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Basics of Diagnostic Ultrasound

 

Indications For Diagnostic Ultrasound

Identifying soft tissue issues including:

  •  Inflammation

  • Tears and ruptures

  • Lesions

  • Fluid collections

  • Soft tissue masses

Contraindications/Precautions

  • None 

Complications

  • None

Applying Diagnostic Ultrasound for Biofeedback

Transversus Abdominis

  • Patient position: supine, legs extended or in hook lying position, skin exposed from inferior lateral ribs to ASIS

  • Transducer: 11 Mhz  

  • Transducer placement: Transverse; Antero-lateral abdomen lateral to rectus abdominus and variably between ASIS and costochondral cartilage 

  • Assess contraction quality and quantity

  • Cue the patient to "Bring belly button to spine" to contract Transversus Abdominis

Pelvic Floor:

  • Patient position: supine, legs extended or in hook lying position

  • Transducer: 5 Mhz  

  • Transducer placement: transversely across the abdomen about 2 inches above the pubic bone, angled about 10 degrees from the abdomen and facing the perineal area.   

  • Assess contraction quality and quantity

  • Cue the patient to "pretend like they need to stop the flow of urine" to contract the pelvic floor muscles

Applying Diagnostic Ultrasound for Measurements

Multifidus Thickness Measurement:

  • Patient Position: prone, skin exposed T12-S2, pillow under abdomen to minimize lordosis.

  • Transducer: 5Mhz

  • Transducer placement:Sagittal;Lateral to the spinous process over the articular pillar, Angle slightly ventromedially to achieve optimum image

  • Assess at multiple levels and bilaterally

  • Take the measure from the tip of the zygopophyseal joint to the inside edge of the superior border of the multifidus muscle. 

  • Norms:

       Males: AP: 2.6 cm, Lateral: 2.8 cm

       Females: AP: 2.2cm, Lateral: 3.0 cm

Multifidus Cross-Sectional Area:

  • Patient Position: prone, skin exposed T12-S2, pillow under abdomen to minimize lordosis.

  • Transducer: 5Mhz

  • Transducer placement: Transverse plane

  • Identify the targeted spinous process

  • To view unilaterally: move just lateral to spinous process over the articular pillar revealing the spinous process, multifidus and erector spinae as well as the articular pillar/ facets inferiorly

  • Identify the borders:

    • Superiorly: Thoracolumbar fascia

    • Inferiorly:Vertebral lamina

    • Medially: Tip of the spinous process

    • Laterally: Fasica surrounding the multifdus and separating it from the longissimus muscle. 

  • Use caliper tool on the ultrasound to draw around multifidus around these borders. 

  • Norms:

       Level of L4: Males 8 cm2  Females: 6 cm2

       Level of L5:  Males: 9 cm2  Females: 7 cm2

  • Used to assess segmental dysfunciton

 

 

 

 

 

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