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does not move with joint movement as intact fibers would23 Tenosynovitis or peritendinitis Thickened tendon sheath or peritendon with increased fluid With or without increased power Doppler signal Normal ligament Hyperechoic, compact morphology, less ordered fibrillar pattern than tendon Low-grade ligament injury May be normal or thickened, hypoechoic With or without increased power Doppler signal Intermediate or highgrade ligament injury Fiber disruption, surrounding hematoma or fluid With or without increased power Doppler signal Normal muscle Mostly hypoechoic, interspersed hyperechoic lines and dots (perimysium and epimysium) Normal nerve Less compact-appearing and more varied shape than tendon and ligament Semicompact bundle of hypoechoic nerve fascicles surrounded by hyperechoic tissue Neuritis (focal or diffuse) Abnormal nerve enlargement, fascicular swelling, blurring of the interstitium, perineural thickening (in the chronic state), possible scarring in entrapment cases20 With or without increased power Doppler signal Downloaded from www.ccjm.org on August 19, 2022. For personal use only. All other uses require permission. CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 85 • NUMBER 4 APRIL 2018 299 FORNEY AND DELZELL muscle herniation. Although ultrasonography may yield a definitive diagnosis for a muscle problem, further imaging may be needed. Nerves Ultrasonography is useful for peripheral nerve investigation but requires a steep learning curve for sonographers and interpreting physicians.58,59 It is best suited for directed questions regarding focal abnormal nerve findings on physical examination. Ultrasonography can help identify areas of nerve entrapment caused by a mass or dynamic compression. It can detect neuritis (Table 1), lesions of peripheral nerves (eg, nerve-sheath) R E S EAR CH A R TIC L E Open Access Orthopaedic residents demonstrate retention of point of care ultrasound knowledge after a brief educational session: a quasi experimental study Samuel Larrivée1* , Robyn Rodger2 , Patricia Larouche1 , Jeff Leiter1 , Tomislav Jelic2 and Peter MacDonald1 Abstract Background: Musculoskeletal point of care ultrasound (MSK POCUS) has many uses for orthopaedic surgeons, but orthopaedic trainees are rarely exposed to this modality. The purpose of this project was to assess the usefulness in clinical education of a newly implemented MSK POCUS course in an orthopaedic surgery program. Methods: An MSK POCUS course for orthopaedic surgery residents was developed by an interdisciplinary team. Online videos were created to be viewed by residents prior to a half-day long practical course. An online survey covering the level of training of the resident and their previous use of ultrasound (total hours) was completed by the participants prior to the course. Resident’s knowledge acquisition was measured with written pre-course, sameday post-course and six-month follow-up tests. Residents were also scored on a practical shoulder examination immediately after the course and at six-month follow-up. Changes in test scores between time points were evaluated using Wilcoxon signed-rank tests. Results: Ten orthopaedic surgery residents underwent the MSK POCUS curriculum. Pre-course interest in MSK-POCUS was moderate (65%) and prior exposure was low (1.5 h mean total experience). Written test scores improved significantly from 50.7 ± 17.0% before to 84.0 ± 10.7% immediately after the course (p < 0.001) and suffered no significant drop at 6 months (score 75.0 ± 8.7%; p = 0.303). Average post-course practical exam score was 78.8 ± 3.1% and decreased to 66.2 ± 11.3% at 6 months (p = 0.012). Residents significantly improved their subjective comfort level with all aspects of ultrasound use at 6 months (p = 0.007–0.018) but did not significantly increase clinical usage frequency. Conclusion: An MSK POCUS curriculum was successfully developed and implemented using an interdisciplinary approach. The course succeeded in improving the residents’ knowledge, skills, and comfort with MSK POCUS. This improvement was maintained at 6 months on the written test but did not result in higher frequency of use by the residents. Keywords: Point of care ultrasound, Musculoskeletal ultrasound, Sonography, Resident education, Orthopaedic surgery, Online curriculum © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. * Correspondence: larrives@myumanitoba.ca 1 Department of Surgery, Section of Orthopaedic Surgery, Rady Faculty of Health Sciences, University of Manitoba, AD4 – 820 Sherbrook St, Winnipeg, Manitoba R3A 1R9, Canada Full list of author information is available at the end of the article Larrivée et al. BMC Medical Education (2019)
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