Department of Veterans Affairs, VA Connecticut Healthcare System, Newington Campus
Arben Brahaj, M.D.
Physical Medicine and Rehabilitation
John Waterman, M.D.
Rheumatology
Training is to take place in the Specialty Clinic, VA Connecticut Healthcare, Newington campus. First 30 minutes are lectures and live hands on demonstration with the trainees. Fellows and attendings will take turns lecturing. The second 30 minutes are live procedures with previously scheduled patients. Every teaching session will be led and guided by one of the attending physicians and live injections will be done under supervision of the attending.
Learning Objectives
- Normal and abnormal sonographic anatomy
- Fundamental musculoskeletal pathology for rheumatology indications
- History of present illness
- Physical exam
- Differential diagnoses
- Ultrasound exam techniques
- Standardized protocols
- Diagnostic musculoskeletal ultrasound
- Ultrasound guided injections
- Obtaining consent
- Procedure techniques
- Procedure note
- Billing and CPT codes
- Integrate musculoskeletal ultrasound in rheumatology practice
- Prepare for ultrasound certification exam
Curriculum
Introduction to Musculoskeletal Ultrasound
- Basic ultrasound physics
- Doppler modes
- Knobology and nomenclature
- Normal sonographic anatomy
- Interventional techniques, needle guidance
- Needle guidance techniques
- Joint, bursa, tendon and tendon sheath, nerve blocks
- Identifying and grading of synovitis and bony erosions
Upper Extremity: Shoulder
- Shoulder anatomy: normal
- Shoulder pathologies: HPI, physical exam, differential diagnosis
- Bicipital brachii tendon Long head: short and long axis, dynamic evaluation
- Subscapularis
- Supraspinatus
- Infraspinatus
- Acromioclavicular joint
- Subacromial-subdeltoid bursa, subacromial impingement, dynamic evaluation
- Spenoglenoid notch and suprascapular
- Posterior glenohumeral joint and labrum
- Infraspinatus
Upper Extremity: Elbow
- Elbow anatomy: normal
- Shoulder pathologies: HPI, physical exam, differential diagnosis
- Anterior: brachilais, biceps brachii, median nerve, anterior joint recess
- Medial: ulnar collateral ligament, common flexeor tendon, ulnar nerve
- Lateral: common extensor tendon, radial collateral ligament, radial nerve
- Posterior: posterior joint, triceps brachii, olecranon bursa
Upper Extremity: Wrist and Hand
- Wrist and hand anatomy: normal
- Wrist and hand pathologies: HPI, physical exam, differential diagnosis
- Dorsal wrist: extensor tendon compartments
- Volar wrist: flexor tendon compartments, median nerve, ulnar nerve
- Hand: finger joints, flexor tendons, pulleys
- Live wrist and hand injections
Lower Extremity: Hip
- Hip anatomy: normal
- Hip pathologies: HPI, physical exam, differential diagnosis
- Anterior hip: hip joint, iliopsoas, rectus femoris, lateral femoral cutaneous nerve
- Lateral hip: greater trochanter
- Posterior hip: sacroiliac joint, piriformis, sciatic nerve
- Live hip injections
Lower Extremity: Knee
- Knee anatomy: normal
- Knee pathologies: HPI, physical exam, differential diagnosis
- Anterior knee: quadriceps tendon, patella tendon, superior patella recess
- Medial knee: MCL, medial meniscus, pes anserine bursae, saphenous nerve
- Lateral knee: LCL, lateral meniscus, iliotibial tracht, biceps femoris, fibular nerve
- Posterior knee: Baker cyst, PCL, ACL, neurovascular structures
- Live knee injections
Lower Extremity: Ankle and Foot
- Ankle and foot anatomy: normal
- Ankle and foot pathologies: HPI, physical exam, differential diagnosis
- Anterior ankle: tibiotalar joint, tibialis anterior, EHL, EDL
- Medial ankle: tibilais posterior, tibial nerve, FHL, deltoid ligagment
- Lateral ankle: peroneus longus and pernous brevis tendons, ankle ligagment
- Posterior ankle: Achilles tendon, retrocalcaneal bursa
- Foot: plantar fascia, foot and toe joints, Morton neuroma
- Live ankle and foot injections