“Hello darkness” Toepassing van echografie in peespathologie A. Herman, Reumatoloog | Antonius ziekenhuis|

Indeling Wat is de echografie? -Principes -Opbouw Wat is de toepassing van echografie? -Diagnostiek -Behandeling

Principes Voortplanting van geluid in de verschillende substanties

Opbouw Transducer (zender/opvanger) Beeldverwerking, bewerking en opslaan

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Toepassing Diagnostiek Behandeling 5

Ruptuur

Ruptuur Biceps 7

Intratendinous rupture of the biceps tendon

Labrum ruptuur

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Artritis 11

Artritis 12

Artritis van de pols 13

Artritis en pannusvorming bij RA

Tendinopathie Biceps tendinopathie Tendinitis 15

Tendinitis, ruptuur (en calcificatie)

Epicondylitis 17

Calcificatie

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Tenosynovitis/ Tendinitis Extensor digitorum De 1 ste compartiment ECU 20

Bursitis

Cyste, Ganglion en Abces

Tumor 23

Knuckle pads

Vreemd lichaam Glass splinter anterior of the ulnar artery with the tip in the ulnar nerve distal to Gyons tunnel

Fractuur

Medial meniscal protrusion & rupture

To do or Not to do ! 28

To do or Not to do ! 29

Behandeling 30

The role of ultrasound guided peri-tendinous injection in the treatment of non-calcific tendinopathy Abstract Purpose: To evaluate the effectiveness of the percutaneous ultrasound guided peri-tendinous injection in improving or treating non- calcific tendinopathy The Egyptian Society of Radiology and Nuclear Medicine. Production and hosting by Elsevier B.V. All rights reserved. 31

Results: Significant reduction in patients pain and disability score. The clinical success rate was 87%, with a technical success rate of 100%. Conclusion: Ultrasound is a non invasive imaging technique that allows real time guidance for interventional therapy of non-calcific tendinopathy improving the result of peri-tendinous corticosteroid injection. 32

Sonographically Guided Tendon Sheath Injections Are More Accurate Than Blind Injections Implications for Trigger Finger Treatment American Institute of Ultrasound in Medicine | J Ultrasound Med 2011; 30:197–203 Objectives Trigger finger is frequently treated with tendon sheath injections. This cadaveric study evaluated the accuracy and safety of blind and sonographically guided tendon sheath injections. Methods A total of 40 fingers (excluding thumbs) of 5 fresh cadavers were used. Methylene blue dye was injected into the flexor tendon sheath using either a blind or sonographically guided injection technique (20 fingers for each technique). 33

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Conclusions We found that sonographically guided tendon sheath injections were more accurate and may be potentially safer than blind injections. These findings suggest that sonographically guided injections should be considered over blind injections when treating trigger finger. 35

Ultrasound-guided Injections for de Quervain’s Tenosynovitis Clin Orthop Relat Res (2012) 470:1925–1931 Abstract Background Nonsurgical management of de Quervain’s tenosynovitis often includes corticosteroid injections. If the injection does not enter the compartment, or all subcompartments, response to the injection is variable. Questions/Purposes We determined (1) the incidence of two or more subcompartments, (2) the incidence of anatomic variations during surgical release after failed injections, and (3) the relief of pain after ultrasound-guided injections. 36

Conclusion We found ultrasound-guided injections to be useful for treatment of de Quervain’s tenosynovitis. Our success with ultrasound-guided injections was slightly better than that reported in the literature and without adverse reactions. Level of Evidence Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. 37

CS injection of tenosynovitis in patients with chronic inflammatory arthritis: the role of US RHEUMATOLOGY Objective. The main aim of this study was to investigate the short-term efficacy of CS loco-regional treatment performed under US guidance in tenosynovitis of patients with chronic inflammatory arthritis. Conclusions The present study shows the efficacy of US-guided peritendinous CS injections in the management of patients with chronic inflammatory arthritis presenting as US-proven tenosynovitis. 38

A Randomized, Double-Blind, Controlled Study of Ultrasound- Guided Corticosteroid Injection Into the Joint of Patients With Inflammatory Arthritis ARTHRITIS & RHEUMATISM, Vol. 62, No. 7, July 2010, pp 1862–1869 Objective: Most corticosteroid injections into the joint are guided by the clinical examination (CE), but up to 70% are inaccurately placed, which may contribute to an inadequate response. The aim of this study was to investigate whether ultrasound (US) guidance improves the accuracy and clinical outcome of joint injections as compared with CE guidance in patients with inflammatory arthritis. 39

Conclusion US guidance significantly improves the accuracy of joint injection, allowing a trainee to rapidly achieve higher accuracy than more experienced rheumatologists. US guidance did not improve the short-term outcome of joint injection. 40

Echo geleide injectie 41

Echo geleide injectie 42

Barbotage 43

Vragen? 44

45 Met welke klinisch symptoom kan onderstaand beeld associëren? 1- Tennisarm 2- Popeye sign 3- Gottron sign 4- Artritis van MTP1

46 Met welke klinisch symptoom kan onderstaand beeld associëren? 1- Tennisarm 2- Popeye sign 3- Gottron sign 4- Artritis van MTP1

47 Wat wordt hier afgebeeld? 1- Tenosynovitis 2- Bursitis 3- Artritis pols 4- Cyste

48 Wat wordt hier afgebeeld? 1- Tenosynovitis 2- Bursitis 3- Artritis pols 4- Cyste

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