Office-Based Ultrasound in Sports Medicine Practice

Abstract

Increasing knowledge, interest, and visibility in the field of sports medicine has equipped clinicians in the field with a novel array of diagnostic and therapeutic options but has also provided a higher level of complexity in patient care. True understanding of the vast spectrum of radiographic technology available to the sports clinician has become more critical than ever. Advances particularly in the areas of magnetic resonance imaging, diagnostic office ultrasound, and 3-dimensional reconstruction computed tomography, as well as nuclear medicine, offer the clinician a myriad of diagnostic options in patient evaluation. As these advances accumulate, the challenge to optimize care, contain cost, and interpret the extensive data generated becomes even more difficult to manage. Improving technology, education, and application of office ultrasound offers an interesting new tool for the bedside evaluation in real time of dynamic motion and pathology of sports-related injuries. As studies continue to validate ultrasound's effectiveness in diagnosing injuries to the upper and lower extremities compared with more costly magnetic resonance imaging and more invasive exploratory surgery, its promise as a cost-effective diagnostic tool is growing. A particularly promising development in the care of sports injuries is the expansion of injection therapies, and in-office ultrasound provides assurance that prolotherapy, platelet-rich plasma, dry needling, corticosteroid, and viscosupplementation are delivered accurately and safely. Communication with patients continues to increase in complexity because a greater understanding of the presence of radiographic abnormalities irrelevant to the current complaint is gained. All the accumulated data must then be interpreted and communicated to the patient with a firm understanding of not only the patient history and physical examination but also the availability, indications, contraindications, sensitivity, specificity, and even the cost implications of the spectrum of diagnostic options.

Point‐of‐care musculoskeletal ultrasound is critical for the diagnosis of hemarthroses, inflammation and soft tissue abnormalities in adult patients with painful haemophilic arthropathy

“…This presents a growing need for optimization of treatment strategies for adult PWH who have joint disease, and who might benefit from the standards of care available in rheumatology and sports medicine. These disciplines have improved their diagnostic and intervention strategies by use of point‐of‐care MSKUS to diagnose, monitor and guide treatment in a precise and sophisticated way . For example, point‐of‐care MSKUS has not only become invaluable to diagnose early synovitis and other joint abnormalities in rheumatoid arthritis and osteoarthritis, but also to monitor response to disease‐modifying agents .…”

“…With high frequency transducers, tissue resolution approaches or is even greater than with routine MRI , and Doppler capability enables determination of synovial blood flow. MSKUS has been validated for a wide spectrum of musculoskeletal pathology in rheumatology, orthopaedics, podiatry and sports medicine, and is used there for point‐of‐care diagnosis, ultrasound‐guided interventions and monitoring of treatment responses . MSKUS is now also proposed to follow haemophilic joint status over time , applying scoring algorithms similar to the radiographic Pettersson score (2) or the MRI Denver scale .…”

Ultrasound in Athletes

“…According to their analysis, the application of pointof-care ultrasound has proven to be cost-effective and has increased patient satisfaction, reducing repeated hospital appointments and improving quality of care. Other proponents of ultrasound have pointed to the cost-effectiveness and cost-comparison of ultrasound relative to other forms of imaging, advocating for further integration of diagnostic and therapeutic ultrasound into office-based practice of sports medicine (18).…”

Commentary: Integrating Diagnostic Ultrasound into Athletic Training Education Programs

“…Because of these advancements, the integration of diagnostic ultrasound into clinical practice by a variety of practitioners, including orthopedic physicians, podiatrists, and primary care physicians, across many different clinical settings has increased, and it is now widely accepted as an important adjunct to the physical exam. [1][2][3] This integration of diagnostic ultrasound has extended beyond research-based lab studies and is becoming part of the evaluation within the exam room, which has led to the coined phrase point-of-care ultrasound, or POCUS. 4,5 Internationally, POCUS, particularly in sports and exercise medicine, 6,7 is a well-accepted imaging modality present in most clinical settings.…”