MUSCULOSKELETAL ULTRASOUND DIAGNOSIS

AN INTRODUCTION TO

IN SPORT AND EXERCISE MEDICINE – PART 1

This article has been divided into two parts. This first covers the introduction, history, equipment, pros and cons and training issues associated with musculoskeletal ultrasound in sports medicine. The second article will cover typical clinical applications for musculoskeletal ultrasound in non-secondary care musculoskeletal practice. This includes three main sections - pure diagnostic MSKUS ie. using ultrasound equipment to aid more accurate diagnosis; interventional MSKUS ie. involving the use of guiding instruments for either ‘needling’, aspiration or injection; and thirdly biofeedback MSKUS to augment verbal and tactile instruction in rehabilitation.

By Lt Colonel Duncan G Robertson RAMC, MRCGP, DCH MSc, PGCMskUS, MFSEM and Dr James Brown MBChB, BSc MSc(SportsMed), FFSEM

INTRODUCTION During the 1980s the imaging of muscu- loskeletal injuries was revolutionised by the development of MRI scanning (1). Suddenly it became possible to accurately visualise soft tissue injuries that had often previously required surgical exploration.

MRI image of patellar tendinosis

This new imaging allowed clinicians to improve the way patients were managed whether operatively or not however it was left to early pioneers and did not reach mainstream musculoskeletal imaging.

Over the last decade there have been sig- nificant leaps forward in technology. The image resolution from high performance ultrasound machines is now in some cases better than MRI and as a result, diagnostic ultrasound is increasingly employed as an

US image of same injury in comparison

attractive first line imaging tool for clini- cians responsible for the evaluation and treatment of soft tissue injury. Attaining and maintaining 'skill competency' to an acceptable level is perhaps the main hurdle to overcome. In the recent past some clin- icians performed diagnostic ultrasound on patients solely on the back of a 2-3 day introductory course. However, in this age of clinical appraisal and 'best practice', it seems likely that this scenario will become increasingly rare and difficult to justify (2). Even amongst consultants performing mus- culoskeletal ultrasound (MSKUS), one study showed that two-thirds of the group had never undergone a formal assessment of their skills (3).

MSKUS and other imaging modalities are often complimentary, and both may be indicated to allow a complete management plan

Figure 1: MRI image and US image of patellar tendinosis (orange circled areas indicate neovascularisation) www.sportex.net

With increased access to post graduate courses and cheaper (often portable) machines, MSKUS has found an expanding role in aiding the diagnosis and manage- ment of musculoskeletal conditions outside of the traditional departments of radiology and it is likely that this trend will contin- ue into the future. Sports physicians, orthopedic surgeons, rheumatologists, physiotherapists, osteopaths and chiro-

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