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Persistent/ Recurrent trigger finger after a release of the A1 pulley. Triggering occur between the noose formed by the two slips of the FDS and the FDP at the Camper’s chiasm at the distal edge of the A2 pulley. Always check for other possible points of conflict. #mskrad

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Gonzalo Serrano-Belmar.

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22,983 просмотров • 3 лет назад •via X (Twitter)

Здоровье и велнесОбразованиеНаука и технологии#mskrad
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Комментарии: 5

Фото профиля The Dapper Doctor
The Dapper Doctor3 лет назад

Me as an Abdominal Radiologist, pretending to understand any of this

Фото профиля Gonzalo Serrano-Belmar.
Gonzalo Serrano-Belmar.3 лет назад

That's what drawings are for! I thought they were abdominal radiologist proof 🤣 🤣.

Фото профиля Juliusz Sroczyński
Juliusz Sroczyński3 лет назад

Nice case and beatiful graphics. I observed that Sometimes thickened FDS is stuck between A1 and A2 causing lack Of flexion and extension as well

Фото профиля MSK Ultrasound for POCUS Practitioners
MSK Ultrasound for POCUS Practitioners3 лет назад

@Dr_Ramon_Balius I’m lost on this one…can you give me an idiot’s guide on what I’m supposed to be seeing?

Фото профиля Lindsay Evans
Lindsay Evans3 лет назад

@lulutonrad

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Trigger finger: ultrasound diagnosis and treatment Patient with stiffness in the first finger of the right hand, especially in the morning, which is accompanied by a sensation of clicking or crunching when moving the finger, associated with sensitivity and a lump in the palm at the level of the metacarpophalangeal joint. An ultrasound study shows a diffuse increase in the thickness of the flexor tendon, observing the tendon snapping at the level of pulley A1 in a dynamic study when the tendon slides. Initially, infiltration of 1 cc of trigon and 1 cc of 2% mepivacaine into the tendon sheath is performed under ultrasound control to subsequently proceed to fenestration of the pulley until the tendon is released. Sometimes, it can be associated with physiotherapy to unload the muscles in the forearm, performing proximal peritendinous infiltration of the first finger's flexor muscle to prevent the pathology's recurrence.
0:25

Trigger finger: ultrasound diagnosis and treatment Patient with stiffness in the first finger of the right hand, especially in the morning, which is accompanied by a sensation of clicking or crunching when moving the finger, associated with sensitivity and a lump in the palm at the level of the metacarpophalangeal joint. An ultrasound study shows a diffuse increase in the thickness of the flexor tendon, observing the tendon snapping at the level of pulley A1 in a dynamic study when the tendon slides. Initially, infiltration of 1 cc of trigon and 1 cc of 2% mepivacaine into the tendon sheath is performed under ultrasound control to subsequently proceed to fenestration of the pulley until the tendon is released. Sometimes, it can be associated with physiotherapy to unload the muscles in the forearm, performing proximal peritendinous infiltration of the first finger's flexor muscle to prevent the pathology's recurrence.

sergio serrano belmar

11,965 просмотров • 1 год назад

Complete rupture of the flexor digitorum superficialis (FDS) tendon 📍 Distal insertion at the middle phalanx, with retraction to the base of the proximal phalanx. 🧗‍♂️ 20-year-old climber with sudden, sharp pain during climbing. 🔍 Key point of this case: dynamic clinical–ultrasound correlation ▶️ First part of the video (most important): The distal phalanx is actively flexed while blocking the DIP joint. This maneuver isolates the flexor digitorum profundus (FDP), so on ultrasound we should see only FDP excursion — which is exactly what happens. The distal phalanx is flexed without blocking the DIP joint, allowing flexion of the PIP joint. In this situation, both FDP and FDS should normally show excursion. ❌ However, the FDS remains completely still, confirming complete tendon–bone dissociation. ▶️ Second part of the video: 🩻 Final confirmation: • Empty tendon sheath at the expected distal insertion • Retracted FDS tendon stump proximally 🎯 Take-home message: Dynamic ultrasound, combined with proper clinical maneuvers, is crucial to demonstrate functional dissociation and accurately diagnose complete FDS rupture, especially in climbers. #mskrad
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Complete rupture of the flexor digitorum superficialis (FDS) tendon 📍 Distal insertion at the middle phalanx, with retraction to the base of the proximal phalanx. 🧗‍♂️ 20-year-old climber with sudden, sharp pain during climbing. 🔍 Key point of this case: dynamic clinical–ultrasound correlation ▶️ First part of the video (most important): The distal phalanx is actively flexed while blocking the DIP joint. This maneuver isolates the flexor digitorum profundus (FDP), so on ultrasound we should see only FDP excursion — which is exactly what happens. The distal phalanx is flexed without blocking the DIP joint, allowing flexion of the PIP joint. In this situation, both FDP and FDS should normally show excursion. ❌ However, the FDS remains completely still, confirming complete tendon–bone dissociation. ▶️ Second part of the video: 🩻 Final confirmation: • Empty tendon sheath at the expected distal insertion • Retracted FDS tendon stump proximally 🎯 Take-home message: Dynamic ultrasound, combined with proper clinical maneuvers, is crucial to demonstrate functional dissociation and accurately diagnose complete FDS rupture, especially in climbers. #mskrad

Gonzalo Serrano-Belmar.

12,513 просмотров • 6 месяцев назад

The soft tissue components of the biceps pulley system include: •Subscapularis •Supraspinatus •The coracohumeral ligament (CHL) •The superior glenohumeral ligament (SGHL) The subscapularis has superficial and deep fibers that envelope the groove, creating the “roof” and “floor”. They also coalesce with those from the supraspinatus and SGHL/CHL complex. They attach at the lesser tuberosity to create the proximal and medial aspects of the pulley system, with soft tissue extensions serving to further envelope the LHBT in the bicipital groove. #mskrad
0:25

The soft tissue components of the biceps pulley system include: •Subscapularis •Supraspinatus •The coracohumeral ligament (CHL) •The superior glenohumeral ligament (SGHL) The subscapularis has superficial and deep fibers that envelope the groove, creating the “roof” and “floor”. They also coalesce with those from the supraspinatus and SGHL/CHL complex. They attach at the lesser tuberosity to create the proximal and medial aspects of the pulley system, with soft tissue extensions serving to further envelope the LHBT in the bicipital groove. #mskrad

Gonzalo Serrano-Belmar.

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Morton's neuroma occurs at the terminal bifurcation of the common plantar digital nerve. The deep transverse metatarsal ligament connects the metatarsals. Below the ligament, we find the nerve, and above the ligament, the bursa. And distal to the anterior free edge of the ligament, the neuroma. It is at this level that the nerve makes a pronounced dorsal turn at the distal free edge of the ligament. We can see this demonstrated in the video/illustration. This explains one of the theories; entrapment between the plantar soft tissues and the ligament. The dorsal approach for me is the best 👍 . We avoid the thick plantar skin. Compressing with the finger on the plantar side and sliding it also lets us differentiate the distinct components, where the ligament remains immobile. We can also mobilize the nerve and see how it imprints against the anterior free edge of the ligament, understanding the pathomechanism. Finally, the Mulder maneuver always helps. #mskrad
1:00

Morton's neuroma occurs at the terminal bifurcation of the common plantar digital nerve. The deep transverse metatarsal ligament connects the metatarsals. Below the ligament, we find the nerve, and above the ligament, the bursa. And distal to the anterior free edge of the ligament, the neuroma. It is at this level that the nerve makes a pronounced dorsal turn at the distal free edge of the ligament. We can see this demonstrated in the video/illustration. This explains one of the theories; entrapment between the plantar soft tissues and the ligament. The dorsal approach for me is the best 👍 . We avoid the thick plantar skin. Compressing with the finger on the plantar side and sliding it also lets us differentiate the distinct components, where the ligament remains immobile. We can also mobilize the nerve and see how it imprints against the anterior free edge of the ligament, understanding the pathomechanism. Finally, the Mulder maneuver always helps. #mskrad

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Degloving injury Separation between the inner and outer components of the RF muscle is demonstrated by the mobilization of the minimal amount of fluid at the interface by muscle hand-squeezing Substantial difference in prognosis between a partial and a degloving injury #mskrad
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Median Nerve post carpal tunnel release. Still symptomatic. A small band of transverse carpal ligament remains at the proximal tunnel (most incomplete releases occur at the distal end)
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