使用床旁超声来增强体格检查技能的习得:膝关节和肩关节

Point of care ultrasound is easy to use, portable, and can be performed in various settings. It is safer and cheaper than imaging techniques like computer tomography. POCUS helps when exam findings are difficult to appreciate by palpation, percussion, or auscultation, and facilitates learning of cardiac, pulmonary, abdominal, musculoskeletal, and vascular exams.

Ultrasound allows easy visualization of knee anatomy, helping learners correlate physical exam findings with underlying structures. This visualization increases confidence and understanding by showing the anatomic basis for exam maneuvers. Learners can identify tendons, ligaments, menisci, and fluid collections that are difficult to appreciate through palpation alone.

Ultrasound detects quadriceps and patellar tendon injuries, medial and lateral collateral ligament injuries, meniscal tears, effusions, degenerative changes, and bursitis of the suprapatellar, prepatellar, infrapatellar, and pes anserine bursae. It also identifies bone fractures and other musculoskeletal abnormalities in the knee region.

Ultrasound is a dynamic imaging modality that highlights joint and muscle movement in real-time. For shoulder impingement syndrome, learners better understand the condition by observing anatomy and dynamic movements under ultrasound. This real-time visualization during specific maneuvers improves confidence and accuracy in performing the shoulder physical exam.

Ultrasound is useful in diagnosing rotator cuff disease, biceps brachii injury, and acromioclavicular joint disease. In acromioclavicular arthritis, bone spurs and fluid accumulation appear near the joint. The dynamic imaging capability allows visualization of tendon movement and structural abnormalities that correlate with physical exam findings.

For musculoskeletal examinations, select the linear probe and musculoskeletal preset on the ultrasound machine. The probe indicator is typically oriented proximally in the long axis, while short axis orientation depends on the examiner's preference. Optimize images using depth and gain functions to clearly visualize bones, tendons, ligaments, and muscles.

Bones appear hyperechoic and create shadow artifacts posteriorly. Tendons and ligaments also appear hyperechoic with a fibrillar appearance. In contrast, muscles appear relatively hypoechoic and striated. These distinct appearances help learners identify and differentiate anatomical structures during musculoskeletal ultrasound examination.