POCUS Assessment and Ultrasound MSK Applications and Guided Injection Training
Lesson Plan: Point-of-Care Ultrasound (POCUS) for Musculoskeletal (MSK) Applications
Target Audience:
Healthcare providers (physicians, nurse practitioners, physician assistants, physical therapists) interested in learning MSK ultrasound for diagnosis and procedural guidance.
Learning Objectives:
By the end of the session, participants should be able to:
- Understand the fundamentals of POCUS for musculoskeletal evaluation.
- Identify normal and pathological MSK structures using ultrasound.
- Demonstrate proper probe handling and image acquisition techniques.
- Recognize key ultrasound artifacts and how to optimize imaging.
- Perform ultrasound-guided procedures relevant to MSK care.
1. Introduction to MSK POCUS (30 minutes)
A. Why Use MSK Ultrasound?
- Real-time imaging of soft tissues, joints, tendons, and ligaments.
- Non-invasive, cost-effective, and portable.
- Enhanced accuracy for injections, aspirations, and diagnosis.
B. Basic Physics & Principles of MSK Ultrasound
- Transducer selection:
- High-frequency linear probe (10-15 MHz) for superficial structures.
- Curvilinear probe for deeper joints (e.g., hip).
- Ultrasound modes:
- B-mode (brightness mode) for real-time imaging.
- Doppler mode for vascular assessment.
- Artifacts:
- Anisotropy (tendon hypoechogenicity with poor angle).
- Shadowing (bone and calcification).
- Reverberation and refraction artifacts.
2. Probe Handling & Image Optimization (30 minutes, Hands-on Practice)
A. Proper Probe Techniques
- Probe grip and stabilization.
- Rocking, tilting, and fanning for better image acquisition.
B. Image Optimization
- Adjusting depth, gain, and frequency.
- Recognizing hypoechoic vs. hyperechoic structures.
- Differentiating fluid vs. solid vs. bone structures.
3. Systematic Approach to MSK Ultrasound (90 minutes, Hands-on Practice)
A. Soft Tissue Evaluation (30 minutes)
- Subcutaneous tissue and fat
- Muscles: Normal striations, fascicles, muscle tears
- Tendons & Ligaments: Normal fibrillar patterns, tears, tendinopathy
- Nerves: Hypoechoic fascicles with a hyperechoic perineurium
B. Joint & Bone Imaging (30 minutes)
- Cartilage: Normal vs. degenerative changes
- Synovium & Effusions: Identifying synovial hypertrophy & joint fluid
- Fractures & Dislocations: Cortical disruption, step-offs
C. Live Scanning of Key MSK Regions (30 minutes)
- Shoulder (rotator cuff, biceps tendon, glenohumeral joint)
- Elbow (common extensor/flexor tendons, ulnar nerve)
- Wrist (carpal tunnel, extensor compartments)
- Hip (joint effusions, iliopsoas bursitis)
- Knee (quadriceps/patellar tendon, meniscus, bursae)
- Ankle/Foot (Achilles tendon, plantar fascia, peroneal tendons)
4. Common MSK Pathologies & Case Studies (30 minutes)
- Rotator Cuff Tears & Tendinopathy
- Biceps Tendinitis & Rupture
- Carpal Tunnel Syndrome (Median Nerve Compression)
- Tennis Elbow (Lateral Epicondylitis)
- Knee Effusions & Baker’s Cyst
- Achilles Tendinopathy & Rupture
- Plantar Fasciitis
5. Ultrasound-Guided Procedures (60 minutes, Hands-on Practice)
A. Needle Guidance Techniques
- In-plane vs. Out-of-plane needle visualization
- Using hydrodissection for enhanced visualization
B. Common Ultrasound-Guided MSK Procedures
- Joint Aspirations (Knee, Shoulder, Hip, Ankle)
- Steroid & PRP Injections (Rotator Cuff, Elbow, Achilles, Plantar Fascia)
- Carpal Tunnel & Perineural Injections
- Trigger Finger Release & Tenotomy
6. Assessment & Feedback (30 minutes)
A. Knowledge Check (10-15 minutes)
- Quiz on probe selection, anatomy, artifacts, and pathology.
B. Skills Assessment (15-20 minutes)
- Practical OSCE-style evaluation with direct supervision.
7. Conclusion & Next Steps (15 minutes)
- Recap key concepts and review learning points.
- Discuss additional resources for self-study and certification.
- Encourage ongoing practice with POCUS models and real-time cases.
Additional Learning Resources
- Books & Online Courses:
- "Musculoskeletal Ultrasound: Anatomy & Technique" – McNally
- Online modules (e.g., AIUM, SonoSim, POCUS.org)
- Hands-on Workshops & Conferences:
- AIUM, AMSSM, POCUS certification courses
- POCUS Apps for Learning:
- SonoSupport, POCUS Atlas, MSK Ultrasound Reference
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Lesson Plan: Ultrasound-Guided Joint Injections Using Point-of-Care Ultrasound (POCUS)
Objective:
By the end of this lesson, learners will be able to:
- Understand the principles of ultrasound-guided joint injections.
- Identify key ultrasound landmarks for common joint injections.
- Demonstrate proper probe handling and needle guidance techniques.
- Perform ultrasound-guided injections on models or cadaveric specimens.
1. Introduction (15 minutes)
A. Importance of Ultrasound-Guided Injections
- Enhanced accuracy and precision
- Reduced complications (vascular or nerve injury)
- Improved patient outcomes and pain relief
B. Principles of Ultrasound for Joint Injections
- Probe selection: High-frequency linear probe (for superficial joints), curvilinear probe (for deeper joints)
- Imaging modes: B-mode for real-time visualization
- Needle visualization techniques: In-plane vs. out-of-plane approach
2. Ultrasound Basics & Probe Handling (30 minutes)
A. Ultrasound Machine Settings
- Gain, depth, and frequency adjustments
- Optimizing image quality for joint visualization
B. Hands-on Practice: Probe Manipulation & Image Acquisition
- Identifying anatomical structures
- Differentiating between soft tissue, bone, and synovial fluid
- Using a gel phantom or practice pad to simulate needle insertion
3. Common Joint Injections & Ultrasound Landmarks (60 minutes, hands-on practice)
A. Knee Joint Injection
- Indications: Osteoarthritis, rheumatoid arthritis, effusion
- Landmarks: Patella, suprapatellar recess, femoral condyles
- Technique: Longitudinal or transverse approach, in-plane needle guidance
B. Shoulder (Glenohumeral) Joint Injection
- Indications: Frozen shoulder, arthritis, rotator cuff pathology
- Landmarks: Humeral head, glenoid, biceps tendon
- Technique: Posterior or lateral approach with in-plane guidance
C. Hip Joint Injection
- Indications: Osteoarthritis, trochanteric bursitis
- Landmarks: Femoral head, acetabulum, iliopsoas tendon
- Technique: Anterior approach with curvilinear probe
D. Ankle Joint Injection
- Indications: Arthritis, tenosynovitis, post-traumatic pain
- Landmarks: Tibiotalar joint, talus, extensor tendons
- Technique: Anterior approach, in-plane guidance
4. Advanced Techniques & Troubleshooting (30 minutes)
A. Doppler Use for Vascular Avoidance
- Identifying blood vessels to prevent intravascular injection
B. Hydrodissection Technique
- Using fluid to separate tissues and improve needle visibility
C. Common Pitfalls & How to Overcome Them
- Poor needle visualization
- Patient movement
- Probe positioning errors
5. Live Practice & Simulation (60 minutes, hands-on with guidance)
- Practice on live models, cadaveric specimens, or synthetic simulators
- Perform full ultrasound-guided injections under supervision
6. Assessment & Feedback (30 minutes)
A. Knowledge Assessment
- Quick quiz on key concepts (probe selection, injection techniques, landmarks)
B. Practical Skills Assessment
- Direct observation by instructors using a checklist
C. Feedback & Discussion
- Review of strengths and areas for improvement
- Q&A session for clarifications
7. Conclusion & Take-Home Points (15 minutes)
- Recap key concepts: Probe handling, anatomical landmarks, needle guidance
- Encourage continued practice with POCUS training models
- Discuss next steps for integrating ultrasound-guided injections into clinical practice
Additional Resources:
- POCUS apps for mobile learning
- Online ultrasound training modules
- Hands-on workshops and cadaver labs
Web Resources:
MSK Australia
Ultrasound Guided Ankle and Subtalar Joint Injection Techniques:
https://www.youtube.com/watch?v=9BgGRJn4WWw
Lateral Ligament Assessment:
https://www.youtube.com/watch?v=rY8pBenyxeU
Assessment of Achilles Tendon:
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