Musculoskeletal

Ultrasound
HENDRA

Emerging technology

Diagnostic
Therapeutic/Interventional

Musculoskeletal Ultrasound

Extension of physical exam.

Built in control.
Quick exam with quick answers.
Pain-free with no claustrophobia.
Dynamic examination.
Digital images to print, save, transport.

Is MSKUS Evidence Based?

Retrospective study of 1,012 patients treated

by MSK and sports physicians over a 10month period by Sivan et al. concluded that
the use of clinic-based MSK US enables a onestop approach, reduces repeated hospital
appointments and improves quality of care.

Musculoskeletal Care. 2011;9(2):63-8

Improved Outcomes

RCT by Sibbitt et al. in 148 painful joints were

randomized.
US guided had 43% reduction (p<0.001) in
procedural pain.
58% reduction (p<0.001) in absolute pain scores at
the 2 wks outcome.
75% reduction (p<0.001) in significant pain and 62%
reduction in non-responder rate.
Increased detection of effusion by 200% and volume
of aspirated fluid by 337%.
Journal of Rheumatology. 2009: 36(9):1892-902

MSKUS vs. MRI

In a prospective study of 124 patients, US and

MRI had comparable accuracy for identifying
and measuring the size of full-thickness and
partial-thickness rotator cuff tears, with
arthroscopic findings used as the standard.

J Bone Joint Surg Am. 2004; 86-A(4):708-16

Advantages over other imaging

Cost (10-20% the cost of MRI).

Portability
Patient friendly (Interactions)
No C/I
High resolution
Reproducibility (Follow the pathology)
Easy follow up with repeat tests and
measurement.
Doppler to screen for inflammation/vascularity.

Sports Medicine Applications

Tendons
Muscles
Ligaments
Nerves
Joints
Cartilage

Anterior Shoulder Ultrasound

Ultrasound Cases

Carpal tunnel syndrome

De Quervains Tenosynovitis

Intersection Syndrome

16 yo baseball pitcher w/ Elbow pain

Loose Bodies

Lymphadenitis/Phlebitis

Rotator Cuff Tear: Full

Thickness

Partial Thickness Tear

AC Joints

Effusion w/ periarticular fluids/Joint Luxation

Percutaneous Tenotomy

Calcific tendinopathy: 52 yo female

Left shoulder pain for years.
2 x 1.8 cm calcification within supraspinatus
for 7 yrs.
8 cortisone shots in the past: short-term relief.
Night pain, unable to lift arm overhead.
Doesnot want to have surgery.
ASA/Plavix, h/o cardiac stents.

Calcific tendonitis

Biceps Tendinosis

Hip Ultrasound

Hip Pathology

Foreign body

Quadriceps Muscle Rupture

Achilles Tendon

Plantar Fascia

Ultrasound Injections

Shoulder Joint: Subacromial/deltoid, AC, SC, Biceps

Hip Joint: Greater Trochanteric, Iliopsoas, Ischial
Tuberosity
Knee Joint: Pre-patellar, Meniscus Cyst, Bakers Cyst
CMC Joint, STT Joint
Lateral/Medial Epicondyle
FHL
Lateral Femoral Cutaneous Nerve
Tenotomy
PRP

Anatomic Anomalies

Bifid Median Nerve and Artery

Thank you!