Musculoskeletal Ultrasound: A Noninvasive Way to Determine the Source of Pain

When you have an injury, it can be frustrating to not know what your diagnosis is or be able to pinpoint the exact source of pain. It can be just as exasperating not to know how to treat the issue so you can get back to doing the daily activities and sports you enjoy.

What is a Musculoskeletal ultrasound?

Musculoskeletal ultrasound is a type of musculoskeletal imaging that helps to diagnose many different orthopedic and sports injuries as well as the causes of many types of of muscle, ligament, tendon and joint pain. Like traditional forms of radiography including computerized tomography (CT) and magnetic resonance imaging (MRI) musculoskeletal ultrasound is a noninvasive medical test. It can help diagnose injury, but also adds a complementary dimension of imaging evaluation using sound waves to create images of damaged soft tissues in the extremities.

How does Musculoskeletal Ultrasound work?

Musculoskeletal (MSK) ultrasound works by using sound waves to produce images of the inside of the body. It is the same technology that many have experienced with the ultrasound of a baby. In this case it is just used to look at muscles, tendons, and joints. A probe called a transducer and ultrasound gel is placed on the body part. The transducer transmits high frequency sound waves through the gel into the body. The transducer then collects these sound waves and transforms them into an image. The ultrasound images are viewed in real time allowing movement and evaluation of the body part.

What does musculoskeletal ultrasound diagnose?

Musculoskeletal ultrasound is used in orthopedic practice to diagnose injury as well as for needle guidance when performing injections. MSK ultrasound is commonly used to diagnose:

• Tendonitis including tennis elbow, golfers elbow, wrist tendonitis, patellar tendonitis, etc.
• Tendon tears of the rotator cuff, biceps tendon, triceps tendon, and quadriceps tendon
• Ganglion cysts
• Joint effusions (swelling)
• Dislocations
• Subtle occult fractures (not visible on X-ray)

Is it safe?

Ultrasound is non-invasive and safe for patients of all ages. Since it does not use radiation, there is no exposure to the patient. It is an excellent alternative for patients who are claustrophobic or who have metallic implants in the body and cannot undergo an MRI.

How long does it take?

Typical scans take 15-30 minutes to perform. If the patient is undergoing an injection there may be additional time for preparation, set up, observation after injection, etc. All procedures are performed in office. Time permitting, most are done the day of the visit/appointment.

How is a MUSCULOSKELETAL ULTRASOUND different from MRI or X-ray?

Unlike MRI, patients undergoing ultrasound do not have to remain perfectly still or lie in an enclosed space to undergo the procedure. It is also not contraindicated in patients with pacemakers or metallic implants. It is a fraction of the cost of MRI as well making it a cost effective diagnostic modality. It does not use ionizing radiation like x-ray and is therefore safe to perform on patients of all ages and on all body parts.

How is the procedure performed?

Depending on the body part examined, the patient is positioned either seated in a chair or lying on the examination table. The examiner places ultrasound gel on the affected body part and passes the transducer over the area to obtain the appropriate images. Other than some pressure from the transducer, there should be no discomfort from the exam. The examiner interprets the images at the time of the visit and will then discuss them and the treatment plan with the patient.

Does it hurt?

Other than pressure from the transducer, there should be no discomfort from the examination.

What do I wear?

The examiner will place the patient in the appropriate attire for the specific examination. Typically shorts for hip, knee and ankle exams and a gown for upper extremity exams.

Who determines the results and when do I get them?

MSK ultrasound is performed at OrthoCarolina by physician assistants and physicians. The results are interpreted by the examiner at the time of the visit. The findings are discussed and a treatment plan is then agreed upon.

Scot Rheinecker, PA-C is a physician assistant with OrthoCarolina Concord and is also part of the OrthoCarolina Motorsports Outreach team.