Download Scan Plan- Ultrasound Workshop Posterior Leg

Scan Plan: Ultrasound Workshop Posterior Leg
Prone Position
At the Foot
1. Sural Nerve
a. Lesser Saphenous Vein
b. Note the Fascia and how shallow it is
2. Posterior Tibial Nerve and
a. Posterior Tibial Artery
b. Medial Malleolus
c. Follow this nerve up the leg and note how high you can block it
Popliteal Region: Surface Anatomy: Note these Anatomical Landmarks
1. Path of the Common Peroneal Nerve
a. Biceps Femoris Muscle Long Head
b. Fibular Head where the Common Peroneal Nerve
2. Note these muscles
a. Vastus Lateralis Muscle
b. Semi-tendinosis Muscle and Tendon
c. Semi-membranosis Muscle
d. Tendon of the Gracilis Muscle
e. Sartorius Muscle
With the Ultrasound
Popliteal Nerve
Tibial Nerve
Common Peroneal Nerve
See-Saw Maneuver
Popliteal Artery and Vein
Biceps Femoris Long Head and Short Head
The next goal is to trace the sciatic nerve cephalad to the subgluteal region
1. Palpate the boney landmarks in the gluteal region
a. Greater Trochanter
b. Ischial Tuberosity
c. Note the midpoint between these two bony landmarks as the location of
the sciatic nerve
2. Imagine a dotted Line from the Popliteal Region to the SubGluteal Region
showing the path of the Sciatic Nerve
3. Trace this using the Ultrasound taking into account the need to pivot the
ultrasound probe when going over the bony structures of the pelvis to obtain the
best view
Gluteal Region: Surface Anatomy: Note these Anatomical Landmarks
1. Sacral Hiatus: View the sacral Hiatus with the Ultrasound
2. Greater Trochanter
a. Palpate this by starting from above to mark it for the Labat Line
b. Palpate the inside of the femur at the level at the level of the Ischial
Tuberosity
3. Ischial Tuberosity
a. What three muscles insert here
b. Note the midpoint between the two bony landmarks of the Ischial
Tuberosity and the inside of the femur at this level as the location of the
sciatic nerve
4. Gluteus Maximus: recall that this muscle is diagonal
5. Biceps Femoris: this is the only muscle that crosses the Sciatic Nerve
6. IlioTibial Tract
7. Vastus Lateralis
8. Old Fashioned way of determining the location of the Sciatic Nerve
a. Labat Line: PSIS to the Greater Trochanter
b. Winnie Modification: a line drawn from the greater trochanter to the
Sacral Hiatus
c. The origin of the Piriformis Muscle from the pelvic surface of S2, S3 and
S4 is, in a way, outlined by these two lines
d. Try Internal and External Rotation of the leg with the knee bent to see
sliding of the piriformis muscle over the sciatic nerve and under the
gluteus magnus
With the Ultrasound
1. Note the Ischial Spine, the widest part
a. Inferior Gluteal Vessels
b. Pudendal Vessels and Nerve
2. Try to view the Sciatic Nerve
a. In the position of the Gemellus Muscles and Internal Obturator Tendon
where Sciatic Nerve appears to be in a saddle
b. In the area of the Quadratus Femoris where the Sciatic Nerve appears to
be triangular in shape
c. In the area of the Biceps Femoris This is the only muscle that really
crosses the Sciatic Nerve
Examine the lower back
1. Petit Triangle
a. Erector Spinae Muscles
b. Quadratus lumborum
c. Oblique muscles
i. External
ii. Internal
iii. Transversus Abdominus
d. Latissimus Dorsi
2. Lumbar Spine
a. Spinous Process
b. Lamina
c. Transverse Processes
d. Psoas Block