Ultrasound examination of the joints. Examination of the knee joints as a diagnostic method Thematic improvement of the ultrasound of the joints

Ultrasound of the knee joint is a type of ultrasound examination that allows you to visualize the knee joint. This study helps to make a differential diagnosis between diseases such as rheumatoid arthritis, traumatic injuries and degenerative pathology.

Often, the pathological process can be detected on ultrasound at an early stage, due to which the treatment in many cases is successful. This study is safe, it can be performed even by a child.

Where to do the study - this study is carried out by all ultrasound doctors and even orthopedic traumatologists in the ultrasound diagnostic rooms.

How to prepare for the procedure

No preliminary preparation for the procedure (hunger, drinking water, etc.) is required. But you should not perform a study within four to five days after intra-articular injections.

Research methodology

Scanning of the anterior and lateral sections of the knee joint is carried out with the patient lying on his back, with knees extended. For better visualization of the intra-articular cartilage (menisci), the patient is asked to bend the legs at the knee joints.

To examine the posterior sections of the joint, the patient is turned over on his stomach. After the examination, the patient receives a study protocol with a conclusion.

Sonography is carried out in several projections, here are some of them:

1. Front longitudinal projection

The sensor is placed above the patella parallel to the axis of the thigh. In this position, the hyperechoic patella is examined with the femur, which is also visualized as a linear hyperechoic structure.

Between them, a suprapatellar bag is visible in the form of a triangle, located under the tendon of the quadriceps femoris. When the sensor is displaced below the patella, the patellar ligament, tibia, infrapatellar bursa, and fat body are visualized.

2. Anterior transverse view

The sensor is placed above the upper edge of the patella. At the same time, the femur and hyaline cartilage are visualized (a hypoechoic uniform band), the suprapatellar bursa is visible in diameter. The synovial membrane in a healthy person is not visualized. When the transducer is moved down, the anterior tibial condyles are visible.

3. Rear transverse view

Examination takes place lying on the stomach. Thus, the posterior condyles of the femur, hyaline cartilage and up to the popliteal fossa are visualized.

4. Posterior lateral view

The condyles of the femur and tibia, the intercondylar joint space, and the posterior horn of the lateral meniscus are examined.

5. Posterior longitudinal medial view

The medial part of the popliteal fossa with the condyles of the femur and tibia, the joint space, cartilage, the posterior horn of the medial meniscus, and the semimembranosus tendon are examined.

What is the doctor's visit in normal and pathological conditions?

Norm

Normally, with ultrasound of the knee joints, all structures are examined. In this case, the articular surfaces should be smooth, clear, without deformations, there should be no effusion in the joint cavity, the synovial membrane is not visible, and the articular bags and torsion will look like hypoechoic formations of a folded structure with multiple branches. Hyaline cartilage should be homogeneous in structure.

Pathology

Often patients are interested in what ultrasound of the joints of the legs shows. After all, this is not the stomach, to which we are already accustomed to scanning. So, this type of research helps to determine the disease with 99.9% accuracy. These are torn ligaments, and arthritis, and complex intra-articular fractures, and other pathologies.

All pathological changes in the knee joint can be divided into groups:

1. Traumatic damage to the tendon-ligament apparatus of the joint (rupture of the patellar ligament or tendon of the quadriceps femoris, microtraumatization of the external lateral ligament, etc.).

Injuries to the ligamentous apparatus occur during a fall, inadequate load on the joint and awkward sudden movements. In this case, complete ruptures look like a complete violation of the integrity of the tendon, with the appearance of hypoechoic areas between the ends of the damaged ligament. Hematomas may be seen.

With a partial rupture, the contours of the tendon are preserved, but a hypoechoic area is clearly visible at the site of injury. When the patella is fractured, a hypoechoic gap is visualized between the bone fragments. With polytrauma, an examination of the ankle joint is indicated.

Features of the study, price

The main feature of the study is its accuracy and reliability, but the doctor performing the study must have a good knowledge of the anatomy of the knee joint. Often, with associated injuries, ultrasound of the ankle joint is also performed.

Scanning can be done in a city clinic equipped with special equipment, and in any specialized diagnostic center. For a child, this study can be done in a children's orthopedic dispensary. The cost of the procedure varies from 600 to 2000 rubles.

Training in ultrasound of the joints in Moscow is a demanded service, since the specifics of the work require knowledge of the nuances. Qualified specialists with many years of practice teach. The documents issued give the right to take a highly paid position.

What is the peculiarity of an ultrasound specialist of the joints?

The position of the doctor of ultrasound diagnostics of the first category is a highly paid position. To take this bet, you must have the appropriate qualifications. The title of a specialist in Ultrasound of the joints training for which our center offers.

Ultrasound of the joints can accurately determine the type of disease. The method is safe and informative. Proper decoding depends on the quality of the session. The training program of the center provides not only basic knowledge, but also a complete list of modern knowledge on working with equipment.

A specialist in the direction of ultrasound of the joints has the skills and knowledge to give an accurate diagnosis from the picture. New generation equipment allows you to see a clear picture of the state of the skeletal system.

Advantages of distance learning

Distance learning allows you not to break away from the main activity. You just need to register and get a schedule of classes. To attend lectures, an Internet access point and a media device (PC, tablet, laptop) are sufficient.

Benefits of distance learning:

flexible schedule - training at a convenient time for the applicant;
favorable cost - the cost of only paying for the course;
relevant materials - the program is supplemented and improved with each course;
competent teaching - honored specialists work with students;
certified center - we work under a license from the Ministry of Health of the Russian Federation, we have the right to issue documents on advanced training;
no need to take time off from work.

With our services, you get up-to-date knowledge, supplement your theoretical base. After the end of the course, a document is issued on the GOSZNAK form with entry in a single register.

Favorable prices, affordable schedule

With our services, you will pass the retraining in time. The authorities will receive a specialist corresponding to the requirements of state standards. Realizing the importance of your time and working conditions, we have created a flexible course that allows you to allocate time for a convenient schedule. Having received a certificate of a new type of specialist, you can increase positions and rates.

In case of damage to large or small movable joints, complex diagnostics are required. Ultrasound of the joints of the lower extremities or upper extremities is the most popular examination method. This technique is so called because the manipulation uses ultrasonic waves that act on the damaged area. The doctor's monitor shows how badly the structures of the musculoskeletal system and nearby tissues are damaged. Ultrasound diagnostic technique is popular due to the fact that it is convenient to carry out, does not cause discomfort and pain to the patient, and does not provoke adverse reactions.

When is an instrumental study required?

Ultrasound of bones and joints is performed in almost any joint disease, since it allows the doctor to fully assess how advanced the clinical picture is. Ultrasound examination is required for such pathological conditions:

tendon rupture or damage to the integrity of ligaments and muscles localized near the joints;
bursitis;
a complex of dystrophic abnormalities in articular cartilage;
cystic formation in the synovial bag;
degenerative processes in cartilage tissue;
meniscus injury;
bone fracture;
dislocations and subluxations;
systemic inflammatory response of connective and soft tissues;
arthritis or arthrosis;
hernia in the spine and protrusion;
lumbar injury;
osteoarthritis, coxarthrosis.

Ultrasound diagnostics is used for the manifestation of pain attacks in the area of movable joints, crunching during movement, limited motor function, and swelling.

The study will establish a change in the structure of soft tissues.

And also ultrasound of the joints is sometimes required to perform a surgical intervention, which allows better control over the process of manipulation. Most often, the procedure is carried out in the following areas:

temporomandibular joint;
shoulder movable joints;
carpal;
knee;
foot joints;
hip;
spinal column;
wrist joint.

Do I need to prepare for an ultrasound of the joint?

For ultrasound of the joints of the arms, legs or other parts of the body, the patient does not require special preparation. And also there is no need to specifically follow the diet before the ultrasound examination procedure. At the reception, wear loose and comfortable clothing that does not pinch the damaged movable joint. The patient needs to take a towel or a thick napkin with him, through which the remnants of the gel applied to the diseased area are removed. And also the patient should have a medical referral for an ultrasound of the jaw and other movable joints. In order for the doctor during the procedure to be able to assess the state in dynamics, it is recommended to take a medical card, which contains information about the course of the joint disease.

Features of the ultrasound diagnostic technique

The procedure is safe for babies.

Ultrasound of the hand, finger and other parts of the body can be performed on any day and time of the day. Manipulation is not carried out only after the introduction of injections into the damaged joint, in which case it is better to wait for a certain period. Ultrasound examination does not harm the body, therefore it is used in the diagnosis of diseases in children and adults. During the procedure, the patient is located on the couch, while exposing the area of the body being examined. Ultrasound of the joints is performed in the following sequence:

The patient takes a horizontal position, laying a towel or napkin under the examination area.
Using special sensors, the doctor views the injured movable joint from the front and side.
If possible, the site is examined from the back. For example, during ultrasound diagnostics of the knee, the patient lies on his stomach, and the doctor examines the area under the knee with a sensor.
The specialist evaluates the condition of the damaged area and the features of the course of the pathological process.
In parallel, the state of a healthy paired joint is compared.
A form is issued that shows the results of ultrasound diagnostics.

As the disease progresses, the study is carried out several times.

If the Doppler method of examination is used during ultrasound, then it is also possible to assess the condition of the choroid plexuses localized near the damaged joint. The orthopedist or traumatologist helps the patient to decipher the results obtained during ultrasound diagnostics. If necessary, a re-examination will be carried out. It is often necessary in the chronic course of an articular disease in order to be able to study the pathology in dynamics.

Full name	Academic degree	Academic title	Position
ZABOLOTSKAYA Natalia Vladlenovna	Doctor of Medical Sciences	assistant professor	Professor
LELYUK Svetlana Eduardovna	Doctor of Medical Sciences	Professor	Professor
RYBAKOVA Marina Konstantinovna	Doctor of Medical Sciences		Professor
BATAEVA Roza Saidovna	Candidate of Medical Sciences		Assistant professor
BRYUKHOVETSKY Yuri Anatolievich	Candidate of Medical Sciences	assistant professor	Assistant professor
NAUMOVICH Elena G.	Candidate of Medical Sciences		Assistant professor
FEDOROVA Evgeniya Viktorovna	Candidate of Medical Sciences	assistant professor	Assistant professor
SALTYKOVA Victoria Gennadievna	Doctor of Medical Sciences		Professor

The Department of Ultrasound Diagnostics of the Russian Medical Academy of Postgraduate Education of the Ministry of Health of the Russian Federation was founded on February 1, 1992 and was the first profile department in the post-Soviet space. The Department of Ultrasound Diagnostics was separated from the Department of Medical Radiology (Head of the Department - Professor Yu.N. Kasatkin).

And the department was born like that. In 1987, the Ministry of Health of the USSR approved the curriculum for the training of specialists in ultrasound diagnostics, developed at the Department of Medical Radiology. And then it begins cyclic training of doctors in ultrasound diagnostics with the involvement of the All-Russian Scientific Center of the USSR Academy of Medical Sciences (S.A. Balter), the 4th State Institution of the USSR Ministry of Health (A.V. Zubarev) and the Research Institute of Coloproctology of the Ministry of Health of the Russian Federation (L.P. Orlova). The coordinating function is assigned to TSOLIUv.

In 1989, N.V. Zabolotskaya, and in 1991 - A.N. Khitrov. In 1990, Yu.A. Bryukhovetsky, since 1991 he has been participating in training. In 1992 Yu.A. Bryukhovetsky becomes an assistant to the department.
At the time of creation (01.02.92) the department included 5 full-time teaching staff (the head of the department - 1, assistants - 4) and 1 - teaching and support staff (senior laboratory assistant). By this time, both cycles of professional retraining and thematic improvement were carried out at the department. In 1992 M.V. Medvedev, A.I. Sokolov, M.N. Skvortsova and E.V. Fedorova, in 1993 - E.G. Naumovich. In different years, M.A. also worked at the department. Osipov (1994-2000), M.D. Musaeva (Mitkova) (1996–1999), G.G. Rudko (1996–1998), B.I. Zykin (1996–1998), O.V. Proskuryakova (1997–1999), I.A. Ozerskaya (2003-2009).

In 1992-1996 104 training cycles were conducted. 2913 students were trained. In 1997-2001 124 training cycles were conducted. 3459 students were trained. In 2002-2006 97 training cycles were conducted. 4071 listeners were trained. In 2007-2011 98 training cycles were conducted. 4109 students were trained. In 2012-2013 39 training cycles were conducted. 2308 students were trained.
In total, from 1992 to 2013, the department conducted 462 training cycles and trained 16860 (14552 until 2012) students.

For the period 2009-2013. The employees of the Department of Ultrasound Diagnostics published 48 articles and 37 abstracts of reports in leading specialized refereed journals, presented 105 reports at Russian and international symposiums, conferences and congresses.

The department defended 11 dissertations for the degree of doctor and 40 - candidate of medical sciences. 6 more works are being carried out for the degree of doctor and candidate of medical sciences.

All employees of the department are editors or members of the editorial board of the journal "Ultrasonic and Functional Diagnostics", and also participate in the work of other specialized journals.

Zabolotskaya N.V. and Rybakova M.K. are members of the Executive Committee of the Russian Association of Specialists in Ultrasound Diagnostics in Medicine. Mitkov V.V. is the President of the Association, and Saltykova V.G. - executive secretary.

The department has developed and approved by the Ministry of Health of the Russian Federation: a unified and standard training program for doctors of ultrasound diagnostics; 14 manuals for doctors; qualification tests in ultrasound diagnostics (2, 3 and 4 generations); training program in clinical residency in ultrasound diagnostics.

In 1996-1998 the five-volume "Clinical Guide to Ultrasound Diagnostics" (1-5 volumes) (Vidar) was completed, in the creation of which not only the staff of the department, but also many leading specialists from Russia and the CIS countries participated. Later, the first three volumes also appeared on CDs. In 2003, the “Practical Guide to Ultrasound Diagnostics” appeared. General ultrasound diagnostics” (under the editorship of V.V. Mitkov) (M., Vidar, 2003). These books were the main teaching aids for several generations of ultrasound doctors and are still in demand today.

In 1997-2009 Department staff publishes a number of monographs:

"Differential ultrasound diagnostics in obstetrics" (M.V. Medvedev, E.V. Yudina), M., Vidar, 1997
"Ultrasound mammography" (N.V. Zabolotskaya, V.S. Zabolotsky), M., Storm, 1997
"Differential ultrasound diagnostics in gynecology" (M.V. Medvedev, B.I. Zykin, V.L. Khokholin, N.Yu. Struchkova), M., Vidar, 1997
"Ultrasonic angiology" (V.G. Lelyuk, S.E. Lelyuk), Moscow, Realnoe Vremya, 1999
"Dopplerography" ed. V.V. Mitkova (M.I. Ageeva, Yu.A. Bryukhovetsky, N.V. Zabolotskaya, V.V. Mitkov, M.D. Mitkova, Yu.N. Chereshneva), M., Vidar, 1999
"Dopplerography in the diagnosis of diseases of the liver, gallbladder and pancreas" (V.V. Mitkov), M., Vidar, 2000
"Doppler study in obstetric practice" (M.I. Ageeva), M., Vidar, 2001
"Terminological Dictionary" (V.V. Mitkov, Yu.A. Bryukhovetsky, N.V. Zabolotskaya, E.A. Zubareva, M.K. Rybakova), M., Medica, 2003
"Ultrasound angiology" (V.G. Lelyuk, S.E. Lelyuk), M., Realnoe Vremya, 2003
“Ultrasound research methods in neonatology (under the editorship of L.I. Ilyenko, E.A. Zubareva, V.V. Mitkov) M., Expressprint, 2003
"Neurosonography in young children" Minsk, Paradox, 2004
"Cerebral circulation and blood pressure" M., Realnoe Vremya, 2004
"New technologies of ultrasound mammology" (N.V. Zabolotskaya, V.S. Zabolotsky), M., STROM, 2005
"Echography in gynecology" (I.A. Ozerskaya), M., Medica, 2005
"The reproductive system of a girl, teenager, girl" (I.A. Ozerskaya, N.V. Zabolotskaya, M., Vidar, 2007
“A practical guide to ultrasound diagnostics. Echocardiography "(M.K. Rybakova, M.N. Alekhin, V.V. Mitkov), M., Vidar, 2008
"Chronic pelvic pain in women of reproductive age" (I.A. Ozerskaya, M.I. Ageeva), M., Vidar, 2009
"New technologies of ultrasound mammography". (practical guide), N.V. Zabolotskaya, V.S. Zabolotsky, Ed. "Strom" Moscow 2010.
Echocardiography in tables and diagrams. Desktop reference book.» M.K. Rybakova, V.V. Mitkov. Ed. 1st. M.: Vidar, 2010.
Echocardiography in tables and diagrams. Desktop reference book.» Rybakova M.K., Mitkov V.V. Ed. 2nd. M.: Vidar, 2011.

In addition, the staff of the department took part in writing a large number of scientific monographs:

"Ultrasound diagnosis of diseases of the veins of the lower extremities" (A.R. Zubarev, V.Yu. Bogachev, V.V. Mitkov), M., Vidar, 1999
"Ultrasound diagnosis of diseases of the external genital organs in men" (A.R. Zubarev, M.D. Mitkova, M.V. Koryakin, V.V. Mitkov), M., Vidar, 1999
"Dopplerography of perinatal brain lesions" (E.A. Zubareva, I.V. Dvoryakovsky, A.R. Zubarev, A.B. Sugak), M., Vidar, 1999
"Dopplerography in gynecology" ed. B.I. Zykina, M.I. Medvedev (S.E. Lelyuk), M., Realnoe Vremya, 2000
"Guide to Diagnostic Imaging" ed. Sh.Sh. Shotemora (M.K. Rybakova), M., Soviet sport, 2001
"Cerebrovascular reserve in atherosclerotic lesions of the brachiocephalic arteries" (S.E. Lelyuk), Kyiv, Ukrmed, 2001
"Children's ultrasound diagnostics", ed. M.I. Pykova, K.V. Vatolina, (N.V. Zabolotskaya), M., Vidar, 2001
"Doppler ultrasound and duplex scanning" (Lelyuk S.E.) Neurology. National leadership. Chapter 11. "GEOTAR-Media" Moscow 2008.

In 2000, the publishing house "Medicina" published a "Guide to Ultrasound Diagnostics" edited by P.E.S. Palmer (translated by A.N. Khitrova, scientific edition by V.V. Mitkov).

In the publishing house "Vidar":

“Echocardiography” by H. Feigenbaum (translated by M.K. Rybakova, Yu.A. Bryukhovetsky, N.V. Korneev, M.Yu. , O.R. Derevyanko, I.A. Aseeva, scientific editor - V.V. Mitkova)
Echography in obstetrics and gynecology. Theory and practice” transl. from English. Edited by E.V. Fedorova and A.D. Lipman) M., Vidar, 2004
"Ultrasound examination of blood vessels", V.J. Zvibel, D.S. Pelerito (translated under the scientific editorship of V.V. Mitkov, Yu.M. Nikitin, L.V. Osipova), M., Vidar, 2008
"Mammography" (translated from English under the general editorship of N.V. Zabolotskaya), M., MEDpress-inform, 2009.

In addition, two training videos have been released:

"Rare and interesting cases from echocardiographic practice"
“Normal anatomy of the heart. Standard echocardiographic positions and measurements” - M.K. Rybakova, V.V. Mitkov.

Department of "Ultrasound Diagnostics and Surgery" FPC MR RUDN University on the basis of City Clinical Hospital No. 24 and No. 64 of Moscow invites you to professional retraining by specialty "Ultrasound diagnostics"

Learning features:

a) Preliminary development of methods ultrasonic research on modern simulation devices:
- using convex probe for transabdominal research;
- using miniconvex probe for transvaginal examination;

b) Practical development of generally accepted and special, developed at the department, ultrasound techniques liver, gallbladder, bile ducts, pancreas, spleen, kidneys, adrenal glands, gastrointestinal tract, thyroid and mammary glands, pelvic organs in men and women, general examination of the abdominal cavity and retroperitoneal space;

in) Individual approach to teaching methods ultrasonic research;

G) Usage in the learning process archive of video materials of the department with opportunities self viewing;

d) Step by step control theoretical and practical knowledge in the learning process;

e) Acquaintance listeners from methods of minimally invasive interventions under ultrasound control;

Assistant Malushenko R.N. holds practical lesson with listeners on methodologies ultrasonic liver studies, gallbladder and pancreas.

Professor Ivanov V.A., shows the audience ultrasound technique extrahepatic bile ducts and major duodenal papilla.

Associate Professor Denisov A.E. accepts offset on method of ultrasound examination of the liver.

- Working off practical skills on methodologies ultrasonic kidney research and adrenal glands.

Testing listeners according to the methodology ultrasonic studies of the liver, gallbladder, extrahepatic bile ducts and pancreas.

- Discussion of a clinical case. Determining the role of ultrasound in the complex diagnostics . Peculiarities writing protocol and formation conclusions ultrasonic research.

Lectures on Ultrasound Diagnostics diseases of the liver, gallbladder, bile ducts, pancreas, spleen, kidneys, adrenal glands, gastrointestinal tract, thyroid and mammary glands, pelvic organs in men and women, with the involvement of leading professors in this region, with demonstration of own videos ;

Practical lesson: development of methods of ultrasound examination of the gallbladder and bile ducts.

- Participation in research and independent work on diagnostic ultrasound devices;

- Seminars with ultrasound diagnosis of diseases of the pancreas. Using the technique color doppler imaging.

- Seminars with viewing video material from the archive of the department by ultrasonic diagnosis of liver disease, gallbladder, extrahepatic bile ducts.

- Simulation session with individual development of transabdominal techniques ultrasonic liver and kidney studies.

- Simulation apparatus for individual development of transvaginal techniques ultrasonic research and control received image with the standard embedded in the device Images.

- Conducting simulation classes with training in methodology transvaginal ultrasonic research.

- Individual practice practical skills transvaginal ultrasound in simulation classes.

- Education listeners modern terminology in ultrasound diagnostics.

- Education listeners writing protocols ultrasound using modern terminology in ultrasound diagnostics and skill development formation of conclusions as a result of the