Soft Tissue and MSK

Case from Ultrasound of the Week: UOTW #58

42 year old female with no past medical history presents with increasing foot pain over the past 5 days. She reports that she has had decreasing sensation in the plantar surfaces of both her feet over the past few months, but did not think anything of it. She also endorses subjective fevers and nausea. 


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What to Know
  1. List the indications, contraindications, and limitations of soft tissue and musculoskeletal CUS.
  2. Identify clinically relevant sonographic anatomy including skin, soft-tissue, bones, muscle, tendon and lymph nodes.
  3. Recognize pathologic findings and pitfalls when evaluating of the following for cellulitis, abscess, foreign body, fracture, tendon injury, joint dislocation and effusion.

Introduction to Bedside Ultrasound
Free iBook download Vol 1 and Vol 2
Chapter 14: Hip
Chapter 15: Shoulder
Chapter 25: Soft Tissue
Chapter 26: MSK Basics

US Podcasts
Hip US Aspiration and Injection
Ultrasound of Radius Fracture! 4/5/2013
Scanning the Scaphoid 10/2/2011
Mike Stone's Intra-Articular Shoulder Injection 

ACEP US Section Resources

ACEP Sonoguide Soft Tissue Page by Brian Euerle
ACEP Sonoguide MSK Page by John Gullett and Christopher Raio

SAEM Academy of EUS Resources

Musculoskeletal Ultrasound: Muscle and Tendons by Matthew Fields
Hip Sonography by James Moak 

Key Articles
  1. ACEP Emergency Ultrasound Guidelines 2016
  2. Tayal VS, Hasan N, Norton HJ, Tomaszewski CA. The effect of soft-tissue ultrasound on the management of cellulitis in the emergency department. Acad Emerg Med. 2006;13(4):384–388.
  3. Srikar, A BM. Sonography First for Subcutaneous Abscess and Cellulitis Evaluation. J Ultrasound Med. 2012:1509–1512.
  4. Gaspari RJ, Blehar D, Polan D, Montoya A, Alsulaibikh A, Liteplo A. The Massachusetts abscess rule: a clinical decision rule using ultrasound to identify methicillin-resistant Staphylococcus aureus in skin abscesses. Acad Emerg Med. 2014;21(5):558-67.
  5. Stone MB, Wang R, Price DD. Ultrasound-guided supraclavicular brachial plexus nerve block vs procedural sedation for the treatment of upper extremity emergencies. Am J Emerg Med. 2008;26(6):706–710.
  6. Vieira RL, Levy JA. Bedside Ultrasonography to Identify Hip Effusions in Pediatric Patients. Ann Emerg Med. 2009.