foundation for skilled assessment of the musculoskeletal system, it is essen- As you learn about the examination of the musculoskeletal system, think. Musculo-Skeletal System. (Trunk, Limbs, and Head). General Statements: Bilaterally, paraxial mesoderm become somites and somitomeres. (Somitomeres . Musculoskeletal System. Professor Alan Hedge. DEA / Functions of the Musculoskeletal System. → Support and protect the body and its organs.

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Musculoskeletal System Pdf

PDF | This chapter presents a discussion on diseases of the musculoskeletal system of nonhuman primates. Clinical features and epidemiology. Explain abbreviations for terms related to the musculoskeletal system. 6. Successfully complete all chapter exercises. 7. Explain terms used in medical records. The musculoskeletal is the interac%on of muscles and tendons and ligaments and bones and joints and associated %ssues that move the body and maintain its.

Abstract The extent of ageing in the musculoskeletal system during the life course affects the quality and length of life. Loss of bone, degraded articular cartilage, and degenerate, narrowed intervertebral discs are primary features of an ageing skeleton, and together they contribute to pain and loss of mobility. This review covers the cellular constituents that make up some key components of the musculoskeletal system and summarizes discussion from the Aarhus Regenerative Orthopaedic Symposium AROS Regeneration in the Ageing Population about how each particular cell type alters within the ageing skeletal microenvironment. In the ageing skeleton, bone volume and mass declines in both sexes and in people of all ethnic backgrounds, often manifesting as osteoporosis and an increased risk of fracture. Loss of cartilage thickness in synovial joints with age contributes to osteoarthritis while decreasing structural integrity within the intervertebral discs IVDs leads to loss of disc height, and collapse and compression within the spine. In these individual tissue compartments, there is a delicate cellular balance where the differentiation and activity of specific cell types are matched to the local requirements. Whereas some skeletal elements rely on individual cell types acting remotely and in isolation e. Bone Bone strength and volume is preserved as we age by the constant, balanced remodeling of the skeleton—a balance that is not maintained in the ageing bone microenvironment. Stem cells and ageing bone Bone-forming osteoblasts derive from mesenchymal stem cells MSCs. Consequently, alterations in the number and activity of MSCs have the potential to affect a range of musculoskeletal tissues by altering progenitor cell numbers, not least osteoblasts. Sirtuins The influence of ageing and longevity-related mechanisms on such crucial regulators of transcription within skeletal cells may also contribute strongly to the age-related change we see in normal cell biology. Importantly, SirT1 declines with ageing in a variety of tissues including musculoskeletal sites and may be a common mediator of both ageing and the onset of age-related disorders. Loss of SirT1 with increasing age may therefore enhance inflammatory responses, osteoclast formation, and adipocyte formation, common physiological features of ageing and crucial systems in the maintenance of musculoskeletal health. As SirT1 levels decline with age, sclerostin is released from inhibition to suppress bone formation. FoxO is implicated in ageing, where C.

Insertional irregularity of the bone is often thought to be a result of partial tear of the supraspinatus insertion. Uncommonly, complete tears or avulsions of the supraspinatus tendon are identified Fig. Infraspinatus tendon injuries will have a similar appearance to the insertion of the supraspinatus as an irregular osseous surface Fig.

Normal infraspinatus muscle with central tendon fibers arrowheads. Normal infraspinatus tendon arrows with the caudodistal teres minor insertion TM. Arrowhead, teres minor tendon. Contracture of the supraspinatus or infraspinatus muscles can occur and will often appear as hyperechoic musculature or narrowing of the respective tendon.

Ultrasound of the Musculoskeletal System

If the contracture is unilateral, comparative views of the respective muscles are useful in identifying early signs of this disorder. Complete tear of the SST. Thickened joint capsule is seen arrows with a partial tear of the SST and displacement of the biceps tendon BT arrowhead. Biceps tendon injuries can either be primary or secondary.

Occasionally, the biceps tendon sheath will be thickened with hyperechoic tissue or hyperechoic fluid surrounding it, which is more common in biceps tenosynovitis. The biceps tendon can have mottled hypoechoic foci within the tendon as a result of this inflammation and degradation of the biceps tendon over a period of time Fig.

Dystrophic mineralization within the biceps tendon can also be seen. Biceps tendon tears can be identified with ultrasound and are generally classified as interstitial, partial, or complete tears.

The interstitial tears will appear as focal hypoechoic areas with focal enlargement and deviation of the fibers. There is no disruption of the fibers with this type of tear.

A partial tear of the tendon would appear similar to this with visualization of fiber disruption. Partial tendon tears can occur anywhere within the tendon, but are commonly seen at the origin see Fig. A complete biceps tendon tear would be identified as a lack of visualization of the tendon in the biceps groove and can commonly be seen retracted in the distal aspect of the tendon sheath see Fig. Heterogenous infraspinatus with fiber loss arrows. Tenosynovitis with thickening of the tendon sheath arrows.

Biceps tendon arrowheads A ; partial tear of the biceps tendon arrows B ; complete tear of the biceps tendon with retraction distal within the sheath arrows C ; thickening of the joint capsule with undulation of the capsule during range of motion due to an adhesion arrowheads D. Adhesions of the biceps tendon to the tendon sheath or joint capsule can be identified as hyperechoic thickened areas, most commonly at the proximal margin of the tendon sheath and origin of the biceps tendon see Fig.

Dynamic ultrasound of the biceps tendon can be performed to evaluate for adhesions. With an adhesion, a hyperechoic tag may be identified between the joint capsule or tendon sheath and the biceps tendon surface or may appear as bunching of either the joint capsule or the biceps tendon as the forelimb is put through a range of motion. The shoulder joint is occasionally evaluated for osteochondral defects.

The humeral head is a convex hyperechoic curvilinear line with a thin hypoechoic layer representing cartilage Fig. These osteochondral defects are most common within the caudal humeral head and will appear as irregular surfaces to the hyperechoic osseous margin see Fig. Osteochondral flaps or joint mice can be identified within the joint space and appear as hyperechoic, usually flat-appearing structures within the caudal joint pouch or within the tendon sheath.

Care should be taken to differentiate a freefloating or adherent flap from dystrophic mineralization, gas, or osseous fragments, such as avulsions of the tendon.

Occasionally, an osteochondral flap can be identified with fluid dissecting between the cartilage flap and bone surface and will appear as a double or multiple hyperechoic linear surface see Fig. The structures of the stifle joint that can be identified include the patellar ligament and tendon, cranial joint space, including the infrapatellar fat pad, synovium and cranial cruciate ligament, and both the medial and the lateral menisci.

The patellar ligament can appear as a thickened, hypoechoic area within the ligament 9 10 Cook Fig. Normal humeral head A. Osteochondrosis with a defect in the caudal humeral head arrows B. Osteochondritis dissecans with a double hyperechoic line representing the cartilage flap arrows C. The hypertrophy and desmitis are similar in appearance ultrasonographically and can be differentiated by pain, which is associated with the desmitis. The hypertrophy of the patellar ligament will regress in 4 to 8 weeks, following a procedure that changes the biomechanical stresses of the patellar ligament examples include tibial plateau leveling osteotomy or tibial tuberosity advancement.

The menisci can be identified with ultrasound as hyperechoic, triangular structures along the medial and lateral aspects of the joint Fig. To evaluate the cranial aspect of the meniscus, the transducer is placed cranial to the medial collateral ligament and angled slightly caudally to evaluate the cranial portion of the meniscal structure. To fully evaluate the caudal portion of the meniscus, the transducer is moved caudal to the collateral ligament and angled cranially to evaluate the caudal portion.

The medial and caudal aspects of the meniscus are the most common locations of meniscal tears. Four abnormal characteristics have been identified with ultrasound to diagnose meniscal abnormalities.

These abnormal characteristics include 1 fluid accumulation surrounding the meniscus; 2 change in the meniscal echogenicity, mottled or hypoechoic; 3 change in the meniscal shape see Fig. Displacement is only identified when a displaced bucket handle tear of the meniscus is the cause.

Normal meniscus. The normal, triangular appearance of the medial meniscus with the surface at the level of the femoral and tibial cortex A. Abnormal shape of the meniscus arrows with flattening of the tibial side of the triangular meniscus arrowhead B. Bucket handle meniscal tear. Abaxial displacement of the meniscus arrows from the alignment of the femoral F and tibial cortical surface C. Often, the fibular head interferes with the visualization of the central and caudal portion of the lateral meniscus.

The cranial cruciate ligament is difficult to evaluate with ultrasound because the ligament is off axis to the surface of the joint, resulting in anisotropy and nonvisualization of the ligament margins and fibers. The distal insertion of the cruciate ligament can occasionally be identified as a hypoechoic structure with a hyperechoic surface, which is the connective tissue or periligamentous structure.

Occasionally, a cruciate tear can be identified when the tear is at the distal aspect of the ligament and the ligament fibers are retracted. These tears will be identified as irregular soft tissue structures in the region of the cruciate attachment site as well as synovial thickening in chronic disease Fig.


Thickening of the synovium arrowheads within the cranial stifle joint secondary to a chronic cranial cruciate ligament rupture. F, femur. During the ultrasound, careful evaluation of the region for concurrent superficial digital extensor tendon injuries is important. The superficial digital tendon proximally is deep to the other tendons and becomes the superficial tendon approximately at the distal diaphyseal level of the tibia.

The superficial digital flexor tendon travels distal to the calcaneus with insertion sites at the lateral and medial surface of the tuber calcaneus and continues distally to the phalanges. These injuries may include lacerations or avulsion injuries. Degenerative injuries to the tendon can also be seen with diabetes or steroid administration, resulting in a variety of tears and dystrophic mineralization Fig.

A retinacular tear can be diagnosed on ultrasound because the superficial digital flexor tendon will commonly luxate from the groove as the normal transducer pressure is placed on the tendon.

As with the shoulder joint, ultrasound of tarsal osteochondral lesions can be identified, depending on the location of the lesion. Advanced imaging is typically not necessary, because osteochondral lesions are easily diagnosed with orthogonal radiographs and a skyline tarsal view. The irregular margins of the talus with hyperechoic synovial thickening and hypoechoic effusion are commonly identified in these cases. Gastrocnemius tear in the long axis. The tendon is an enlarged, hypoechoic tendon with loss of normal fiber pattern A.

Gastrocnemius tendon tear in transverse axis. Focal hypoechoic defects within the enlarged, mottled tendon B. Superficial digital flexor tendon arrows with effusion. The iliopsoas muscle is a fusion of the psoas major and iliacus muscles. The iliacus muscle arises from the ventral surface of the ilium. The 2 combined muscles insert on the lesser trochanter of the femur Fig.

The injuries to the iliopsoas are commonly seen at the musculotendinous junction and distal to the Fig. Normal iliopsoas tendon arrowheads. Arrow indicates insertion of the tendon A.

Thickened iliopsoas tendon with hypoechoic interdigitations arrows within the tendon representing partial tears proximal to the lesser trochanter arrowhead B. The coxofemoral joint effusion arrowhead is identified with thickening of the joint capsule arrows and mild femoral head remodeling C. Iliopsoas injuries are diagnosed with ultrasound as a thickened, hypoechoic tendon, usually between the musculotendinous junction and lesser trochanteric insertion. Avulsions of the iliopsoas can also be identified with a mineralized fragment of the lesser trochanter and retraction of the tendon from its fragment bed.

The coxofemoral joint should concurrently be evaluated with the iliopsoas during the ultrasound procedure. Commonly increased volume of fluid within the coxofemoral joint is identified on ultrasound with or without thickening of the joint capsule and irregularities of the osseous margins.

Ultrasound of the coxofemoral joint can be useful in the evaluation of hip laxity, osteoarthrosis, hip dysplasia, and avascular necrosis of the femoral head see Fig. Common abnormalities of the elbow include triceps tendon, biceps brachii insertional tendinopathy, and medial coronoid disease. The medial coronoid disease can be identified as an irregular osseous surface of the medial coronoid, proliferation of the medial coronoid process, or a distinct fragment and fragment bed of the medial coronoid process.

Secondary changes of the elbow can also be identified as an irregular osseous surface of the medial epicondyle as well as thickening of the soft tissue structures adjacent to the medial joint, collateral ligament, and anconeal process. Fluid accumulation within the tendon sheaths can be visualized as well as retinacular tears. Ultrasound of other joints can also be performed with general guidelines for abnormalities, including thickening of the joint capsule; irregular, thickened, hyperechoic synovium; and increased joint fluid volume.

Comparison to the contralateral limb is often performed in the joints that are not commonly imaged with ultrasound. Although the shoulder is the most common joint and tendon evaluated, almost any other joint or tendon can be imaged. The same characteristics of canine ultrasound would also apply to feline musculoskeletal ultrasound, although the structures would be smaller. Musculoskeletal ultrasound can be limited by the depth of the structure, overlying osseous structures, and experience of the ultrasonographer.

The basics of ultrasound are the same, and just like anatomy is important in other areas of ultrasonography, it is critically important in musculoskeletal system. Also, knowledge of the common, and sometimes uncommon, musculoskeletal disorders is vital. Tendon echogenicity: ex vivo study. Radiology ;— On the ultrasound properties of tendon.

Ultrasound Med Biol ;— Musculoskeletal sonography technique: focused versus comprehensive evaluation. Sonography of the musculoskeletal system in dogs and cats. Vet Radiol Ultrasound ;— Musculoskeletal system. Atlas of small animal ultrasonography. Ames MO : Blackwell Publishing; Small animal diagnostic ultrasound.

Radiol Med ;94 5 —5.

Performing a regional examination of the musculoskeletal system (‘REMS’)

Ultrasound of soft-tissue masses: pitfalls in interpretation. Australas Radiol ;44 3 —4. Hermanson JW.

The muscular system. Philadelphia: W. Saunders Co; Ultrasonographic evaluation of the canine shoulder. Vet Radiol Ultrasound ;40 4 —9. Canapp SO, Kirby K. Disorders of the canine forelimb: veterinary diagnosis and treatment.

Canine sports medicine and rehabilitation. Ames IA : Wiley-Blackwell; Ultrasonography for the diagnosis of diseases of the tendon and tendon sheath of the biceps brachii muscle.

Vet Surg ;30 1 — Sonographic findings in canine common calcaneal tendon injury. Vet Comp Orthop Traumatol ;— Biceps tenosynovitis in the dog: radiographic and sonographic findings.

Performing a regional examination of the musculoskeletal system (‘REMS’)

Vet Comp Orthop Traumatol ;—7. Vet Radiol Ultrasound ;56 1 :3— The heel strike induced shock waves were recorded every 5 min on the tibial tuberosity and sacrum. The data obtained were analyzed in both temporal and frequency domains. The results reveal significant increase in the dynamic loading experienced by the human musculoskeletal system with fatigue.

The analysis of the recorded signals suggests that fatigue contributes to the reduction of the human musculoske- letal system's capacity to attenuate and dissipate those shock waves. This capacity appears to be a function not only of the fatigue level, but also of the vertical location along the skeleton. Relevance Fatigue during running may affect the ability of the human musculoskeletal system to attenuate and dissipate the heel strike induced shock waves.

The study of the fatigue effect on shock wave attenuation provides information that may benefit the runner. All rights reserved. Introduction and several possible means of protection have been suggested []. It is still not clear, however.

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