="00:00:49.755" end="00:00:52.983" style="s2">The transducer should be swept<br />from medial to lateral to</p>
<p begin="00:00:52.983" end="00:00:56.314" style="s2">evaluate the entire quadriceps tendon.</p>
<p begin="00:00:56.314" end="00:00:58.883" style="s2">The transducer should<br />then be rotated 90 degrees</p>
<p begin="00:00:58.883" end="00:01:02.627" style="s2">counterclockwise for a short<br />axis view of the tendon.</p>
<p begin="00:01:02.627" end="00:01:05.157" style="s2">The medial and lateral condyles are seen</p>
<p begin="00:01:05.157" end="00:01:07.914" style="s2">as bright hyperechoic lines.</p>
<p begin="00:01:07.914" end="00:01:10.818" style="s2">The cartilage of the knee is<br />seen superficial to the bone</p>
<p begin="00:01:10.818" end="00:01:13.581" style="s2">as a black anechoic line.</p>
<p begin="00:01:13.581" end="00:01:17.041" style="s2">The pancake shaped speckled<br />suprapatellar tendon is seen in</p>
<p begin="00:01:17.041" end="00:01:21.394" style="s2">cross-section anterior to<br />the suprapatellar bursa.</p>
<p begin="00:01:21.394" end="00:01:23.652" style="s2">The transducer should be<br />swept from the patella</p>
<p begin="00:01:23.652" end="00:01:26.636" style="s2">to the musculotendinous<br />insertion of the tendon</p>
<p begin="00:01:26.636" end="00:01:28.969" style="s2">to complete the examination.</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="00:00:07.468" 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="00:00:07.317" end="00:00:08.978" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:08.978" end="00:00:12.109" style="s2">with a musculoskeletal exam<br />type is used to perform</p>
<p begin="00:00:12.109" end="00:00:15.195" style="s2">an ultrasound-guided injection<br />of the medial collateral</p>
<p begin="00:00:15.195" end="00:00:16.888" style="s2">ligament of the knee.</p>
<p begin="00:00:16.888" end="00:00:18.877" style="s2">The patient is in a supine position</p>
<p begin="00:00:18.877" end="00:00:21.545" style="s2">with the knee flexed 90 degrees.</p>
<p begin="00:00:21.545" end="00:00:25.073" style="s2">The transducer is placed<br />longitudinally over the inner knee</p>
<p begin="00:00:25.073" end="00:00:27.571" style="s2">at the joint space with<br />the orientation marker</p>
<p begin="00:00:27.571" end="00:00:29.959" style="s2">directed to the patient's head.</p>
<p begin="00:00:29.959" end="00:00:32.263" style="s2">The medial collateral ligament can be seen</p>
<p begin="00:00:32.263" end="00:00:35.025" style="s2">as a fibular patterned compact structure</p>
<p begin="00:00:35.025" end="00:00:38.035" style="s2">superficial to the bright<br />hyperechoic distal femur</p>
<p begin="00:00:38.035" end="00:00:40.155" style="s2">and proximal tibia.</p>
<p begin="00:00:40.155" end="00:00:43.123" style="s2">The medial meniscus is a<br />triangular shaped structure</p>
<p begin="00:00:43.123" end="00:00:45.288" style="s2">between the two bones.</p>
<p begin="00:00:45.288" end="00:00:47.754" style="s2">The medial collateral<br />ligament should be traced from</p>
<p begin="00:00:47.754" end="00:00:50.910" style="s2">insertion on the femoral<br />condyle down to the darker</p>
<p begin="00:00:50.910" end="00:00:54.390" style="s2">hypoechoic pes anserine tendon complex.</p>
<p begin="00:00:54.390" end="00:00:56.865" style="s2">The transducer is adjusted<br />so it is centered over</p>
<p begin="00:00:56.865" end="00:00:59.099" style="s2">the medial collateral ligament.</p>
<p begin="00:00:59.099" end="00:01:01.765" style="s2">The needle is inserted<br />in the skin just proximal</p>
<p begin="00:01:01.765" end="00:01:03.498" style="s2">to the transducer.</p>
<p begin="00:01:03.498" end="00:01:06.162" style="s2">The needle is slowly<br />advanced to lie in plane</p>
<p begin="00:01:06.162" end="00:01:08.783" style="s2">to the transducer beam<br />and is seen as a bright</p>
<p begin="00:01:08.783" end="00:01:11.277" style="s2">hyperechoic linear structure.</p>
<p begin="00:01:11.277" end="00:01:13.992" style="s2">The needle is slowly advanced<br />under direct ultrasound</p>
<p begin="00:01:13.992" end="00:01:16.988" style="s2">visualization until the<br />tip is seen in proximity</p>
<p begin="00:01:16.988" end="00:01:19.844" style="s2">to the ligament where an<br />injection can be done.</p>
<p begin="00:01:19.844" end="00:01:22.136" style="s2">After the procedure is finished, the area</p>
<p begin="00:01:22.136" end="00:01:24.615" style="s2">should be scanned to ensure<br />that there is no evidence</p>
<p begin="00:01:24.615" end="00:01:26.615" style="s2">of bleeding in the area.</p>