03 September 2024 : Review article
Ultrasound Imaging in Diagnosis and Management of Lower Limb Injuries: A Comprehensive Review
Krystian Maruszczak
1ABCDEF*, Maciej Kochman 1ACDEF, Tomasz Madej 2CDE, Piotr Gawda 3ADEG
DOI: 10.12659/MSM.945413
Med Sci Monit 2024; 30:e945413
Introduction
Muscle Structure and Ultrasonographic Imaging
US Imaging of Lower-Limb Muscle Injuries
Tendon Structure and Ultrasonographic Imaging
US Imaging of Lower-Limb Tendon Injuries
Ligament Structure and Ultrasonographic Imaging
US Imaging of Lower-Limb Ligament Injuries
US Imaging of Other Lower-Limb Injuries
Future Directions
Conclusions
References
Table 1 Grading systems for muscle injuries based on US imaging findings.
| Grade | US findings | ||
|---|---|---|---|
| Peetrons 2002 [38] | Chan et al, 2012 [104] | Loizides et al, 2017 [105] | |
| Minor elongations affecting less than 5% of the muscle | Normal appearance with either localized or widespread heightened echogenicity, and without any distortion in muscle architecture | Muscle edema with minor abnormalities (<5% of the muscle surface) that might seem hypo- or hyperechoic | |
| Partial rupture of 5 to 50% of the muscle with a hypoechoic or even anechoic space within the muscle fibers | Muscle fibers exhibit gaps, with increased vascularity at the site of disruption and changes in echogenicity around the lesion. There is an absence of perimysial striation near the muscle-tendon junction | Disruption of muscle fiber continuity with altered echogenicity (>5% of the muscle surface)Fluid accumulation or hematoma is frequently found around the fascia or along the muscle fascia“Bell sign” is often observable | |
| Full rupture of the muscle or fascia, with the collection leaking away from the injured area of the muscle | Muscle fibers are completely separated, accompanied by the presence of a hematoma and retraction of the muscle ends | Complete discontinuity of muscle fibers with visible muscle stumps and a hematoma in the “muscle break” | |