الفهرس 
ANATOMYOnly 14 pages are availabe for public view
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Abstract
US is the most practical and rapid method of obtaining images of the MSK system. It can be performed readily in the clinic, with assessment of multiple joints at the same appointment, providing a ‘one stop’ answer to many MSK problems. This relatively inexpensive technology with the benefits of portability and real-time dynamic examination has made it possible to provide a diagnostics service in the community or even on the sports field.
Ultrasonography (US) performed with high-resolution linear-array probes has become advanced in the assessment of ligaments around the ankle joint. US can provide a detailed depiction of normal anatomic structures and is effective for evaluating ligament and tendon integrity.
US performed by the physician provides an excellent opportunity for patient education and to explain the rationale for treatments. With increasing experience the examiner is able to perform focused examination which provides immediate answers to any clinical queries raised.
However, the main disadvantage of diagnostic ultrasound examination is that it is operator dependent. In tendinopathy, the sonographer has to interpret gray scale and power Doppler tendon appearances and decide on what images are acquired and archived.
Therefore, an algorithm can be devised to take this into account. If a clinician has suspicion for a focal tendon abnormality, such as tear, then ultrasound can be considered. If the clinician is suspecting something more than a focal tendon problem then MRI should be considered. The drawback of this algorithm is that the decision on choice of imaging relies on the clinicians’ suspicions of specific pathology. As an alternative algorithm, sonography may be considered the first line of imaging for joint problems after radiography.
Our study aimed to assess the diagnostic accuracy of ultrasonography for the assessment of tendons and ligaments around the ankle joint.
Our results showed that, in tendinous pathology, Achilles tendon is the most commonly injured ankle tendon, followed by tibialis posterior and the tendinitis/teno-synovitis was the most encountered tendons pathology. In ligamentous injuries, anterior talo-fibular ligament and calcaneo-fibular ligaments were the most frequently injured ligaments. Associated pathology included 4 cases of effusion and 9 cases with retro-calcaneal bursitis. Comparison to clinical data ultrasonography proved to be more accurate tool in diagnosis and characterization of ankle soft tissue injuries.
In conclusion, this study showed that imaging plays a major role in the management of ankle problems. Ultrasound is an excellent tool for imaging focal soft tissue abnormalities, and used as primary tool of investigation.
Technical and methodological limitations
This study has a number of limitations, first of all the small number of study group which didn’t include normal volunteers. This made it difficult for us to diagnose less common tendino-ligamentous pathological entities e.g peroneal split tear and medial collateral ligament pathologies. Second, the sonographic examination of only clinically significant cases maybe the cause of unavailability of cases of tendinosis which could elicit minor/negligible symptoms.
Also, it is recommended that other studies are performed to compare accuracy of sonographic findings to operative or endoscopic findings.