Utility of point-of-care musculoskeletal ultrasound in the evaluation of emergency department musculoskeletal pathology

Situ-LaCasse, Elaine; Grieger, Ryan W.; Crabbe, Stephen; Waterbrook, Anna L.; Friedman, Lucas; Adhikari, Srikar

doi:10.5847/wjem.j.1920-8642.2018.04.004

Cited by 32 publications

(26 citation statements)

References 20 publications

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“…Ultrasonography is a powerful diagnostic method in musculoskeletal pathologies as it allows real-time, high-resolution examination [19]. The use of ultrasound in emergency services provides practical and reliable data [20]. The limits of the haematoma area were clearly demonstrated with the bedside ultrasound in our patient.…”

Section: Discussionmentioning

confidence: 68%

Ultrasound use of post-traumatic gluteal haematoma in a patient using warfarin

Demir

Kazancı

Smereka

et al. 2019

Disaster Emerg Med J

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Most of the muscle pathologies consist of traumas. The use of oral anticoagulants increases post-traumatic bleeding and haematoma risk. Ultrasonography has an important place in diagnostic examination of the soft tissue haematomas that appear in post-traumatic period. In this study a patient is presented who used warfarin and was admitted at the emergency department with hip pain and difficulty in walking, and who had gluteal haematoma on ultrasound after falling down. Hip pains in patients using warfarin must be alarming in terms of gluteal haematoma. Ultrasound offers fast and reliable results in preventing complications.

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Section: Discussionmentioning

confidence: 68%

Ultrasound use of post-traumatic gluteal haematoma in a patient using warfarin

Demir

Kazancı

Smereka

et al. 2019

Disaster Emerg Med J

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“…The use of POCUS has been documented to change management, prompting physicians to perform an arthrocentesis or abandon plans to perform the procedure based on sonographic findings and spare the patient from the procedure’s associated risks. 2 , 10 Given the demonstrated ability of POCUS to aid in arthrocentesis in prior literature, it seems reasonable to assume the potential benefit in training EM residents to utilize POCUS when evaluating for an effusion and performing an arthrocentesis.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies have found that POCUS can aid in patient safety as a tool for procedural needle guidance. 2 , 16 Ultrasound needle guidance was found to reduce the number of attempts and decreased patient-reported pain compared to landmark technique and maximizing the amount of fluid removed during an arthrocentesis. Given this support from the prior literature, adequate needle visualization was a key component of the arthrocentesis didactic session the residents received.…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies have shown that EM residents are not only teachable, but overall perform well after didactic sessions aimed at both musculoskeletal US exams and ultrasound–guided procedures. 2–6 A prior study by Berona et al evaluated EM resident-performed US on cadavers for diagnosis of effusions and compared the success of a landmark-guided approach with an ultrasound-guided technique for arthrocentesis of various joints. 7 This study found that while EM residents were able to successfully identify joint effusions with US, they were unable to detect significant differences in actual procedural success between the two modalities.…”

Section: Introductionmentioning

confidence: 99%

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The Use of Point-of-Care Ultrasound for Arthrocentesis Among Emergency Medicine Residents

Acuña¹,

Yarnish²,

Situ-LaCasse³

et al. 2021

OAEM

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Introduction The objective of this study is to determine if EM resident physicians are able to successfully utilize POCUS to perform an arthrocentesis in the ED. This is a retrospective review of ED patients who received an ultrasound-guided or ultrasound-assisted arthrocentesis performed in the ED over a 6-year period by an EM resident physician. Methods This was a retrospective review of ED patients who received an ultrasound-guided or ultrasound-assisted arthrocentesis performed in the ED over a 6-year period by an EM resident physician. An ED POCUS database was reviewed for POCUS examinations where an arthrocentesis was performed. Electronic medical records were then reviewed for demographic characteristics, history, physical examination findings, ED course, additional imaging studies, and the impact of the POCUS study on patient care and disposition. Results A total of 101 POCUS examinations of patients were included in the final analysis. The POCUS examinations and procedures were performed by 59 different EM residents at various levels of training. Overall, 92.1% (93/101) of the procedures were successful. When assessing for image quality, 98/101 (97%) had recognizable structures at minimum. The majority of the patients (84/101, 83.2%) received additional imaging of the affected joint. In the minority of cases (23/101, 22.8%), the ultrasound-assisted approach was utilized, while 78/100 (77.2%) utilized the ultrasound-guided approach. For the studies that utilized the ultrasound-guided approach, the quality of needle visualization was determined to be “good” 40/78 (51.3%). Conclusion EM resident physicians are able to utilize POCUS to perform an arthrocentesis in the ED. Further research is encouraged to determine whether having residents utilize POCUS to perform an arthrocentesis has a significant impact on outcomes and patient care.

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“…The use of ultrasound to delineate the structures of the musculoskeletal system is well-documented throughout the literature [22]. Point-of-care ultrasound has been shown throughout the literature to be a useful tool when diagnosing various musculoskeletal pathology, identifying structures and aiding various musculoskeletal procedures [23].…”

Section: Discussionmentioning

confidence: 99%

Derivation of a Standardized Method to Identify the Anterior Compartment of the Lower Extremity Using Point-of-Care Ultrasonography

Filler¹,

Orosco²,

Mitchell³

et al. 2021

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Introduction: Anterior compartment syndrome (ACS) of the lower extremity is a well-recognized surgical emergency. The anterior compartment is the most frequently missed of the four compartments during lower extremity fasciotomy. This study describes a novel approach that combines sonographic measurements and physical examination landmarks to accurately identify the anterior compartment. Materials and Methods: This study was conducted as a prospective anatomical study of 94 volunteers at a single institution. Physical exam and sonographic methods were utilized to derive measurements of the anterior compartment, followed by biometric and validation data. Results: Volunteers for the derivation and validation phases of study were similar regarding gender, height and weight, age, and BMI. The derivation set revealed the distance to the anterior compartment to be 2.77 cm (median 2.6 cm, range 1.5 -5.4 cm) from the mid-axial line and resulted in identification of the anterior compartment 100% of the time (p < 0.001). Findings were reproducible in the internal validation set with 100% accuracy. Conclusion: The fascial planes of the anterior compartment can be identified with 100% accuracy when utilizing physical examination and sonographic methods. This can serve as a foundation for future studies evaluating ways to reduce of the number of missed anterior compartment fasciotomies in the setting of ACS.

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Utility of point-of-care musculoskeletal ultrasound in the evaluation of emergency department musculoskeletal pathology

Abstract: Our study findings illustrate the utility of POCUS in the evaluation of a variety of musculoskeletal pathologies in the ED.

Cited by 32 publications

References 20 publications

Ultrasound use of post-traumatic gluteal haematoma in a patient using warfarin

Ultrasound use of post-traumatic gluteal haematoma in a patient using warfarin

The Use of Point-of-Care Ultrasound for Arthrocentesis Among Emergency Medicine Residents

Derivation of a Standardized Method to Identify the Anterior Compartment of the Lower Extremity Using Point-of-Care Ultrasonography

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