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Ultrasound Examination — Standard Ultrasound Cross Sectional Planes (DEGUM Recommendations)
Abstract
Ultrasound examination of the joints of the musculoskeletal system can supply important additional information for treating a number of clinical conditions and injuries. This can apply to both intraarticular structures, such as hyaline cartilage and periarticular soft tissue structures seen in calcific tendinitis, or rotator cuff defects. Especially in the case of degenerative and inflammatory changes of the joints, the availability of ultrasound cross-sectional images makes a valuable contribution. The presented standard cross-sectional planes are oriented according to leading osseous structures. For the physician with limited ultrasound experience, these structures enhance the initial learning curve. For experienced personnel, these standard cross-sectional planes facilitate quick and easy adjustment of the transducer, maximizing the sonographical overview of the investigated joint. Beyond this the documented images of standard cross-sectional planes are easily interpreted by other experienced personnel. This chapter describes the basic ultrasound techniques and standard ultrasound sectional planes of presented joints using DEGUM guidelines (Meeting of the work group Musculoskeletal System, January 20, 1996).
... After providing consent to participate in the study, participants completed a digital evaluation form (E1) at station 1; subsequently they watched a total of two teaching videos, each lasting approximately four minutes, describing the palpatory and sonographic marking of soft spots/access points for knee and shoulder arthroscopy -each video was watched twice (see ▶Fig. 2). Certified ultrasound experts and experienced shoulder and knee surgeons demonstrated the method in the videos according to the current literature [4,[17][18][19][20][21]. ...
... Participants had to locate the access points/portals according to the techniques demonstrated in the video. These were based on current recommendations [4,[17][18][19]21] and DEGUM guidelines [20] and were additionally derived from the technique of Konermann et al. [22] and Cicak et al. [21]. Participants marked the points determined by palpation (PDP) and points determined by sonography (PDS) on the film using a UV marker pen. ...
Purpose Arthroscopy is one of the most common interventions in orthopedics. Hence it is important to train users early in order to ensure the safest possible identification of access portals (AP). This prospective study aimed to compare a palpatory (PalpMethod) with a sonographic (SonoMethod) method for AP location in the shoulder and knee joints.
Materials and Methods The study included trainee doctors (n=68) attending workshops (lasting approx. 90 minutes). In these workshops a teaching video initially demonstrated the PalpMethod and SonoMethod of AP identification. An experienced operator first marked the access portals on the test subject with a UV pen (determined ideal point [DIP]). Adhesive film was then affixed to the puncture regions. Subsequently participants marked on shoulders and knees first the point determined by palpation, then the point determined by sonography. Analysis involved DIP visualization with a UV lamp and employed a coordinate system around the central DIP. In addition, participants completed an evaluation before and after the workshop.
Results The analysis included 324 measurements (n=163 shoulders and n= 161 knees). The majority of participants had not previously attended any courses on manual examination (87.9%) or musculoskeletal ultrasound (93.9%). Overall, the markings participants made on the shoulder using the SonoMethod were significantly closer to the DIP than those made by the PalpMethod (Palp 18.8mm ± 14.5mm vs. Sono 11.2mm ± 7.2mm; p<0.001). On the knee, however, the markings made by the PalpMethod were significantly closer to the DIP overall (Palp 8.0mm ± 3.2mm vs. Sono 12.8mm ± 5.2mm; p<0.001). Conclusion The results show that the SonoMethod produces more accurate markings on the shoulder, while the PalpMethod is superior for the knee.
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