1. Musculoskeletal (MSK)

2. Outline Technology Overview Imaging Detailed Anatomy – Median Nerve – Metacarpophalangeal Joint – Digital Pulleys – Radial Artery – Temporomandibular Joint – Upper Trapezius – Achilles Calcaneal Insertion – Tarsal Tunnel http://anatomy-diagram.net/wp-content/uploads/2015/11/human-anatomy- muscle-skeleton-human-skeletal-system-free-picture.jpg

3. Technology Overview Transducers

4. Technology Overview System Features

5. Median Nerve The median nerve is derived from the brachial plexus and is one of 3 major nerves that supply that hand Clinical Relevance: Passing under the carpal tunnel (flexor retinaculum) the median nerve can be compressed = carpal tunnel syndrome Anatomy http://emedicine.medscape.com/article/1369028-overview E epineurium; F fascicle; P perineurium; V vessel. https://studentconsult.inkling.com/read/wheaters-functional-histology-atlas-young-5th/chapter- 7/figure-7-13 Anatomy of a Peripheral Nerve

6. Median Nerve Imaging 6-15 MHz 50 MHz Vevo MD Ultra High Frequency Conventional Ultrasound

7. Metacarpophalangeal (MCP) Joint The MCP joints are found in the hand between each metacarpal and proximal phalanx MCP joints allow a range of movement in the finger Clinical Relevance: The MCP joint typically becomes arthritic with Rheumatoid Arthritis Anatomy

8. Metacarpophalangeal Joint imaging Vevo MD Ultra High Frequency Conventional Ultrasound Imaging

9. Digital Pulleys The annular ligaments of the finger (A pulleys) are located on the palmar aspects of the fingers The A1pulley originates from the MCP joint The A1 pulleys can disrupt the action of the flexor tendons causing pain and limiting movement = trigger finger Anatomy http://www.reumatologiaclinica.org/en/clinical- anatomy-hand/articulo/S1699258X12002422/ http://www.iowahand.com/trigger.html

10. Digital Pulleys Imaging Conventional Ultrasound Vevo MD Ultra High Frequency

11. Radial Artery The radial artery is a branch off the brachial artery in the forearm In the hand it contributes to the superficial and deep palmar arches Clinical Relevance: The radial pulse is detected as the radial artery passes over the distal radius. Anatomy Byrne, R. A. et al. (2012) Vascular access and closure in coronary angiography and percutaneous intervention Nat. Rev. Cardiol. doi:10.1038/nrcardio.2012.160 http://teachmeanatomy.info/upper-limb/vessels/arteries/

12. Radial Artery Imaging Conventional Ultrasound Vevo MD Ultra High Frequency

13. Radial Artery Imaging (within the anatomical snuffbox) Drake: Gray’s Anatomy for Students; 2 nd Edition

14. Temporomandibular Joint The temporomandibular joint (TMJ) is a bilateral articulation between the mandible and temporal bones, which form the jaw An articular disc separates the joint into 2 compartments This disc can become displaced which can lead to limited jaw movement and pain Anatomy http://www.mdguidelines.com/temporomandibular-joint-syndrome

15. Temporomandibular Joint Imaging Conventional Ultrasound Vevo MD Ultra High Frequency

16. Upper Trapezius Muscle The trapezius is a bilateral, wide, flat muscle in the upper back Functions: move, rotate and stabilize scapula; extend head and neck Exist as three sets of fibers on each side (lower, middle, upper) – Imbalances in these fibers can affect posture Anatomy

17. Upper Trapezius Muscle Fibers Imaging Conventional Ultrasound Vevo MD Ultra High Frequency

18. Achilles Calcaneal Insertion The Achilles is a tendon in the posterior ankle that attaches the leg muscles to the calcaneus (heel) It is the thickest tendon in the body and functions include plantar flexion of the foot and knee flexion The Achilles can be torn, ruptured, or become inflamed Anatomy http://www.aafp.org/afp/2002/0501/p1805.html

19. Achilles Tendon Imaging Conventional Ultrasound Vevo MD Ultra High Frequency Achilles-Calcaneal Insertion

20. Tarsal Tunnel Small area on the ankle, posterior to medial malleolus Covered by the flexor retinaculum Contains: posterior tibial artery and vein, tibial nerve, several tendons Nerve entrapment can occur (tarsal tunnel syndrome) causes pain and weakness in foot muscles Anatomy Tarsal Tunnel

21. Imaging Conventional Ultrasound Vevo MD Ultra High Frequency Flexor Retinaculum Tibial Nerve Tibial Artery and Vein

22. Overview High-frequency ultrasound allows visualization of small anatomy not visible with conventional ultrasound (down to 30µm) Cutting edge technology can lead to new medical discoveries Touch-screen, customizable interface leads to improved workflow and reduced examination times Highly advanced transducers designed for the smallest patients Same size as grain of rice!