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Friday, 1 April 2016 | Author : Flex Free

MUSCULOSKELETAL ULTRASOUND (US)

What is Ultrasound (US) Examination?

We have known ultrasound examinations in the medical world for a long time. Ultrasonography (US) is a diagnostic tool that is commonly used especially in the field of obstetrics to see the condition of the fetus in the womb of pregnant women and to see other organs in the stomach.

How does Ultrasound Work?

Ultrasound works by emitting ultrasound waves through a transducer with gel as mediator, then waves will be reflected back in the form of an image on a monitor screen so that we can see our internal organs in the monitor and can immediately find out the abnormality.

The first use of ultrasound waves in the medical world was in 1942 to diagnose brain tumors. The research of ultrasound have been increasingly developed including in the musculoskeletal field, to identify the musculoskeletal structure like muscles, joint cartilage, tendons, bones and soft tissues around the joints. The use of ultrasound at that time was not maximal due to technological limitations so that the resolution of the images obtained was not good and could not be used for real time examinations.

Why Ultrasound Examination is Important in Musculoskeletal Abnormality?

Musculoskeletal disorders are often associated with high expenditure from employers due to the absence of workers, loss of productivity and high number of health services, disability and compensation costs for workers.

Nearly 70 million doctor visits recorded in the United States, and nearly 130 million care visits including outpatient visits, hospitals and emergency rooms due to this disorder.

Musculoskeletal rehabilitation plays a role in diagnosing and treating patients with disorders, and disabilities due to illness, disorders or trauma to muscles, bones, joints and other soft tissues around the joints.

The purposes of the Musculoskeletal Rehabilitation program are to improve and restore functional capacity, reduce symptoms, and restore the patient’s ability to do normal activities before the injury or illness and to improve patient welfare.

The need for an accurate diagnosis before treatment is very necessary. In the past, Physical and Medical Rehabilitation Medicine only relied on basic understanding of anatomy, physical examination maneuvers and rarely used imaging techniques.

Sometimes some musculoskeletal disorders are difficult to confirm with physical examination only. For example, pain in the shoulder or knee joint can be caused by many parts of the area, and those parts are so close to each other. Usually, doctor will ask for supportive examination for muscles, bones, joints, cartilage of joints, tendons and soft tissues around the joint (musculoskeletal) cases, using X-ray, CT-scan or MRI and musculoskeletal ultrasound. Each type of examination has their advantages and disadvantages.

Some Complicated Body Parts in Musculoskeletal System

Currently, ultrasound is commonly used in musculoskeletal field to help diagnosing and to assist therapeutic measures in the form of musculoskeletal injections. Ultrasound helps to determine the part of the pain precisely because medical action will be very different for each part and each type and level of damage that occurs. So ultrasound helps to confirm the type of abnormality, the organ that has a problem and its location precisely.

This imaging modality is in great demand given its superiority over other imaging modalities in terms of availability and convenience, safety, and diagnostic potential. Various medical disciplines, especially those related to bones, muscles, joints and other soft tissues abnormalities, have used it a lot for different purposes and focus according to their needs.

Rheumatologists use ultrasound examinations to confirm a diagnosis of inflammation in the tendon and synovial (joints and joint membrane), bone and cartilage changes in joint inflammation (arthritis), to guide injection and to evaluate the patient's condition after a treatment.

Radiologists use ultrasound to find out and to confirm the diagnosis of all musculoskeletal disorders without therapy and intervention.

Neurologists use ultrasound to identify nerve abnormalities or problems and to guide interventions such as injection, nucleoplasty, etc.

The Physical and Rehabilitation Medicine Specialist uses ultrasound with the same purpose as the Rheumatology, Orthopedic and Neurological Specialists as mentioned, but also associated with assessing the tissue functions especially after receiving specific treatment.

Ultrasound Examination Indication in Musculoskeletal Abnormality

Some US indications in musculoskeletal abnormalities:

  1. Impaired extremities function accompanied by pain
  2. Bone or soft tissue injury
  3. Tendon or ligament abnormality
  4. Joints or joint membranes inflammation and crystals or fluid accumulation in the joints
  5. Nerve pinch, injury or weakness and mass or injured soft tissue structure changes/displacement
  6. Evaluation of mass, swelling and accumulation of fluid in soft tissue
  7. To detect the presence of foreign objects in the soft tissues
  8. For invasive treatments or procedures planning or guidance
  9. To detect congenital and developmental abnormalities
  10. To evaluate after surgery or after certain treatment procedures conditions

Ultrasound Examination Advantages

Ultrasound examination advantages in musculoskeletal:

  • Cheaper than MRI or CT Scan.
  • Non-invasive, does not need incision, non-radiation and safe for pacemaker and metal implant users and children and can be done repeatedly.
  • Does not have contraindications and side effects.
  • Relatively simple tools with quite good mobility compared to MRI and CT scan.
  • The image from US is obtained from body physical composition changes, while the image from MRI examination is based on body's chemical composition changes.
  • US is a real time examination which means that the image at the time of examination can change when the muscle or soft tissue has a problem, is moved, manipulated, intervened, etc.
  • Examination can be done immediately when the patient complains about pain or after the trauma. Doctors can do the examination without special preparation, and special rooms. At the time of examination the patient can interact directly with the doctor so that the patient can immediately find out the abnormality.
  • Ultrasound does not need a long time to take, special room, or patient special preparation like fasting before the examination.
  • Several musculoskeletal disorders examination is relatively short compared to other tests and can normal area examination can be done for comparison
  • Ultrasound examination is done by moving the painful part so that the abnormality will be more visible. The musculoskeletal structure is a system of motion so that the examination will be clearer by moving the structure. Other investigations are static, do not allow movement during the examination.
  • Can be used as an illness progression monitor after treatment so that the therapy program will be more accurate and controlled. Doctor will record the data at the beginning of the illness and at the end of the treatment to evaluate the therapy process.
  • Can be used as a guide in intervening measure such as injection, joint fluid aspiration, ganglion and cysts aspiration, and biopsy so that the intervention will be very accurate and the patient can see the intervention process. The position of the injection target and the direction of the moving needle can be seen by the ultrasound. The injected drug will be right at the target location, and could be able to avoid needles penetrate organ such as blood vessels and nerves

Fluid Aspiration in Shoulder Joint and Baker Cyst behind the Knee and Drugs Injection Therapy Guided by Ultrasound

Ultrasound Examination Disadvantages in Musculoskeletal

  • Not all doctors can do ultrasound examinations in the musculoskeletal field. Special training and experience in ultrasound examination are needed so that ultrasound examination is very dependent on the expertise, ability and experience of the operator (operator dependent).
  • Sometimes musculoskeletal structures that are located in a deeper part cannot be seen by ultrasonography so other investigation such as CT scans or MRI is needed.

When compared to its advantages and disadvantages, ultrasound examination in the musculoskeletal field is very useful and has become the second stethoscope or the preferred choice of examining tool for doctors in examining musculoskeletal cases, all musculoskeletal cases are indications for ultrasound examination.

Ultrasound examination (US) helps to accurately confirm the diagnosis so that the treatment given is appropriate. Research on shoulder injection, where organs are overlapping, and carried out by expert and experienced doctors, shows that the accuracy of injection without ultrasound is only 56%, while with ultrasound the accuracy reaches 94%.


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