Musculoskeletal Ultrasound - Why we use it in our clinical practice.

The importance of diagnostic ultrasonography and how it can be used in diagnosis and measuring treatment progression.

Diagnostic ultrasound gives us a great image of structural anatomy. Now I’m a big ultrasound imaging fan but findings must always be put into context, it should always be part of a clinical history and thorough assessment. It will never replace these, but may help to guide the decision making progress. However the use of MSK Ultrasound is only as good as the practical skill of the sonographer and their clinical reasoning of the case.

MSK Ultrasound can’t see inside a knee joint to see a meniscal injury, but we may pick up some secondary signs (cyst or swelling) that may well tie in with the clinical presentation and history. It can’t see past bone, but we can see the bony cortex, and it's more difficult to see deep joints (ie: hip) but it can be massively advantageous in lots of scenarios.

Common Examples of the use of MSK Ultrasound:

• Shoulder Pain / Rotator Cuff Pathology

• Elbow / Wrist and Hand Pain

• Lateral hip (gluteal tendinopathy)

• Hip pathology (but will be limited by bulk)

• Anterior Knee pain

• Achilles pain

• Foot and Ankle injuries

Case Example 1:

Fall whilst out walking onto the shoulder. Inability to raise arm and pain.

Ultrasound images unfortunately demonstrate an acute full thickness supraspinatus tear.

Due to activity levels, requires surgical repair

Case Example 2:

Athlete with achilles pain post running, no change in pattern / training volume.

Ultrasound images show an intact achilles tendon, with very little changes within the achilles but an acute inflammation around the tendon showing this is an acute injury that with appropriate management should settle quickly and not mean significant off of running.

If you feel Ultrasound imaging may help to guide your patient journey please book here to see Stuart Butler - Physiotherapist and Sonographer.