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This chapter describes normal and pathological findings in the knee and leg of pediatric patients by ultrasound. Knee joint is accessible but with a complex anatomy, especially in early stages of development due to cartilage and growing structures.

Background Cubital tunnel syndrome (CuTS) is the second most common compressive neuropathy of the upper limb following carpal tunnel syndrome and is the most common site for entrapment for the ulnar nerve Objectives Our aim is to evaluate the role of ultrasonography (US) as a diagnostic tool for Cubital tunnel syndrome (CuTS) in comparison with nerve conduction study (NCS). Methods: twenty elbows with CuTS and twenty asymptomatic controls were assessed by NCS and underwent ultrasonography of elbows. Data from patients and controls were compared to determine the diagnostic relations in patients with CuTS and the grade of severity Results There was a high degree of correlation between NCS of the ulnar nerve, clinical parameters and variable US measurements. The CSA of the ulnar nerve was the most sensitive parameter and a cut-off point of 9.5 mm2 behind medial epicondyle was found to be 100% sensitive and 80% specific. The ulnar nerve ratios (UNR) had a diagnostic accuracy of 95% with 85% specificity. Conclusion Ultrasonographic measurements of the ulnar nerve CSA and UNR have a comparable diagnostic value as a non-invasive and an alternative modality for the evaluation of CuTS References [1] Simon N, Ralph J, Poncelet A, Engstrom J, Chin C, Kliot M. A comparison of ultrasonographic and electrophysiologic inchingin ulnar neuropathy at the elbow. Clin Neurophysiol. 2015;126(2):391-398. [2] Omejec G, Podnar S. Normative values for short-segment nerve conduction studies and ultrasonography of the ulnar nerve at the elbow. Muscle nerve. 2015;51(3):370-377. [3] Yoon J, Walker F, Cartwright M. Ultrasonographic swelling ratio in the diagnosis of ulnar neuropathy at the elbow. Muscle nerve. 2008;38(4):1231-1235. [4] Bayrak A, Bayrak I, Turker H, Elmali M, Nural M. Ultrasonography in patients with ulnar neuropathy at the elbow: Comparison of cross-sectional area and swelling ratio with electrophysiological severity. Muscle nerve. 2010;41(5):661-666. Disclosure of Interests None declared

Orofacial myofascial pain is prevalent and most often results from entrapment of branches of the trigeminal nerves. It is challenging to inject branches of the trigeminal nerve, a large portion of which are shielded by the facial bones. Bony landmarks of the cranium serve as important guides for palpation-guided injections and can be delineated using ultrasound. Ultrasound also provides real-time images of the adjacent muscles and accompanying arteries and can be used to guide the needle to the target region. Most importantly, ultrasound guidance significantly reduces the risk of collateral injury to vital neurovascular structures. In this review, we aimed to summarize the regional anatomy and ultrasound-guided injection techniques for the trigeminal nerve and its branches, including the supraorbital, infraorbital, mental, auriculotemporal, maxillary, and mandibular nerves.

Background Musculoskeletal ultrasonography imposes itself as reliable tool for the disease activity assessment of rheumatoid arthritis (RA) being more sensitive than clinical in detection of synovitis. There is no consensus on the exact joint number should be examined. Naredo et al. developed reduced 12-joint count1 while Backhaus et al. scored only seven small joints2. Although both were found to reflect disease activity it is suitable in a busy clinic to assess the lowest joint count. Objectives To investigate the validity of 7-joint ultrasonography (US7) scores in assessment of disease activity in Egyptian RA patients compared with simplified 12-joint ultrasonography (US12) scores and correlate both to composite disease activity indices. Methods Fifty Egyptian RA adult patients diagnosed according to the ACR1987 criteria were subjected to detailed history, 28 tender & swollen joint counts (TJC, SJC). The disease activity was assessed by calculating DAS28-CRP, SDAI and CDAI. The Ultrasonographic assessment was performed using a LOGIQP6 with 10–13 MHz broadband linear array transducer by one well-trained blinded rheumatologist. The synovial hypertrophy on GS & PD images were graded using a semi-quantitative 0–3 scale. The simplified US12 was performed as originally described1. However the GS & PD synovitis were computed in two separate scores instead of one. The US7 was performed at the clinically dominant side as described by Backhaus et al2. Two Sum-US7 scores were added; Sum (GS)-US7 after grading the GS-tenosynovitis and Sum (PD)-US7. Ultrasonography inter/intraobserver reliability was evaluated on 40 stored images using randomization and blinded techniques.The study was approved by the local ethics committee. Results The studied population had mean disease duration of 89±60 months. 62% were using more than one DMARD. They showed moderate disease activity as defined by DAS28, SDAI and CDAI (mean 3.7±1.4, 19.9±14.9 & 17.9±13.3 respectively). The GS-scores showed no correlation with disease activity parameters. PD-US12, PD (synovitis)-US7 and Sum (PD)-US7 significantly correlated with the SJC, CRP levels (P values 0.03, 0.04 and 0.01) and DAS28 (P values 0.02, 0.009 and 0.001), furthermore Sum (PD)-US7 correlated with SDAI and CDAI (P values 0.013& 0.042 respectively). Correlation coefficient between the different ultrasonographic scores showed no differance. The ultrasonography reliability showed significant agreement (P Conclusions Our results confirm the validity of PD-scores in assessment of disease activity. However they make the significance of GS questionable. The Sum-(PD) US7 seems to perform better than the original one, it was strongly correlated with CRP and with the three disease composite indices. The studied scores correlated with each other favoring the use of less time consuming US7score. References Naredo E, et al. Validity, reproducibility, and responsiveness of a twelve-joint simplified power Doppler ultrasonographic assessment of joint inflammation in rheumatoid arthritis. Arthritis Care Res. 2008;59(4):515–22. Backhaus M, et al. Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: A pilot project. Arthritis Care Res. 2009;61(9):1194–201. Disclosure of Interest None declared

Soft tissue imaging is a peculiar area where musculoskeletal ultrasonography is not only handy but also outstanding with its valuable findings. In addition to being of significant importance, soft tissue imaging has displayed diversity in musculoskeletal ultrasonography. We are therefore of the opinion that soft tissue examination is one of the most important applications of musculoskeletal ultrasonography.