1991 :super specialties perceptions
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1 Ved Chaturvedi, MD, DM Research & Referral Hospital New Delhi President Indian Rheumatology Association MSK Ultrasound..A decade experience of bedside MSK US by a clinician. Was it worth it.?
2 1991 :super specialties perceptions Cardiology..ECHO Angioplasty Gastro Endoscopy Neurology MRI Endocrinology..Hormone
3 Clinical Immunology & Rheumatology Nothing Antibodies..Pathologist Peeping in the joint.??
4 Perception of peeping in joint Respect in society Immediate diagnosis Direct patient-doctor relationship
5 MSK Ultrasound..
6 2003 Many OA patients with discomfort on back of knee?bakers cyst
7 2003 MSK Ultrsound Joint probe
8 2003
9 Scanning Technique
10 C/o: Pain in the poplitial region
11 USS Knee joint - Baker s cyst in OA
12 Baker cyst
13 Baker cyst
14 Baker cyst
15 Ruptured baker s cyst
16 Baker cyst with synovial hypertrophy
17 Baker s cyst in RA Synovial effusion & proliferation Synovial proliferation
18 Baker's cyst
19 Bakers cyst.more common in OA.. Thick walled 32 Thin walled 68 Small (<2.5 ) 62 Big (> 2-5 ) 38 RA 22 OA 52 Spa 10 Idiopathic 16 Bakers cyst.more common in OA.. Ved Chaturvedi API CON 2004
20 MSK US : Learning Phase
21 History MSK ultrasound ECHO Joint probe acquired 2004.Conducted First National workshop 2004 : EULAR course 2009 :IRACON Jaipur 2011 : Faculty SGPGI workshop 2011 : Faculty CMC Vellore workshop 2013 : Guest Lecture JIPMER 2013 : Faculty APLAR Indonesia
22 Was it worth it? Can See entire course of tendon in longitudinal plane despite an oblique course Guidance of aspiration, biopsy & injection therapy Assessment of synovial thickening/ detection of fluid collections Undifferentiated arthropathy
23 Why US superior Satisfaction Long history taking in MSK disease
24 18 Yr old girl BL knee effusion RF positive Already on DMARDS, No response History retaken Fall fr cycle at onset
25
26 Knee is good to begin with
27 Suprapatellar Effusion
28 Synovial Hypertrophy in suprapatellar Fossa
29 Synovial Polyp
30 Two cardinal words Black White In between
31
32 Anecheoic Black Hyperecheoic White Hypoechoeic..In between..grey
33 Different tissue Muscle.Hyperechoic, Tendons.Hyperechoic Nerve More Hyperechoic. Gas. Hyperechoic Fluid..Anaechoic
34 Sonographic characteristics of normal tissues
35 HLA B27 Associated SpA
36 Heel pain
37
38
39 Case 45 yr old man Pain right heel x 2 mnths Tendonitis of the Achilles tendon Managed with local injection!!!
40 Normal Achilles tendon
41 Achilles tendinitis and retrocalcaneal bursitis
42 Rupture Achilles tendon
43 Erosion calcaneum
44 Erosion calcaneum
45 Steroid in Retro-calcaneum Bursa
46 Steroid crystals in RCB
47
48 Plantar fascitis
49 Normal Plantar fascia
50 Tenosynovitis of Tibialis posterior
51 Doppler image Tibialis posterior
52 Normal Hip Joint
53 Hip joint effusion
54 Hip joint Effusion
55 Foreign Body Synovitis
56 Case 25 Yr old lady Polyarthralgia x 2 mnths On exam : NAD
57
58
59
60
61 IMP: EARLY RHEUMATOID ARTHRITIS
62 Case 40 yr old man Chronic persistent poly-arthritis No inflammatory features
63 Polyarthritis with no inflammatory features & deformities
64 Snow storm appearance
65 Double contour sign
66 Case 32 Yr old lady Pain and swelling in small joints of hands & feet and pain right shoulder joint X 8 mnths On Exam:
67 USS of the wrist joint Synovial effusion with proliferation and bony erosive changes Power Doppler shows an increased flow.
68 Bone erosion Longitudinal transverse
69 Erosive RA
70
71 Joint procedures : MCP
72 Case 52 yr old man On T/t for RA with Infliximab Developed lump right axilla On exam: large non-tender axillary nodes
73
74 Lymphoma
75 Synovial Sarcoma
76 Synovial Chondromatosis Multiple cartilaginous bodies in the synovium
77 Artifacts : Anisotropy Focal areas of hypoechogenicity when the probe is not at 90 to the linear structure being imaged Solution: Scan in multiple planes
78 Drawbacks Anisotropy Shadowing from bony surfaces/ calcifications Detailed knowledge of anatomy is essential Operator dependent
79 Take Home Message Clinical Correlation like ECHO Cardiography Dynamic examination Ability to scan multiple joints Intervention Satisfaction
80 Comparison with clinical measures PDUS is superior to DAS28 in evaluating disease activity, and predicting joint destruction PDUS is better than the DAS28 for predicting a response to therapy GSUS and PDUS are both more reliable than the clinical scores Rheumatol. Int. 32, (2012) Arthritis Care Res. 63, (2011) Arthritis Rheum. 64, (2012).
81 Predictive markers Synovial vascularity detected by PDUS predicts higher risk of radiographic progression compared with treatmentresponsive joints (vascularity improvement of 70% at week 8; relative risk ) Other factors which predict erosions and poorer outcome: Synovitis (GSUS, OR 3.14; PDUS, OR 2.79) ECU tenosynovitis Distal ulna erosions Semin. Arthritis Rheum. 41, (2012
82 Clinician perspective.. Mostly useful for conditions which we see day to day Rotator cuff, some sports medicine & Orthopedic conditions may not be our cup of tea Not to get scared of detail anatomy, most of time not needed i Many future uses, but one would see what mind knows
83 Clinicians perspectives Time consuming Spoils clothes Lady attendant Jelly & cold whether can be troublesome Sometime one feels.was it worth it.yes.yes yes
84 Keep it up in-spite of obstacles..
85 Ved Chaturvedi, MD, DM Research & Referral Hospital New Delhi President Indian Rheumatology Association MSK Ultrasound..A decade experience of bed side MSK US by a clinician.was it worth it.?
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Moda Health Plan, Inc. Medical Necessity Criteria Subject: Actemra (tocilizumab) Page 1 of 15 Origination Date: 09/14 Revision Date(s): 10/2015, 02/2016 Developed By: Medical Criteria Committee 10/28/2015
Rheumatoid Arthritis
Rheumatoid Arthritis While rheumatoid arthritis (RA) has long been feared as one of the most disabling types of arthritis, the outlook has dramatically improved for many newly diagnosed patients. Certainly
Imaging Rheumatoid Arthritis
April 2002 Imaging Rheumatoid Arthritis Aimee Shu, Harvard Medical School, Year III Meet Ms. M 50-year old female 22-year history of seronegative rheumatoid arthritis (RA) Followed at BIDMC rheumatology
LESSON OVERVIEW. Objectives: By the end of the lesson, the Lay Health Worker will be able to:
Objectives: LESSON OVERVIEW By the end of the lesson, the Lay Health Worker will be able to: 1. Describe what arthritis is in general terms. 2. Identify common myths and beliefs about arthritis that may
At the completion of the rotation, the resident will have acquired the following competencies and will function effectively as:
Goals and Objectives Orthopedic Surgery Residency Program - Memorial University Plastic Surgery DEFINITION Traumatic or acquired problems of the musculoskeletal system frequently have a soft tissue component
Systemic condition affecting synovial tissue Hypertrohied synovium destroys. Synovectomy. Tenosynovectomy Tendon Surgery Arthroplasty Arthrodesis
Surgical Options for Rheumatoid Arthritis of the Wrist Raj Bhatia Consultant Hand & Orthopaedic Surgeon Bristol Royal Infirmary & Avon Orthopaedic Centre Rheumatoid Arthritis Systemic condition affecting
Understanding Rheumatoid Arthritis
Understanding Rheumatoid Arthritis Understanding Rheumatoid Arthritis What Is Rheumatoid Arthritis? 1,2 Rheumatoid arthritis (RA) is a chronic autoimmune disease. It causes joints to swell and can result
Trochanteric Bursitis Self Management for Patients
Trochanteric Bursitis Self Management for Patients Updated May 2010 What is the Trochanteric Bursa? The trochanteric bursa is a fluid-filled sac that functions as a gliding surface to reduce friction between