Since 1998, I have been specializing exclusively in diagnostic imaging (ultrasound and magnetic resonance imaging) of the musculoskeletal system (joints, muscles, tendons, ligaments etc.).
The ultrasound machines I use for examinations are Toshiba Xario XG, Toshiba Aplio MX, and Samsung HS 80 EVO. All devices are top world-class machines equipped with the necessary software options and transducers for such diagnostics, allowing for precise diagnosis and monitoring of musculoskeletal pathologies.
In addition to the diagnosis and monitoring of musculoskeletal disorders, I also offer the possibility of performing drug administration/puncture procedures under ultrasound guidance. This method can be used to evacuate pathological fluid collections such as hematomas or cysts, or to administer drugs to many spaces such as tendon sheaths, bursae, or joint cavities.
The administration of steroid drugs in particular requires high precision, which minimizes the side effects of this type of pharmaceuticals (see information on drugs).
In addition, I also perform procedures involving the cutting of retinacula in the hand (retinaculum of the Ist extensor compartment, A1 retinacula of the fingers), flushing of calcifications in the rotator cuff, puncture of the common extensor tendon (tennis elbow), common flexor tendon (golfer's elbow), and needling of the Achilles tendon, patellar ligament (badly healing partial tears).
Both types of procedures are minimally invasive alternatives to surgery in a hospital operating room. The procedures are performed using a needle with a diameter of 0.5-1.2 mm (maximum, such as needles commonly used for blood collection) under local anesthesia (the anesthetic is administered with a needle with a diameter of 0.5 mm).
The corticosteroid (anti-inflammatory, anti-edema, and analgesic drug) that I use most often is a drug called DIPROPHOS. It is a long-acting anti-inflammatory drug. If you have a referral for another drug, please obtain it on your own.
IMPORTANT INFORMATION ABOUT MEDICINES:
1 ml of DIPROPHOS contains 6.43 mg of betamethasone dipropionate (Betamethasoni dipropionas), equivalent to 5 mg of betamethasone, and 2.63 mg of betamethasone sodium phosphate (Betamethasoni natrii phosphas), equivalent to 2 mg of betamethasone.
Possible side effects (mostly in patients treated chronically): Symptoms of Cushing's syndrome: purple stretch marks, acne, excessive hair growth, body shape changes, muscle wasting, high blood pressure, swelling, potassium deficiency, glucose intolerance, osteoporosis, menstrual disorders, impotence. Cataracts, glaucoma, stomach ulcers, gastrointestinal bleeding, pancreatitis, and immune disorders (decreased immunity, susceptibility to infections, fungal infections, impaired wound healing) and growth retardation in children may also occur.
Inform your doctor: If you have osteoporosis, tuberculosis, any viral or fungal infections, peptic ulcer disease, glaucoma, hypertension, diabetes, or are planning to undergo vaccination in the near future. If you are taking diuretics, insulin or oral antidiabetic drugs, cardiac glycosides, oral anticoagulants, isoniazid. If you are or suspect that you are pregnant, or if you are breastfeeding. The product is contraindicated during pregnancy.
1% OR 2% LIGNOCAINUM HYDROCHLORICUM (lidocaine hydrochloride) - a drug for local anesthesia.
Possible side effects: Rare and most often caused by overdose: taste disturbances, numbness of the tongue, ringing in the ears, anxiety, visual sensations, agitation, increased muscle tension, muscle tremors, loss of consciousness and generalized convulsions, coma. Cardiovascular reactions manifest as deterioration of heart muscle function.
Inform your doctor: If you are hypersensitive to local anesthetics, atrioventricular conduction blocks, myasthenia gravis (fatigue, muscle weakness), epilepsy, liver dysfunction. If you are taking antiarrhythmic drugs, cimetidine, beta-blockers, barbiturates, rifampicin, phenytoin, or striated muscle relaxants. In addition, inform your doctor about all medications you have recently taken. If you are pregnant or suspect you may be pregnant, or if you are breastfeeding. Not recommended for use during pregnancy. Use with caution during breastfeeding.
In addition to ultrasound diagnostics, I also perform magnetic resonance imaging (MRI) examinations of the musculoskeletal system. This diagnostic method covers examinations of the foot, knee, hip, shoulder, elbow, wrist, and other structures. Depending on medical indications, I also perform examinations with intra-articular contrast administration.
To perform an examination with intra-articular contrast, I require a referral from the attending physician with a clear indication that the examination is to be performed after the contrast has been administered into the joint cavity.
KNEE ULTRASOUND
- synovial spaces
- knee joint cavity (popliteal, lateral, suprapatellar, medial recess)
- prepatellar bursa
- superficial infrapapatellar
- deep infrapatellar bursa
- gastrocnemius-semimembranous bursa
- superficial pes anserinus sheaths (sartorius, gracilis, and semitendinosus tendons)
- patellofemoral joint
- cartilage and subchondral layer of the femoral condyles
- shape of the femoral part of the patellofemoral joint
- height of the patella
- lateral position of the patella
- anterior (osseous) surface and edges of the patella and patellar tendon
- quadriceps tendon (band from the medial, intermediate, rectus, and lateral heads)
- patellar retinacula
- patellar ligament
- ligaments
- tibial collateral ligament
- peroneal collateral ligament
- medial and lateral meniscus ligaments
- anterior cruciate ligament
- posterior cruciate ligament
- medial patellofemoral ligament (part of the medial patellar ligaments)
- tendons
- sartorius muscle
- gracilis muscle
- semitendinosus muscle
- semimembranosus muscle
- biceps femoris muscle
- gastrocnemius muscle
- hamstring muscles
- menisci
- medial
- lateral
- meniscal cysts
- popliteal fossa
- popliteal muscles
- tibial and common peroneal nerves
- popliteal artery and vein
- popliteal bursae
Assessment of all the above structures, including after surgery.
ULTRASOUND OF THE ANKLE JOINT AND FOOT (DORSAL SIDE))
- synovial spaces (bursae, sheaths, joint cavities)
- medial and lateral ankle bursae
- sheaths of the tibial tendons, long extensors and flexors of the toes, peroneal muscles
- cavities of the tarsal and metatarsal joints (upper and lower ankle joints, Chopart joint, Lisfranc joint, MTP, PIP, and DIP joints
- bony outlines of the joints and bones of the foot (erosions, osteophytes, fractures)
- ganglions
- foot ligaments
- ligaments on the lateral side of the upper ankle joint
- anterior tibiofibular
- posterior tibiofibular
- anterior talofibular
- calcaneofibular
- ligaments of the medial side of the upper ankle joint
- deltoid ligament
- Chopart's ligaments
- calcaneocuboid dorsal ligament
- bifurcate ligament
- dorsal talo-navicular ligament
- Lisfranc joint ligaments
- tarsometatarsal ligaments
- capsular-ligamentous apparatus of the metatarsophalangeal and interphalangeal joints
- foot tendons
- long peroneal muscle
- short peroneal muscle
- tendon sheaths
- tendon ligaments
- tibialis anterior muscle
- extensor hallucis longus muscle
- extensor digitorum longus muscle
- peroneus tertius muscle
- tendon sheaths
- tendon ligaments
- posterior tibial muscle
- flexor digitorum longus muscle
- tendon sheaths
- tendon ligaments
- subcutaneous fatty tissue of the foot
- plantar aponeurosis
- plantar outlines of the metatarsal and toe bones and the calcaneus bone
- tendons of the long flexor muscles of the big toe and toes and the tendon of the peroneus longus muscle
- sesamoid bones of the big toe
- changes in the course of nerves (e.g., Morton's neuroma)
- other atypical soft tissue changes in this area
- structure and vascularity of the Achilles tendon
- adhesions in the tendon space (dynamic examination)
- Achilles tendon bursa and subcutaneous calcaneal bursa
- bony outlines of the tendon bursa and its calcaneal attachment
- hip joint
- effusion, swelling of the synovial membrane in the joint
- bone contours of the anterior part of the femoral head and neck
- cartilage of the anterior part of the femoral head
- contour of the acetabular rim
- cartilaginous rim of the acetabulum
- around the hip joint
- tendon of the rectus femoris muscle
- tendon and bursa of the iliopsoas muscle
- iliotibial band
- bursa of the gluteus maximus muscle/iliotibial band
- tendons of the gluteus medius and minimus muscles
- gluteal muscles
- piriformis, gemelli, obturator and quadratus femoris muscles
- sartorius muscle
- gracilis muscle
- adductor longus muscle
- adductor brevis muscle
- pectineus muscle
- adductor magnus muscle
- quadriceps femoris muscle
- biceps femoris muscle
- semitendinosus muscle
- semimembranosus muscle
- popliteus muscle
- gastrocnemius muscle
- sartorius muscle
- anterior and posterior tibialis muscles
- flexor hallucis longus muscle
- flexor digitorum longus muscle
- peroneal muscles (long and short)
- extensor hallucis longus muscle
- extensor digitorum longus muscle
- peroneus tertius muscle
- short extensor, flexor, adductor, and abductor muscles of the toes
- tendons (including their attachments)
- tendinous system
- muscle bellies
- bursa of the muscle/tendon area
- sheaths, aponeuroses
- fasciae
- sciatic nerve
- tibial nerve
- medial and lateral plantar nerves
- interdigital nerves
- common peroneal nerve, superficial peroneal nerve, and deep peroneal nerve
- acromioclavicular joint
- coracoclavicular ligament, coracohumeral ligament
- subacromial bursa
- rotator cuff
- subscapularis tendon
- supraspinatus tendon
- infraspinatus tendon
- assessment of rotator cuff behavior in dynamic examination (abduction)
- effusion, swelling of the synovial membrane in the shoulder joint cavity
- posterior labrum of the shoulder joint
- long head tendon of the biceps brachii muscle and its fibrous and synovial sheath
- muscles of the shoulder region
- deltoid muscle
- trapezius muscle
- major and minor rhomboid muscles
- levator scapulae muscle
- joint cavity – effusion, hematoma, synovial membrane edema
- outlines of the humerus, radius, and ulna
- outlines of the hyaline cartilage and subchondral layer on the surface of the trochlea and humeral head
- anterior and posterior capsule
- common extensor tendon
- common flexor tendon
- radial collateral ligament and annular ligament
- ulnar collateral ligament (anterior and posterior parts)
- triceps brachii tendon
- ulnar nerve groove and ulnar nerve
- dynamic assessment of ulnar nerve stability (maximum flexion test)
- dynamic examination of the elbow joint to assess the cause of flexion, extension, and pronation/supination deficits of the forearm
- cavities of the wrist joints)
- cavities of the metacarpophalangeal (MCP) and interphalangeal (PIP, DIP) joints)
- outlines of the wrist, metacarpal, and finger bones for erosions and fractures)
- ganglions and hernias of the wrist and finger joints)
- capsular-ligamentous apparatus of the MCP, PIP, and DIP joints)
- ligamentous apparatus of the dorsal side of the wrist)
- short muscles of the hand)
- tendons of the long extensor muscles and their sheaths and ligaments at the level of the wrist, metacarpus, and fingers)
- tendon of the long and short radial extensor muscles of the wrist
- tendon of the long and short extensor muscles and abductor of the thumb
- tendons of the long extensor muscles of the fingers and index finger
- tendon of the long extensor muscle of the fifth finger
- tendon of the elbow extensor muscle of the wrist
- tendons of the long flexor muscles and their sheaths and ligaments at the level of the carpal tunnel, metacarpus, and fingers
- tendons of the superficial and deep flexor digitorum longus muscles
- tendon of the flexor pollicis longus muscle
- tendon of the flexor carpi radialis muscle
- tendon of the flexor carpi ulnaris muscle
- tendon of the palmaris muscle
- radial nerve, superficial and deep branches, zone of transition of the posterior interosseous nerve through the extensor muscle
- ulnar nerve
- median nerve
FOOT ULTRASOUND (PLANTAR SIDE)
ACHILLES TENDON ULTRASOUND
HIP ULTRASOUND
Ultrasound of the lower limb muscles
Muscle assessment covers the entire muscle-tendon unit:
Ultrasound of the peripheral nerves of the lower limb
SHOULDER ULTRASOUND
ELBOW ULTRASOUND
Wrist and Hand Ultrasound
Ultrasound of the peripheral nerves of the upper limb
