31 Aug MSK Ultrasound a future modality
Magnetic resonance imaging (MRI) is the most common modality used to evaluate soft tissue abnormalities and has been for many years. But a newer modality that is starting to take root for the evaluation of musculoskeletal injuries is musculoskeletal ultrasound.
TOP REASONS
- Ultrasound has superior resolution compared to MRI, offering spatial resolution of 150 microns versus 450 microns with MRI.
- Ultrasound can assess tendons, ligaments, and muscle in a dynamic fashion to look for subluxation or abnormal movement caused by ligament and tendon tears. Dynamic imaging is useful for difficult diagnoses, which are only apparent to the patient with specific movements.
- Bony erosions are also seen earlier with ultrasound than with MRI. Using power doppler, synovitis and neo-vascularization of tendinotic tissue can be identified better with ultrasound than any other current imaging modality.
- Aside from diagnosis, musculoskeletal ultrasound is useful as a guide for procedures such as joint injections, aspirations and intra-tendinous injections (e.g., platelet rich plasma). The real-time ability of ultrasound allows continuous visualization of the needle to its target location.SUPRASPINATUS . MRI VS MSK US
Because of this superior resolution, common abnormalities are seen more clearly on sonography than on MRI.
CARPAL TUNNEL
The use of high-resolution ultrasound imaging to study the median nerve in carpal tunnel syndrome is relatively new.
Musculoskeletal ultrasound could be used as a first-line diagnostic tool and, if additional information is required, MRI could be used as a secondary study.
FREQUENT USES OF MSK ULTRASOUND- Rotator cuff, biceps tendon
- Finger, hand tendons and ligaments. Carpal tunnel
- Elbow tendons and ligaments.
- Ankle and Foot (tendons and ligaments).
- Achilles tendon, Plantar fascia.
- Knee (Patellar Tendon, Ligaments, Meniscus and Quadriceps tendons).
- Iliopsoas tendon dysfunction (Snapping hip).
- Trochanteric bursitis. Gluteus minimus and medius tendons.
- Bleeding or other fluid collections within the muscles, bursae and joints.
- Benign and malignant soft tissue tumors.
- Early changes of arthritis, Effusion (fluid) or synovial (lining of the joint) thickening of bursa, tendon sheaths and painful joints.
SKIN AND SOFT TISSUE
- Pressure Ulcers
- Hematoma
- Edema
- Cellulitis
- Infections
- Abscess
- Foreign Bodies
- Ultrasound can be an effective tool for diagnosing problems in patients with difficult-to-evaluate conditions.
- Ability to image in real-time
- Facilitates dynamic examination
- Can interact with the patient while imaging
- Minimally affected by metal artifact
- Ability to guide procedures (injections)
- Enables rapid contralateral limb examination for comparison
- Can be performed in patients with pacemakers
- Alternative for patients with IV contrast allergy
- Alternative for Claustrophobic Patients
For instance, to determine whether a tendon tear is the source of a patient’s shoulder pain, ultrasound is used to precisely inject anesthetic into the tendon sheath and if the patient feels significant improvement, it is an indication that that pain was originating from that tendon.
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