A Scoping Review on the Utility of Ultrasound to Visualize Bursae in Anatomical Dissection Courses

Authors

DOI:

https://doi.org/10.5195/ijms.2024.2406

Keywords:

Education, Medical, Cadaver, ultrasound, Bursa, synovial , review, Ultrasound, Bursae Visualization, Anatomical Dissection, Sonoanatomy, Cadaver Studies, High-Resolution Imaging, B-Mode Ultrasound, Educational Tool, Grey Literature, Medical Education

Abstract

Bursitis is a common condition in clinical practice, often causing pain in the shoulder and buttock areas due to inflamed bursae. Proper diagnosis and treatment depend on knowing the presence and exact location of these bursae. Anatomy classes typically provide limited instruction on bursae because they are difficult to demonstrate during dissection courses. High-resolution ultrasound is an essential and versatile technique for detecting bursitis, and it could also serve as a valuable tool for students to better understand bursae. Relevant studies were screened in the following databases: CENTRAL, MEDLINE, BIOSIS Previews, EMBASE, and Web of Science Core Collection. Grey literature was also considered. Literature was screened on January 3, 2023. Only ultrasound investigations in human cadaver bursae were included, specifically using B-Mode ultrasound. The general characteristics of the included studies and the ultrasound-guided approaches for labeling the bursae were analyzed and examined. T The search found 8,899 matches, but only 15 met the criteria. Fifteen different bursae were studied, and 12 studies were included in the analysis. Both the marking substrate and the injected volume varied. Despite a high overall accuracy of 99% achieved using ultrasound-guided labeling approaches in the included studies, caution is advised due to the small sample size (1 to 24). The current study serves as a review to examine ultrasound studies on bursae in human cadavers. Ultrasound-guided labeling techniques achieve high accuracy and could be a valuable teaching tool in dissection courses. These techniques help visualize difficult-to-dissect structures and provide students with an understanding of sonoanatomy.

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References

Monro A. A description of all the bursae mucosae of the human body; their structure explained, and compared with that of the capsular ligaments of the joints, and of those sacs which line the cavities of the thorax and abdomen; with remarks on the accidents and diseases which affect those several sacs, and on the operations necessary for their cure. Edinburgh: Printed for C. Elliot, T. Kay ..., London; and for Charles Elliot, Edinburgh; 1788.

Koudela K, Jr., Koudelová J, Koudela K, Sr., Kunesová M. Bursitis iliopectinea. Acta Chir Orthop Traumatol Cech. 2008;75(5):347-54.

Dihlmann W, Peters A, Tillmann B. The bursa iliopectinea--a morphologic-computed tomographic study. Rofo. 1989;150(3):274-9.

Resnick DLK, H. S.; Pretterklieber, M. L. Internal derangements of joints. 2nd ed. Philadelphia: Saunders; 2007.

Canoso JJ, Stack MT, Brandt KD. Hyaluronic acid content of deep and subcutaneous bursae of man. Ann Rheum Dis. 1983;42(2):171-5.

Van Mieghem IM, Boets A, Sciot R, Van Breuseghem I. Ischiogluteal bursitis: an uncommon type of bursitis. Skeletal Radiol. 2004;33(7):413-6.

Sawyer E, Varacallo M. Anatomy, shoulder and upper limb, hand ulnar bursa. StatPearls. Treasure Island (FL): StatPearls Publishing

Copyright © 2023, StatPearls Publishing LLC.; 2023.

Stecco C. Atlas des menschlichen fasziensystems: Elsevier Health Sciences; 2016.

Stecco C, Fede C, Macchi V, Porzionato A, Petrelli L, Biz C, et al. The fasciacytes: A new cell devoted to fascial gliding regulation. Clin Anat. 2018;31(5):667-76.

De Oliveira-Lagôa S, Cruz FB, Azócar DLM, Lavilla EO, Abdala V. Anuran forelimb muscle tendinous structures and their relationship with locomotor modes and habitat use. Curr Zool. 2019;65(5):599-608.

Pujalte G, Hudspeth LJ, Troyer WD, Shapiro SA. Ultrasound-guided injection of the long head of the biceps tendon sheath with concomitant subacromial bursa injection through the same needlestick. Clin Anat. 2022.

Tamborrini G, Marx C. Cme-rheumatology 7: trochanter major pain syndrome. Praxis (Bern 1994). 2016;105(3):172-4.

Tamborrini G, Müller-Gerbl M, Müller SA. Cme-sonography 106: subacromial bursa - a myth. Praxis (Bern 1994). 2022;111(15):833-46.

Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169(7):467-73.

Gotschall T. EndNote 20 desktop version. J Med Libr Assoc. 2021;109(3):520-2.

Bramer WM, Giustini D, de Jonge GB, Holland L, Bekhuis T. De-duplication of database search results for systematic reviews in EndNote. J Med Libr Assoc. 2016;104(3):240-3.

Dang D, Kamal M, Kumar M, Paliwal B, Nayyar A, Bhatia P, et al. Comparison of human cadaver and blue phantom for teaching ultrasound-guided regional anesthesia to novice postgraduate students of anesthesiology: a randomized controlled trial. Journal of anaesthesiology, clinical pharmacology. 2024;40(2):276‐82.

Stallenberg B, Destate N, Feipel V, Gevenois PA. Involvement of the anterior portion of the subacromial-subdeltoid bursa in the painful shoulder. AJR Am J Roentgenol. 2006;187(4):894-900.

Aguiar RO, Gasparetto EL, Escuissato DL, Marchiori E, Trudell DJ, Haghighi P, et al. Radial and ulnar bursae of the wrist: cadaveric investigation of regional anatomy with ultrasonographic-guided tenography and MR imaging. Skeletal Radiol. 2006;35(11):828-32.

Aguiar RO, Viegas FC, Fernandez RY, Trudell D, Haghighi P, Resnick D. The prepatellar bursa: cadaveric investigation of regional anatomy with mri after sonographically guided bursography. AJR Am J Roentgenol. 2007;188(4):W355-8.

Finnoff JT, Nutz DJ, Henning PT, Hollman JH, Smith J. Accuracy of ultrasound-guided versus unguided pes anserinus bursa injections. PM&R. 2010;2(8):732-9.

Gaetke-Udager K, Jacobson JA, Bhatti ZS, Smith J, Parameswaran A, Fessell DP. Ultrasound of the gruberi bursa with cadaveric and mri correlation. AJR Am J Roentgenol. 2016;207(2):386-91.

Moore BJ, Johnson W, Finnoff JT, Smith J, Sellon JL. Distribution of sonographically guided injections of the subgluteus minimus and medius bursae in cadaveric model. Med Sci Sports Exerc. 2019;51(6, Suppl. S):592.

Mu A, Peng P, Agur A. Landmark-guided and ultrasound-guided approaches for trochanteric bursa injection: a cadaveric study. Anesth Analg. 2017;124(3):966-71.

Nakase J, Yoshimizu R, Kimura M, Kanayama T, Yanatori Y, Tsuchiya H. Anatomical description and short-term follow up clinical results for ultrasound-guided injection of medial collateral ligament bursa: New conservative treatment option for symptomatic degenerative medial meniscus tear. Knee. 2022;38:1-8.

Norbury JW, Karr NC, Sindhi V, Rathbun KM, Charles SC, McIver MB, et al. Improving the performance time and accuracy of ultrasound-guided interventions: a randomized controlled double-blind trial of the line-of-sight approach and the „apples“ mnemonic. J Ultrasound Med. 2018;37(12):2909-14.

Onishi K, Sellon JL, Smith J. Sonographically guided semimembranosus bursa injection: technique and validation. PM&R. 2016;8(1):51-7.

Pekala PA, Henry BM, Pekala JR, Piska K, Tomaszewski KA. The Achilles tendon and the retrocalcaneal bursa an anatomical and radiological study. Bone Jt Res. 2017;6(7):446-51.

Smith J, Wisniewski SJ, Wempe MK, Landry BW, Sellon JL. Sonographically guided obturator internus injections: techniques and validation. J Ultrasound Med. 2012;31(10):1597-608.

Viegas FC, Aguiar RO, Gasparetto E, Marchiori E, Trudell DJ, Haghighi P, et al. Deep and superficial infrapatellar bursae: cadaveric investigation of regional anatomy using magnetic resonance after ultrasound-guided bursography. Skeletal Radiol. 2007;36(1):41-6.

Wisniewski SJ, Hurdle M, Erickson JM, Finnoff JT, Smith J. Ultrasound-guided ischial bursa injection: technique and positioning considerations. PM&R. 2014;6(1):56-60.

Wu T, Song HX, Dong Y, Li JH. Ultrasound-guided versus blind subacromial-subdeltoid bursa injection in adults with shoulder pain: a systematic review and meta-analysis. Semin Arthritis Rheum. 2015;45(3):374-8.

McGill KC, Patel R, Chen D, Okwelogu N. Ultrasound-guided bursal injections. Skeletal Radiol. 2023;52(5):967-78.

Dzulkifli MA, Mustafar MF. The influence of colour on memory performance: a review. Malays J Med Sci. 2013;20(2):3-9.

Hamza A, Radosa J, Meyberg-Solomayer G, Solomayer EF, Takacs Z, Juhasz-Boess I, et al. Trial integration of combined ultrasound and laparoscopy tuition in an undergraduate anatomy class with volunteer participation - a pilot study. Ann Anat. 2019;221:101-7.

O'Keeffe GW, Davy S, Barry DS. Radiologist's views on anatomical knowledge amongst junior doctors and the teaching of anatomy in medical curricula. Ann Anat. 2019;223:70-6.

Bledsoe A, Zimmerman J. Ultrasound: the new stethoscope (point-of-care ultrasound). Anesthesiol Clin. 2021;39(3):537-53.

Hayashi S, Naito M, Kawata S, Qu N, Hatayama N, Hirai S, et al. History and future of human cadaver preservation for surgical training: from formalin to saturated salt solution method. Anat Sci Int. 2016;91(1):1-7.

Wilke HJ, Werner K, Häussler K, Reinehr M, Böckers TM. Thiel-fixation preserves the non-linear load-deformation characteristic of spinal motion segments, but increases their flexibility. J Mech Behav Biomed Mater. 2011;4(8):2133-7.

Eisma R, Lamb C, Soames RW. From formalin to thiel embalming: what changes? One anatomy department's experiences. Clin Anat. 2013;26(5):564-71.

Wolff KD, Kesting M, Mücke T, Rau A, Hölzle F. Thiel embalming technique: a valuable method for microvascular exercise and teaching of flap raising. Microsurgery. 2008;28(4):273-8.

Stecco C, Fantoni I, Macchi V, Del Borrello M, Porzionato A, Biz C, et al. The role of fasciae in civinini-morton's syndrome. J Anat. 2015;227(5):654-64.

Sawhney C, Lalwani S, Ray BR, Sinha S, Kumar A. Benefits and Pitfalls of Cadavers as Learning Tool for Ultrasound-guided Regional Anesthesia. Anesth Essays Res. 2017;11(1):3-6.

The image titled "Staining of the Iliopectineal Bursa" shows a dissection of the right femoral triangle in a formalin-fixed specimen. The iliopectineal bursa is marked with an asterisk (*), positioned deep to the psoas tendon and ventral to the pectineus muscle (1). The dissection is framed by the adductor longus muscle (2) and the sartorius muscle (3). This illustration highlights the use of ultrasound-guided techniques to inject blue latex into the bursa, which helps students visualize this otherwise difficult-to-dissect structure​.

Published

2024-07-22 — Updated on 2024-09-30

How to Cite

Margenfeld, F., Zendehdel, A., Tamborrini, G., Polzer, J., Naville, M., Poilliot, A., & Müller-Gerbl, M. (2024). A Scoping Review on the Utility of Ultrasound to Visualize Bursae in Anatomical Dissection Courses. International Journal of Medical Students, 12(3), 294–302. https://doi.org/10.5195/ijms.2024.2406

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