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MUSCULOSKELETAL ULTRASOUND OF THE SPINE
MUSCULOSKELETAL
ULTRASOUND
ULTRASOUND
OF THE
SPINE
THOMAS B. CLARK
Spine Handbook
Table of Contents
Sacral
Sacral Hiatus
Sacral Hiatus (short axis)
Sacral Hiatus (long axis)
Caudal (short axis)
Caudal (long axis)
Sacral Foramen
S1 Foramen (short axis)
S2 Foramen (short axis)
S2/S3 (long axis)
S3 Foramen (short axis)
S4 Foramen (short axis)
Ganglion Inparse
Ganglion Inparse (long axis)
Sacroiliac Joint
Sacroiliac Joint (short axis)
Upper Sacroiliac Joint (short axis)
Upper S1 (short axis)
3
4
5
6
7
8
9
10
11
12
13
14
15
Spine Handbook
Table of Contents
Lumbar
Spinous Process (long axis)
Discs (long axis/lateral)
Nerve Roots (parasagittal/oblique)
L3 Facet (oblique)
L3 Medial Branch (short axis)
L3 Psoas Compartment (short axis)
L3/L4 Psoas Compartment (lateral oblique/short axis)
4th Lumbar (short axis)
4th Lumbar Facet (short axis/lateral oblique)
4th Lumbar Medial Branch (short axis/lateral oblique)
5th Lumber Medial Branch (short axis/oblique)
L4/L5 psoas compartment (short axis/lateral oblique)
5th Lumbar (short axis)
Lumbar (long axis)
Lumbar Transverse Process (short axis)
L5 (short axis)
Lumbar Medial Branch (short axis
Lumbosacral Facets (long axis)
Upper Lumbar Plexus (long axis)
Upper Lumbar Medial Branch (short axis)
Upper Lumbar Facet (short axis)
Quadratus Lumborum (long axis)
Mid Lumbar Medial Branch (short axis)
Mid Lumbar Epidural (long axis)
Lower Lumbar Facet (short axis)
Lower Lumbar Medial Branch (short axis)
Lumbar Facets (oblique)
Lumbar Laminae (oblique)
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
Spine Handbook
Table of Contents
Thoracic
Upper
Mid
Lower
Upper Thoracic (short axis)
Upper Thoracic Paravertebral Space
Upper Thoracic laminae/epidural (long axis)
Upper Thoracic epidural (short axis)
Upper Thoracic epidural (long axis)
Upper Thoracic spinous process (short axis)
Upper Thoracic facets (long axis)
Upper Thoracic transverse process (long axis)
Upper Thoracic ribs
49
50
51
52
53
54
55
56
57
Mid Thoracic
Mid Thoracic Costotransverse Joints
58
59
Lower Thoracic (short axis)
Lower Thoracic Costotransverse Joints (short axis)
Lower Thoracic Ribs (long axis)
60
61
62
Thoracic Epidural (mid lower)
Paravertebral (short axis)
Dorsoscapular Nerve
Suprascapular Nerve (long axis)
Suprascapular Nerve (short axis)
Kidney (long)
63
64
65
66
67
68
Spine Handbook
Table of Contents
Cervical
Upper
GON
Occipital C1 (short axis)
Cervical Facets (long axis)
Cervical (long axis)
Cervical (short axis)
Cervical Medial Branches (long axis)
3rd Occipital Nerve (long axis)
71
72
73
74
75
76
Greater Occipital Nerve (short axis)
Greater Occipital Nerve (long axis)
77
78
C6 Nerve Root (short axis)
C6 Nerve Root (long axis)
C6 Stellate (short axis/oblique)
C1/C2 Chord (short axis/oblique)
Cervical Facet Posterior (long axis)
Cervical Mid (short axis)
Cervical Plexus (short axis)
Cervical Plexus (long axis)
Cervical Greater Occipital Artery (long axis/parlateral)
C1/C2 (short axis)
C1 Occiput (short axis)
SubOccipital (long axis)
Mid Cervical (short axis)
Mid Cervical (long axis)
Mid Cervical (short axis/oblique)
Mid Cervical Facet (long axis)
Cervical Epidural (short axis)
Cervical Epidural (long axis)
Lower Cervical (short axis)
Lower Cervical (short axis/oblique)
Cervical Omohyoid (long axis)
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
Spine Handbook
Abbreviations/Definitions
ARP = Articular Process
BS = Brain Stem
CE = Cauda Equina
CP = Cervical Plexus
CTJ = Costotransverse Joint
DR = Dorsal Rami
ERS = Erector Spinae
ES = Epidural Space
F = Foramen
FJ = Facet Joint
GON = Greater Occipital Nerve
IAP = Inferior Articular Process
LALS = Long Axis Linear Slide
LM = Laminae
LPLEX = Lumbar Plexus
MB = Medial Branch
NR = Nerve Root
PLL = Posterior Longitudinal Ligament
PR = Posterior Rami
QL = Quadratus Lumborum
SALS = Short Axis Linear Slide
SAP = Superior Articular Process
SC = Spinal Cord
SI = Sacroiliac Joint
SP = Spinous Process
TON = Third Occipital Nerve
TP = Transverse Process
VB = Vertebral Body
VR = Ventral Rami
Sacral
Sacral Hiatus (short axis)
Patient Position:
Laying on Side slightly rolled on back
Doctor Position:
Standing behind patient
Probe Position:
Short Axis
Needle Approach:
Out of Plane approach
3
Lumbar
Mid Lumbar Medial Branch (short axis)
Probe Position:
Short Axis, paramedian with
moderate medial oblique tilt
Needle Approach:
In plane, lateral to medial
41
Thoracic
Lower Thoracic Ribs (long axis)
Probe Position:
Long Axis, saggital with
minimal
lateral
obliquity
62
Thoracic
Thoracic Epidural (Mid Lower)
Probe Position:
Long Axis, paramedian, parasagittal, with slight medial obliquity
Needle Approach:
Out of plane with slight
cephalad obliquity
63
Cervical
Cervical Plexus (short axis)
Probe Position:
Short Axis, with no cephalad or caudal tilt
Patient Position:
Lateral with neck neutral
85