Musculoskeletal ultrasound is quickly becoming more popular within the sports medicine world. Many physicians in this field, including physiatrists, primary care providers, and orthopedic surgeons are increasingly attending courses and utilizing this imaging modality in their practices. However, sometimes when I explain to a patient that I’m going to use ultrasound for a diagnostic test or to guide my needle during an injection, he or she asks, “ultrasound… like ultrasound that’s used for babies?” To which I respond, “Yes, it’s like that ultrasound. Except we use it for a different purpose.”
The purpose of this post is to educate the reader on the benefits of musculoskeletal ultrasound. It has become an attractive option for physicians in terms of diagnosing tendon, ligament, and nerve disorders. It is also useful for guidance for interventional procedures. For example, until recently, a patient who required an injection into the hip joint would have to have this done under fluoroscopy, meaning with x-ray guidance. This would require scheduling a time with the radiology department and being exposed to the radiation more than once while the needle was being positioned. Now, however, a physician experienced in ultrasound-guided procedures can do this quickly in the office. This is just one example. Allow me to briefly point out the benefits of ultrasound versus other imaging modalities.
1. The patient is not exposed to radiation.
2. There are no contra-indications (for example, patients with pacemakers cannot undergo MRI testing).
3. Portability means easier access. For example, the machine I use is fairly lightweight and looks like a large laptop computer. I can easily take it from one office to another, or to an athletic arena.
4. It can be used for dynamic imaging. If you have a tendon that subluxates (or displaces) with movement, this can be seen on ultrasound, whereas with MRI, the patient needs to be still.
5. It is incredibly useful for needle guidance with procedures. See above for one example. There are many published studies indicating increased accuracy with ultrasound-guided procedures compared with “blind” procedures (those without image guidance).
6. The physician has immediate feedback. For example, I don’t need to rely on a radiologist’s interpretation of the test I ordered. If I’m the one seeing the patient, and I can perform the ultrasound, nothing is lost in translation. Also, I don’t have to wait for the report.
Of course, there are disadvantages. Ultrasound is not useful for identifying anything within the bones or deep within joints. Its use is limited to more superficial structures; deeper structures are more difficult to see. Last, but certainly not least, it that ultrasound imaging is only as good as its user, meaning the more experience the physician has with the ultrasound machine, the better.
As I mentioned previously, there are many courses available for physicians to attend to increase their knowledge and skill with musculoskeletal ultrasound. While certification for musculoskeletal ultrasound is not currently available, planning for a certification examination is currently underway.