Відео

13:36

1:42 在股內髁(有軟骨層)較偏外側的部位 是尋Baker’s囊腫時重要骨標記10:30 註：股內髁( 後表面覆有軟骨，但其所對應的脛骨後方近心端脛骨背面在橫置探頭的掃描畫面則通常看不到軟骨層喔） 🟡 檢查Baker’s囊腫:一開始就往膝內側 (橫)置探頭、找出股內髁10:30 : 探頭橫置(短軸) 畫面下， @ 覆在股內髁關節軟骨背面的(偏內側)是半膜(腱)，貼在股內髁關節軟骨背面(偏外側)則是腓腸(腱)。Baker’s囊腫的蒂從兩腱間冒出。 @ <在短軸觀>時，基於兩腱走向的Anisotropy效應，在近股內髁處，(位內側的)半膜腱與(位外外側)內腓腸腱只有任一腱，能在同視窗下被清楚掃描呈較高回音。其中另一腱呈低回音時，勿誤將之視為囊腫！要去區辨該低回音究竟是否為囊腫，須固定在該低回音處、分別向頭端和向尾端傾斜探頭做聲波發射。 @ 半膜腱自近端沒入遠端關節內 @ 內腓腸腱則由遠端沒入近端關節內，上述是判斷分辨這兩腱的重要概念。 若是肌腱，則： 🟡 ?🤔待確認: 橫置的探頭發射聲波<朝頭端>掃描時，能看清的是大腿端=頭端的[半膜腱]❗️反之則是內腓腸腱。 3:48 結構標示圖 囊腫的短軸6:08 和長軸 6:12超聲像。 Baker’s cyst (長軸6:48 )重要超聲影像標示 圖中亦標出PCL 6:52 6:59 @ 順便提了一下：後(外)側也有可能存在囊腫，但那就不是Baker’s cyst了。若臨床懷疑但超聲無法証實是否有半月板破裂相關的囊腫，那就須做MRI了7:23 🔸探頭橫置膝後方內側、往復緩慢來回作遠/近掃描，以分辨膝後方內側的骨表高回音輪廓究竟是股骨內髁( 則表面會覆厚軟骨層 )還是內側脛骨後面( 則無高回音軟骨)，🔶貝克氏囊腫須在表面(有)軟骨覆蓋的(「股」骨內髁表面)找。 @ 但，🤔無論股內髁後方或內側脛骨後方的骨表面，皆覆著( 「🤔厚？」肌腱層) 。 @ 惟，若探頭放在(股內髁)後方時，偏內的是半膜(腱)，貼在股內髁關節軟骨背面偏外側的則會是腓腸(腱)。 @ 但，探頭橫置時，只有任一腱，能在同視窗下被清楚掃描呈較高回音。 而，探頭若放在內側[脛]骨後方、則內側(脛)骨表面只會是半[膜]腱。 🔶也務必將探頭做朝頭、朝尾的tilt傾斜，來對內側膝的低回音疑似囊腫做區辨14:08其究竟是半膜腱、內腓腸腱抑或囊腫。可謹記前述要領： 🟡? 待確認：探頭發射聲波<朝頭端>掃描時，能看清的是大腿端=頭端的[半膜腱]❗️反之則是內腓腸腱。探頭下的低回音若經探頭朝頭/朝尾掃描而俱呈低回音，方有可能不是半膜腱、內腓腸腱❗️ ******************************** B.探頭[🟩縱]置內側膝後方( 股內髁 ) 15:54 16:39 然後，向內平移到股內髁軟骨消失，再平移向外、看到一條像慧星尾的腱貼在股內髁、再溯向遠端，確認其著骨在離後內側半月板關節綫不遠的脛後端( 註: 此處為半膜腱易傷處)，而可因此 確認出此為半(膜)肌與腱： 17:20 17:31 和位其更表層的半腱腱。 @ 內腓腸肌與腱 19:34 19:40 @ 縱切緊鄰股骨內髁(不含)的近心端，此處有時存在腱鞘囊腫(縱切) @ Baker’s囊腫破裂，便滲下至內外腓腸肌表層間20:21 🔸(半膜腱)在脛的著骨20:35 不要與(PCL)在脛的著骨(較外側) 20:45 20:58混淆 {註: 講者切PCL是純縱切而非近端朝內擺30度斜置探頭} 🔶後膝部位的神經血管束24:01 縱切21:29 橫切21:51 欲看清楚神經組織，設法透過覆蓋其表層較低回音的肌肉做對比顯像: 先使位表層的某方位肌肉的低回音能顯像清晰，再移動並傾斜探頭，設法將低回音肌肉調整到位在視窗中神經的正上方、藉聲波穿透低回音的肌肉，而強化神經外圍較高回音結締組織23:40 24:56 27:48 @ 向近心端回溯•脛神經30:31～31:29和腓總神經30:56 31:10至兩者從坐骨神經分出處31:29。 @探頭橫切在(股內外髁間: 視窗開4cm )的水平高度處、並使(髁間)及偏外的(股外髁後方最凸輪廓：位在深度約1-1.5 cm )同時出現視窗中30:39，即可見[脛]神經(位在明顯的血管表層)。而同一視窗裡，在股外髁外緣更淺些的(股二頭短頭肌肉的內側)31:26，還可辨識出貼附著有(腓總神經)30:47。 @ 追溯及辨識神經組織的技巧是31:34: 將探頭在2-3cm短距離內較快速滑動，來確保神經顆粒感grainy的可辨識度。且探頭的微傾對神經組織Anisotropy的影響不像肌腱那麼明顯。 🔸當向近心端溯[脛]神經和(腓總神經)源自(坐骨神經分支處)止時，視窗須開3-4cm。 🔸但探頭再從近端坐骨神經分支處拉往遠端的1.股外髁後、2.脛骨後、3.腓骨頭後面觀察， 視窗調淺為2 cm： 1. @ 腓總神經在( 股外髁遠端背面骨輪廓位置 )的 ( 股二頭短頭肌肉偏內緣 ) 32:42 32:52 33:24 33:27 2. @ 腓總神經在( 脛骨後方骨輪廓位置 ) 的股二頭肌肉內緣 表淺33:31 33:36 3. @ 腓總神經貼在( 腓骨頭後方位置 )、非常表淺處33:49 @ 趴姿直膝、探頭遠端置於:以兩指捏置在腓骨頭背面的兩側後兩指間所留的空間、調整探頭近端走向，便可掃描出股二頭腱在背面所呈超聲像35:10。 @ 探頭遠端由背面滑向腓骨頭側面，再將探頭近端稍轉向前，即可掃描出恰跨經膕溝/腱而附往股外上髁的LCL。

Very good

Thank you very much

Excellent thank you

Sound not clear sir .

Great video, thanks so much for sharing the knowledge. I have a question please, on the outflow vein showing in your video at 17'30", where/ at what spot would you measure the outflow vein volume? Where else could we measure the volume? Also, would the difference between volume at inflow artery proximal to anastomosis and distal to anastomosis same as outflow vein volume given in some old AVF there is severe anuerysmal change with turbulence flow? Thanks for your time.

Is the IMBUS program open to practicing hospitalists?

Best part was cut… the very end when the cannula was going to go in the vein :(

I am a sufferer of grade 3 (right) and grade 4 (left) avascular necrosis. Can this method cure the pain I suffer? Thank You

This is a veru dangerous video. In a sesne that we do not see clearly the pleura and the space where we would want to deposit the L.A. The idea is- know where you go and every anatomy structures to be identified (not just vertebraes). I would not rely on this video to learn paravertebral block.

beautiful and well explained

Complete and clear explanations. Thanks for sharing.

really good thanks,... could mention your concentration through, I was assuming 0.5 of Ropi or Buvi. Also could mention the pre-injection of Lido? How much pain can the patient expect while awake?

Great video

Great video

Cheer~~~an instance of giving off something such as a liquid, light, or smell.😊

Does Sonosite have any plans to add your "voice assist" software to the ST system?

Excellent presentation. Thank you! Thumbs up!

excellent video

Plz upload full video of mens pelvic usg

she may be a very educated person but the cover photo for this video points out what stupid dumbarse would sir behind a horse like that

Thank you

This was very helpful

Very informative explanation, thankyou very much

I have an ascities built up in a last year and I went twice to emergency room but they turned me down . I’m already at this point that I bought my own Paracentesis kit and albumin , iv lines etc . If noone will help I’ll have to do it on my own

cool

Thank you❤

All the way from Uganda, Africa. Thanks so much for this webinar. I don't know if Dr. Teames shared that PDF but if he did can I please share my email so that u send it to me? It would really be of great help to my people. Thanks so much everyone

great job

very infiormativa lecture۔۔۔thanks

Is she alive

You make MSK more easy. please make webinar on abdominal, breast and thyroid too. once again thanks alot

THANK GOD YOU ARE Back

Masterpiece!!!

very good presentation 😊

I have ptsd from choking as a child ....I'm house bound for 28 years ......but here in the uk they only do it in london for ptsd and i live in newcastle ....so im kinda stuck 😭😭😭😭

What time and vacant time and how much paying i makes ultrasounds

Hi Daniel, really enjoyed your webminar of the medial and lateral knee as always. Do you look into the medial and lateral retinaculum, medial patellofemoral ligament and lateral patellofemoral ligament during the assessment of the medial and lateral knee study? Lastly, do you mind to run through the PCL and oblique popliteal ligament and how you locate them in your up coming posterior knee webinar please? Really looking forward to your talk.

great !

8:40 CTS

The CT reformat compared with the ultrasound sound imaging was extraordinarily useful! The lateral aspect of the tibia being visible on ultrasound never made sense to me until now. Your commentary about palpation of bony landmarks was equally utilitarian. I will remember your observation about distal LCL proximity to biceps femoris tendon. Truly masterful production and performance. Compartmentalizing the anatomical approach is superior to discussing the entire knee. I use SonoSite PX at work and love it.

Great presentation, keep up the good work sir

Excellent overview. Thank you 🙏🏻

Absolutely excellent ! Thank you !

This is so clear - thank you !

Thank you so much for this!

thank you for sharing this :)