Why is it important to learn landmarks that can be used to locate MSK structures on ultrasound?
Some #musculoskeletal anatomical structures may be challenging to recognize, such as #nerves. Others may be difficult to isolate from the surrounding structures, such as #muscles. It is important to #learn relevant #landmarks to assist you with structure recognition and proper #transducer placement.
I’ll show you an example of two structures that may be difficult to locate in the posterior #hip and how you can use landmarks to improve your #scanning ability.
The first is the #piriformis muscle, which you may need to locate to perform ultrasound-guided #steroid injections for piriformis syndrome. If you are familiar with performing #MSK ultrasound of the hip, you can use the ischial Tuberosity (where the hamstrings insert) and the greater trochanter (where the gluteal #tendons insert) as your landmarks. If you place your transducer in a transverse plane over the posterolateral lower buttocks, the piriformis can be visualized as a #muscle with horizontal fibers running between the #ischial_tuberosity and #greater_trochanter. It is the most superficial of the external rotator muscles, lying deep to the subcutaneous fat and #gluteus_maximus muscle, which overlies the entire #buttocks.
Once you get comfortable locating the piriformis muscle, you can use it as your landmark for locating the #sciatic_nerve as it emerges from the piriformis muscle in the posterior hip and becomes visible on #ultrasound. This is also a common site to perform perineural steroid #injections of the sciatic #nerve because it cannot be visualized at the level of the #spine on ultrasound. You should also begin a diagnostic evaluation of the sciatic nerve at this level and follow it in the short and long axis from proximal to distal in the posterior thigh when a #peripheral_nerve ultrasound is requested.
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