Advances and utility of diagnostic ultrasound in musculoskeletal medicine

Abstract

Musculoskeletal ultrasound (US) can serve as an excellent imaging modality for the musculoskeletal clinician. Although MRI is more commonly ordered in the United States for musculoskeletal problems, both of these imaging modalities have advantages and disadvantages and can be viewed as complementary rather than adversarial. For diagnostic US, relative recent advances in technology have improved ultrasound’s ability to diagnose a myriad of musculoskeletal problems with enhanced resolution. The structures most commonly imaged with diagnostic musculoskeletal US, include tendon, muscle, nerve, joint, and some osseous pathology. This brief review article will discuss the role of US in imaging various common musculoskeletal disorders and will highlight, where appropriate, how recent technological advances have improved this imaging modality in musculoskeletal medicine. Additionally, clinicians practicing musculoskeletal medicine should be aware of the ability as well as limitations of this unique imaging modality and become familiar with conditions where US may be more advantageous than MRI.

Ligament Injury and Healing: A Review of Current Clinical Diagnostics and Therapeutics

“…Imaging by diagnostic musculoskeletal ultrasound has also been utilized to view and diagnose various ligamentous injuries [107]. Sonography has the unique capability of demonstrating the current physiologic state of musculoskeletal anatomy.…”

Achilles tendon: functional anatomy and novel emerging models of imaging classification

“…In this area, complete tears are easily differentiated from partial tears, but the nearby plantaris tendon, lying medially, can be mistaken for an intact Achilles tendon [37]. When diagnosis is doubtful, US examination may provide dynamic imaging, and ankle dorsiflexion may be helpful to detect tendon discontinuity [24]. At times, small tendon tears may be undetected, but gentle cyclical pressure with the probe or dorsi-and plantar-flexion of the ankle allows further tendon separation, and allows recognition of AT complete tears poorly demarcated by the presence of haematoma and associated debris [24].…”

“…When diagnosis is doubtful, US examination may provide dynamic imaging, and ankle dorsiflexion may be helpful to detect tendon discontinuity [24]. At times, small tendon tears may be undetected, but gentle cyclical pressure with the probe or dorsi-and plantar-flexion of the ankle allows further tendon separation, and allows recognition of AT complete tears poorly demarcated by the presence of haematoma and associated debris [24]. In Achilles tendon disorders, US and MRI have similar accuracy, mostly when patients are referred for surgery, when the great sensitivity of US (81 %) and MRI (96 %) may reflect the great severity of symptoms [22].…”

“…Ohberg et al found vessels through the entire thickness of the widened part of the tendon of patients with advanced tendinopathy, demonstrating with colour Doppler the correlation between occurrence of neovascularisation and ventral side widening of the tendon [35]. Until the histological cause of positive colour and power Doppler sonography is identified, the mechanism of this increased flow remains speculative [24]. Eccentric calf strengthening exercises [16] decreases these infiltrating vessels possibly by repeated constriction but, when patients are unresponsive, the injection under US guidance of sclerosing chemical substances or high volume formulation may remove these aberrant vessels, possibly normalising the Achilles tendon structure, and significantly relieving clinical symptoms [9].…”

Ultrasound imaging of regenerating rat sciatic nerves in situ

“…Among the greatest advantages of US imaging is that, compared to other imaging techniques, it allows for a faster, easier and more economic assessment of frequent neurological disorders, such as nerve entrapment, hereditary and acquired neuropathies, scaring, as well as localization and characterization of peripheral nerve traumas, thus making it a vital supplement to traditional peripheral nerve electrodiagnostic studies (Bianchi, 2008;Carrillon and Cohen, 2007;Cartwright et al, 2008;Gruber et al, 2007;Koenig et al, 2009;Lento and Primack, 2008;Wiesler et al, 2006). Further, because US allows nerves to be imaged in both longitudinal and cross-section, an assessment can be made as to whether, what and where surgery may be required, which minimizes the need for exploratory surgery (Bianchi, 2008;Cokluk and Aydin, 2007).…”