A combined approach using gross anatomy, physical diagnosis and point of care ultrasound.

 Understand the anatomy of the knee using ultrasound as a learning tool.  Understand utility of ultrasound to supplement the physical exam.  Understand the sonographic appearance of different tissue types and the identification of pathology of the knee.

1. Describe the normal anatomy of the knee. 2. Explain the rationale behind ultrasound transducer utilization in a musculoskeletal exam. 3. Describe the different appearances of tissue types on ultrasound imaging. 4. Demonstrate these standard ultrasound views of the knee: suprapatella long, infrapatella long (proximal and distal) and suprapatella flexed transverse. 5. Correlate the normal anatomy of the knee to its appearance on ultrasound imaging. 6. Recognize the most common pathologies visualized on ultrasound, including joint effusion, tendonitis, and tendon tear. 7. Recognize the ultrasound correlate of a joint effusion fluid wave on physical exam. 8. Demonstrate appropriate communication skills and show empathy towards patient.

Organization: 2 hr Anatomy Lab 30 min PE 30 min Ultrasound Materials: Cadaver US Equipment PE Tables Students will scan/examine each other Preparation: Videos – PD techniques SUSME Textbooks - anatomy Review PowerPoint/Lecture Faculty: US Faculty (MD/Tech) PD Faculty (MD) Anatomy Faculty (MD/PhD)

 Standardized Patient  Students are required to submit 3 views with labeling: quad. tendon, infrapatella tendon, bone (patella, femur, tibia)  Communication skills  Scan reasons and techniques clearly.  Exam performed with courtesy and consideration for patient comfort

 Standardized Patient  Physical Exam:  Flex / Extension  Varus, Valgus  Compare and contrast the medial and lateral ligaments to the joint capsule.  Anterior / Posterior Draw  Describe the positioning of the knee typical for injury to the ACL and explain why.  Ballottement  Ballottement tests for fluid in the suprapatella bursa, what other bursas exist around the knee joint and how would you examine them.

 Image Pathology:  Joint Effusion, Ruptured Ligamentum Patella  Anatomical:  Surface anatomy – landmarks indicated on surface of standardized patient.  Anatomical question to each PE maneuvers. (muscle, nerve)  Additional anatomical structures as necessary.