Musculoskeletal Diagnostic Ultrasound

Ultrasound imaging, scanning, ultrasonography, or just plain sonography is the use of high-frequency sound waves to obtain images for diagnosis or treatment. Ultrasonography is safe and does not use ionizing radiation like x-rays to obtain images. In musculoskeletal ultrasound (MSK US) we use high frequency transducers that produce images with higher resolution than MRI. In addition, we can obtain real time motion studies to see how ligaments, tendons, muscles, and joints function under normal conditions or abnormally when injured, degenerated, or unstable. We can also image nerves and detect abnormalities of position, size, adhesions, and tears in many areas.

MSK US has become the standard of care in Europe and much of the rest of the world due to the convenience, economy, easy accessibility, but mostly facilitation of timely care by primary care providers and specialists alike. Much unnecessary expense and potential risks can be avoided by appropriate and rapid diagnosis and treatment with the use of MSK US. It is underutilized here in the US because of the steep learning curve with diagnostic MSK US and the overreliance on MRIs and CT scans which are abundant but expensive. Also, MRIs are especially suited to spinal imaging where MSK US is weakest, and for internal structures that are challenging even for magnetic resonance imaging such as shoulder labra or knee cruciates. In a recent study published March 2009 by the National Council on Radiation Protection and Measurement, it was concluded "doctors are ordering too many diagnostic tests, driving up the cost of health care in the United States, and potentially harming patients." Much of this is avoided by using ultrasonography for diagnosis when possible. Presently, however, according to the American Institute for Ultrasound Medicine, less than 10% of all ultrasonographers perform diagnostic MSK US.

In our clinic we use diagnostic ultrasound everyday to diagnose tumors, swellings, muscle and tendon tears, joint instability, degenerative changes in musculoskeletal structures, look at nerves, image vascular structures, and to assess blood flow. In addition, we regularly image other soft tissue “small parts” such as thyroids, breasts, scrotums, etc. to help diagnose abnormalities. We use ultrasound to guide injections when necessary and find it an indispensable addition to our clinical practice. Now, using ultrasound in our fifteenth year, we couldn’t imagine practicing without it and are constantly adding to our skill set in scanning.