Ultrasound is a powerful diagnostic tool for evaluating and treating disorders of joints, muscles, tendons and ligaments throughout the body. Diagnostic ultrasound has been used to evaluate musculoskeletal disorders for many years in Europe. Recently this imaging technique has become more prevalent in the United States. With the advent of smaller, less expensive, better resolution machines, diagnostic ultrasound can now be done in the orthopedists’ office. At Greater Hartford Orthopedic Group (GHOG) we are now using ultrasound in our office to help with the diagnosis and treatment of many orthopedic problems.
Magnetic Resonance imaging, MRI, is still the gold standard for imaging many disorders of the musculoskeletal system. MRI scanning and ultrasound are complementary. However ultrasound has some advantages over MRI in certain situations. First, ultrasound can be used in all patients, unlike MRI which can’t be used in patients with pacemakers and certain metal implants. Second, ultrasound can be used to evaluate muscles and joints in motion unlike MRI, which can only see images at rest. Third, MRI scanning requires a separate appointment for the scan while diagnostic ultrasound can be done in the office setting. Lastly ultrasound can be used to more accurately guide many of the injections done in our office.
Musculoskeletal ultrasound has been used extensively in the shoulder. MRI scanning of the shoulder is still the gold standard in this country for diagnosing musculoskeletal disorders. MRI is reportedly 90% accurate for diagnosing full thickness rotator cuff tears. In skilled hands, ultrasound of the shoulder has been shown to be over 90% accurate as well. In addition studies have shown that patients prefer ultrasound to MRI scanning. In addition, there are certain structures in the shoulder such as the biceps tendon that cannot be imaged well with MRI. Injuries such as a subluxating biceps tendon, where the biceps moves in and out of its groove with motion, can only be seen using a dynamic imaging technique such as ultrasound.
Musculoskeletal ultrasound is useful in other joints as well. Ultrasound is very helpful in evaluating elbow problems. For patients with elbow pathology such as tennis or golfers elbow, ultrasound can be used to more accurately locate the damaged tissue.
Ultrasound is not only useful in diagnosing orthopedic problems; it plays a very important role in treating various orthopedic ailments. At GHOG we are using ultrasound to better guide some of our injections. While standard injections into the shoulder such as a subacromial injection for bursitis do not always require ultrasound guidance, some injections such as an injection into the biceps sheath can only be done accurately with ultrasound. Other injections such as an injection into the glenohumeral or acromioclavicular joint for patients with arthritis can be more accurately done with ultrasound guidance.
Ultrasound is used to guide injections in other joints as well. Patients with tennis or golfers elbow can have a steroid injection or platelet rich plasma (PRP) injection placed directly into the damaged tissue under ultrasound guidance. Ultrasound has been quite helpful to us at GHOG for injections and aspirations around the knee joint as well. Hyaluronic acid injections(synvisc,supartz) into the knee are best done with ultrasound to insure accurate placement of the material. Ultrasound guidance is not necessary for routine aspiration or injection around the knee but is useful in a number of clinical situations. Patients found to have tendonitis around the knee may benefit from ultrasound-guided injections of cortisone or platelet rich plasma (PRP) into the damaged area. Having ultrasound in our office is very useful for aspirating cysts around the knee joint such as a bakers cyst. While previously this would have required an additional visit to a radiologist, it can now be done in our office the same day.
There are many other applications and uses for musculoskeletal ultrasound. At GHOG we are making this available to our patients to enable us to provide the best possible orthopedic care. For more information about the use of ultrasound at GHOG please call our office at 860-253-0276.
– Dr. Jay Kimmel and Elizabeth McAvoy, PA