Please feel free to share and copy any images in my files for your presentation as long as you put my reference name in your reference list. The image above is a ganglion cyst of the flexor tendon sheath at MCP 4 level.

Another ganglion cyst at the flexor tendon sheath 5 distal to MCP 5 level

flex tendon sheath cyst distal to MCP 4; Ganglion cysts are noncancerous lumps that most commonly develop along the tendons or joints of your wrists or hands. They also may occur in the ankles and feet. Ganglion cysts are typically round or oval and are filled with a jellylike fluid. Small ganglion cysts can be pea-sized, while larger ones can be around an inch (2.5 centimeters) in diameter. Ganglion cysts can be painful if they press on a nearby nerve. Their location can sometimes interfere with joint movement. If your ganglion cyst is causing you problems, your doctor may suggest trying to drain the cyst with a needle. Removing the cyst surgically also is an option. But if you have no symptoms, no treatment is necessary. In many cases, the cysts go away on their own

Transverse section of the lower anterior thigh shows an old sports injury in the rectus femoris muscle; Rectus femoris is a muscle in the quadriceps, the rectus femoris muscle is attached to the hip and helps to extend or raise the knee. This muscle is also used to flex the thigh. The rectus femoris is the only muscle that can flex the hip. Injury to the rectus femoris muscle may result from overuse, as seen with kicking- or sprinting-related injuries. Inflammation of the muscle causes pain in the groin during physical exercises that use this muscle. The patient may experience pain during knee raises if the muscle is ruptured (torn) or inflamed. An operation may be necessary if the muscle is torn.

fluid collection/ lobulated ganglion cyst rising up from the dorsal side of the ulnar head. Wrist pain often proves to be a challenging presenting complaint.

Determining the cause of ulnar-sided wrist pain is difficult, largely because of the complexity of the anatomic and biomechanical properties of the ulnar wrist

Another lobulated ganglion cyst arising from the radial collateral ligament at MCP 5 level. Radial collateral ligament (RCL) injuries of the thumb are relatively common although they are less common than ulnar collateral ligament injuries, which make up 10% to 42% of collateral ligament injuries of the thumb.

The RCL is especially important for pinch movements and for movements of depression. Complete disruption of the RCL can result in both static and dynamic instability, which can lead to a predictable sequence of a painful deformity resulting in articular degeneration

Flexor tendon sheath fluid in the 5th digit, Trigger finger is a condition in which one of your fingers gets stuck in a bent position. Your finger may bend or straighten with a snap — like a trigger being pulled and released. Trigger finger is also known as; stenosing tenosynovitis It occurs when inflammation narrows the space within the sheath that surrounds the tendon in the affected finger. If trigger finger is severe, your finger may become locked in a bent position.

People whose work or hobbies require repetitive gripping actions are at higher risk of developing trigger finger. The condition is also more common in women and in anyone with diabetes. Treatment of trigger finger varies depending on the severity. Trigger finger can affect any finger, including the thumb. More than one finger may be affected at a time, and both hands might be involved. Triggering is usually more pronounced in the morning, while firmly grasping an object or when straightening your finger.

Tendons are fibrous cords that attach muscle to bone. Each tendon is surrounded by a protective sheath. Trigger finger occurs when the affected finger’s tendon sheath becomes irritated and inflamed. This interferes with the normal gliding motion of the tendon through the sheath. Prolonged irritation of the tendon sheath can produce scarring, thickening and the formation of bumps (nodules) in the tendon that impede the tendon’s motion even more.

Signs and symptoms of trigger finger may progress from mild to severe and include:

• Finger stiffness, particularly in the morning, A popping or clicking sensation as you move your finger, Tenderness or a bump (nodule) in the palm at the base of the affected finger, Finger catching or locking in a bent position, which suddenly pops straight, Finger locked in a bent position, which you are unable to straighten

The volar side of the foot a hyperechoic mass close to the superficial plantar artery causing pain when the patient walks or stand on his feet for a long time.

The foreign body under the skin piece of glass just close to the superficial plantar artery.

The first small superficial digital branches accompany the digital branches of the medial plantar nerve and join the plantar metatarsal arteries of the first three spaces.

• Angio power scan; Power Doppler is a technique that uses the amplitude of Doppler signal to detect moving matter. Power Doppler:is independent of velocity and direction of flow, so there is no possibility of signal aliasing, is independent of angle, allowing detection of smaller velocities than color Doppler, facilitating examinations in certain technically challenging clinical setting, has higher sensitivity than color Doppler, which makes a trade-off with flash artifacts.

The posterior labrum of the right shoulder with a para labrum cyst, the patient experiencing pain in the posterior shoulder ;Paralabral cysts of the shoulder are an infrequent finding on shoulder ultrasound, however, are an important diagnostic entity as they may cause a compression neuropathy of the supra-scapular or axillary nerves depending on where they occur, along with a variety of other symptoms. They may occur in around 2-4% of the population and presentation may be commoner in males (especially around the third to fourth decades). There is a high association with a glenoid labral tear.T hey most frequently occur along the posterior, anterior, and superior aspects of the glenohumeral joint in decreasing order, with inferiorly located cysts being the least common. The postero-superior location may be the most common

Suprapatellar bursitis is an inflammation of the bursa sac that protects the upper front portion of the knee joint. Commonly known as knee bursitis, this condition can significantly impact knee function, causing intense pain. Suprapatellar bursitis may necessitate the use of anti-inflammatory medication and physical therapy to alleviate symptoms. Located just over the kneecap, the suprapatellar bursa is one of the largest bursa sacs in the knee joint. Designed to cushion the joint and prevent friction, the suprapatellar bursa can easily become irritated and inflamed. In most cases, repetitive motion or a direct blow to the suprapatellar bursa will induce bursitis symptoms. Individuals who participate in sports, sustain direct trauma to the knee joint or develop an arthritic condition of the knee are considered at greatest risk for suprapatellar bursitis.

The infrapatellar bursa is located beneath the knee cap, and it has two parts. The superficial infrapatellar bursa is found on top of the patellar tendon, and the deep infrapatellar bursa is found below the patellar tendon. Even though there is an anatomic distinction between the two, clinically it is hard to tell the difference.

Horizontal right medial meniscus tear of the posterior horn. Remember that when the tear looks like vertical to you it is, in fact, a horizontal in position, as it is a C shape around the knee. the meniscus is a piece of cartilage in your knee that cushions and stabilizes the joint. It protects the bones from wear and tear. But all it takes is a good twist of the knee to tear the meniscus. In some cases, a piece of the shredded cartilage breaks loose and catches in the knee joint, causing it to lock up. Meniscus tears are common in contact sports like football as well as non-contact sports requiring jumping and cutting such as volleyball and soccer. They can happen when a person changes direction suddenly while running, and often occur at the same time as other knee injuries, like an anterior cruciate ligament (ACL) injury. Meniscus tears are a special risk for older athletes since the meniscus weakens with age. More than 40% of people 65 or older have them.

Free fluid in the tendon sheath of the extensor Hallucis of the foot. The extensor Hallucis Longus is the only muscle responsible for extending (pulling back) the big toe.

Transverse section of the EHL- extensor Hallusic tendon with a septated fluid collection.Origin – Middle 2/3 of the inner surface of the front of the fibula. Insertion – a Distal phalanx of the big toe. Actions – Extension of the big toe. Dorsiflexion, Inversion

Free fluid at the flexor tendon sheath of the 1st flexor tendon of the volar left foot, distal metatarsal 1 level

calcified mass over the big toe of the foot ,mtp 1 level at the media; side Gout is a painful arthritic condition that can affect any joint, but commonly involves the first MTP joint. Gout occurs when uric acid (urate) crystallizes in the synovial lining of the involved joint. Once in the joint, these crystals induce synovial macrophages to produce inflammatory cytokines such as Interleukin-1 (IL-1).  The urate crystals also induce neutrophils to migrate to the joint, increasing the inflammatory process.

Thank you for reading, for more ultrasound cases you can visit my blog at www.moleopedia.com and look in the ultrasound section.For those who want to learn MSK sonography you can contact me so i can send you the proposal for the hands-on MSK sonography.

Steve Ramsey- Calgary – Canada