SPORTS US TRAINING 1
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Appendix 1. SPORTS US SCANNING PROTOCOLS
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The following document provides scanning protocols for each body region and is
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adopted from the AIUM Guidelines for Performance of the MSK US Examination
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2012 (www.aium.org). Please consider this document as a reference when learning
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and performing SPORTS US examinations. Additional structures or regions should
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be examined as clinically indicated or based on practice needs.
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Shoulder
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A complete shoulder examination is performed in most cases, including the structures
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indicated below. In specific circumstances, a targeted examination of a specific anatomic
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structure may be performed (e.g., follow-up scan of the supraspinatus tendon to assess for
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tear progression)
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Biceps tendon and muscle
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Subscapularis muscle and tendon
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Dynamic exam for biceps subluxation & subcoracoid impingement (as indicated)
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Acromioclavicular joint
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Infraspinatus tendon and muscle
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Teres minor tendon and muscle
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Posterior glenohumeral joint (including dynamic imaging as indicated)
SPORTS US TRAINING 2
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Spinoglenoid notch (as indicated, region of suprascapular nerve)
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Supraspinatus tendon and muscle, with subacromial-subdeltoid bursa
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Dynamic rotator cuff evaluation and impingement testing
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Suprascapular notch (as indicated, region of suprascapular nerve)
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Extended field of view – supraspinatus & infraspinatus muscle bellies (as indicated)
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Elbow
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Examination may involve a complete assessment of 1 or more quadrants or may be
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focused on a specific structure.
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Anterior:
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Anterior humeroradial joint
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Radial fossa
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Dynamic scan of annular recess of radial neck (supination/pronation, as indicated)
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Anterior humeroulnar joint
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Coronoid fossa
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Biceps tendon and muscle, including dynamic scanning
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Brachialis muscle (as indicated)
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Brachial artery and vein (as indicated)
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Median nerve (as indicated)
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Pronator teres muscle and tendon (as indicated)
SPORTS US TRAINING 3
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Radial nerve (as indicated)
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Brachioradialis muscle (as indicated)
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Lateral:
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Lateral epicondyle, common extensor tendon and muscles
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Lateral collateral ligament complex
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Lateral humeroradial joint (including dynamic imaging as indicated)
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Radial nerve bifurcation and course through supinator muscle
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Proximal attachment of brachioradialis
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Proximal attachment of extensor carpi radialis longus
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Medial:
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Medial epicondyle, common flexor-pronator tendon and muscles
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Ulnar collateral ligament
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Dynamic valgus stress of ulnar collateral ligament (as indicated)
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Humeroulnar joint
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Ulnar nerve (also included in posterior region scan)
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Dynamic flexion-extension (as indicated)
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-evaluate for ulnar nerve subluxation
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-evaluate for snapping triceps tendon
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Posterior:
Triceps tendon muscles
SPORTS US TRAINING 4
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Olecranon fossa and posterior joint space
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Olecranon process
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Olecranon bursa
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Ulnar nerve (also included in medial region scan)
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Dynamic flexion-extension (as indicated) (also included in medial region scan)
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-evaluate for ulnar nerve subluxation
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-evaluate for snapping triceps tendon
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Wrist and Hand
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Examination may involve a complete assessment of 1 or more of the 3 anatomic regions
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or may be focused on a specific structure.
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Volar:
Carpal tunnel contents
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Flexor retinaculum
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Median nerve
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Flexor pollicis longus tendon
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Flexor digitorum profundus and superficialis tendons
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Dynamic examination with flexion & extension – tendon & nerve motion
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Palmaris longus tendon
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Flexor carpi radialis longus tendon and radial artery
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Ulnar nerve and ulnar artery within Guyon’s canal
SPORTS US TRAINING 5
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Flexor carpi ulnaris tendon
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Joints as clinically indicated (e.g. volar radiocarpal joint)
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Ulnar/Medial:
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Extensor carpi ulnaris tendon and muscle
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Dynamic examination for extensor carpi ulnaris subluxation
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Triangular fibrocartilage complex
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Ulnocarpal joint
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Dorsal:
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Extensor retinaculum, 6 compartments, 9 tendons and muscles
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Dynamic tendon examination – flexion/extension of the fingers (as indicated)
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Dorsal scapholunate ligament
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Joints (as clinically indicated)
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-Radiocarpal (RC), metacarpophalangeal (MCP), proximal interphalangeal (PIP),
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distal interphalangeal (DIP)
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-Dorsal and volar
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Superficial radial nerve (as indicated)
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Hip
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Examination may involve a complete assessment of 1 or more of the 4 anatomic regions
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or may be focused on a specific anatomic structure.
SPORTS US TRAINING 6
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Anterior Region (patient supine):
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Sagittal oblique, parallel to long axis of femoral neck
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Femoral head, neck, capsule, and anterior synovial recess
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Hip joint assessment for effusion
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Sagittal plane
Anterior labrum
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Transverse
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Femoral vessels and nerve
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Iliopsoas muscle, tendon and bursa
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Sartorius and tensor fascia lata tendons and muscles
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Lateral femoral cutaneous nerve
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Rectus femoris tendon(s) and muscles
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Dynamic scanning if snapping hip (as indicated).
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Lateral Region (side lying with hip flexed 20-30 degrees)
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Gluteus maximus – fascia lata – tensor fascia lata
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Gluteus minimus tendon and muscle
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Gluteus medius tendon and muscle
SPORTS US TRAINING 7
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Greater trochanteric bursa (subgluteus maximus bursa)
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Dynamic scanning for snapping hip (as indicated)
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Medial Region
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Supine neutral
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Femoral vessels and nerve (unless already examined with anterior region)
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Abducted-Externally rotated (frog leg)
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Adductor muscles (A. longus and gracilis  A. brevis  A. magnus) and tendons
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Distal iliopsoas tendon
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Pubic bone and symphysis (joint)
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Distal rectus abdominis muscle and tendon
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Posterior (prone w/wo pillow under hips)
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Gluteus maximus muscle and tendon
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Gluteus medius muscle and tendon
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Deep short external rotators (as indicated)
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Hamstring tendon and muscles
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Ischial tuberosity and bursal region
SPORTS US TRAINING 8
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Sciatic nerve
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Posterior hip joint (as indicated)
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Prosthetic Hip
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Assess for joint effusions and extra-articular fluid collections
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Greater trochanter and integrity of gluteal attachments
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Iliopsoas tendon and bursa
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Impingement on acetabular component
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Knee
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Examination may involve a complete assessment of 1 or more of the 4 quadrants of may
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be focused on a specific anatomic structure.
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Anterior:
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Quadriceps tendon and muscles
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Suprapatellar recess of knee joint
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Patella and prepatellar bursa
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Patellar tendon and tibial tubercle
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Superficial infrapatellar bursa
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Deep infrapatellar bursa
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Vastus medialis and medial retinaculum (also with medial region scan)
SPORTS US TRAINING 9
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Vastus lateralis and lateral retinaculum (also with lateral regional scan)
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Distal femoral cartilage (as indicated)
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Medial:
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MCL/tibial collateral ligament
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Valgus stress testing (as indicated)
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Medial meniscus and tibiofemoral joint space
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Pes anserine tendons and bursa
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Medial patellar retinaculum and patellofemoral joint (also with anterior region scan)
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Lateral:
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Iliotibial band
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Lateral meniscus and tibiofemoral joint space
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LCL/fibular collateral ligament
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Varus stress test (as indicated)
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Biceps femoris tendon and muscles
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Popliteus tendon and muscle
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Lateral patellar retinaculum and patellofemoral joint (also with anterior region scan)
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Proximal tibiofibular joint (as indicated)
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Posterior:
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Popliteal fossa
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Popliteal artery and vein
SPORTS US TRAINING 10
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Semimembranosus tendon and muscle
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Medial & lateral gastrocnemius muscles, tendons, and bursae
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Sciatic, tibial, and common fibular nerves
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Posterior horns of both menisci (as indicated) and tibiofemoral joint
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PCL (as indicated) (may be seen in sagittal oblique plane)
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Ankle /Foot
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Examination may involve a complete assessment of 1 of the 4 quadrants or may be
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focused on a specific structure.
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Anterior:
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Tibialis anterior (from musculotendinous junction to insertion)
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Extensor hallucis longus tendon and muscle
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Extensor digitorum longus tendon and muscle
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Peroneus tertius (congenitally absent in some patients)
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Deep fibular/peroneal nerve and dorsalis pedis artery
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Anterior joint recess (effusion, loose bodies, and synovial thickening)
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Anterior joint capsule
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Anterior inferior tibiofibular ligament
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Medial:
Posterior tibialis tendon and muscle
SPORTS US TRAINING 11
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Flexor digitorum longus tendon and muscle
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Posterior tibial nerve
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Medial and lateral plantar nerves (as indicated)
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Tibial artery and veins
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Flexor hallucis longus tendon and muscle
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Deltoid ligament and medial tibiotalar joint
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Lateral:
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Fibularis (peroneus) longus & brevis tendons and muscles
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Superior fibular (peroneal) retinaculum
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Dynamic assessment for fibular (peroneal) subluxation (as indicated)
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Anterior talofibular ligament
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Calcaneofibular ligament (incl. lateral tibiotalar joint and posterior subtalar joint)
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Posterior talofibular ligament (as able and indicated)
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Sural nerve (as indicated)
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Posterior:
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Achilles tendon and paratenon
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Dynamic scanning in of Achilles (as indicated to assist with tear evaluation)
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Retrocalcaneal bursa
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Retro-Achilles/Superficial Achilles bursa
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Plantaris tendon (may be absent) (as indicated)
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Posterior tibiotalar and subtalar joints
SPORTS US TRAINING 12
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Plantar fascia
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Plantar fat pad
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Digital:
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Assess for synovitis, dorsal and/or plantar
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Metatarsophalangeal (MTP) joints
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Interphalangeal (IP) joints
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Interdigital:
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Dorsal or plantar approach can be used
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Longitudinal and transverse views
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Intermetatarsal bursa (on the dorsal aspect of the interdigital nerve)
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Dynamic scanning, applying pressure for Morton’s neuroma, and/or ultrasonographic
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Mulder’s click (as indicated)
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