The rise in the use of diagnostic ultrasound as a diagnostic tool over the past 30 years has been sudden. It is used by a wide range of healthcare professionals in today’s hospital setting and this method of diagnosis has become routine in the investigation of disease. Musculoskeletal (MSK) Ultrasound allows healthcare professionals to examine tendons, ligaments, nerves and joints with high frequency probes.
How does it work?
During a musculoskeletal ultrasound exam, a hand-held scanning device called a transducer is pressed on your skin with ultrasound gel and transmits high frequency sound waves through the gel and into the body. This produces a black and white image on the screen.
What are the capabilities of MSK Ultrasound?
· Tendon tears or Tendinitis of the rotator cuff in the shoulder, Achilles tendon in the ankle and other tendons throughout the body
· Muscle tears, masses or fluid collections
· Ligament sprains or tears
· Inflammation or fluid (effusion) within the bursa or joints
· Early changes of Rheumatoid Arthritis
· Nerve entrapments such as Carpal Tunnel Syndrome
· Benign and Malignant soft tissue tumors
· Ganglion cysts
· Hernias
· Foreign bodies in the soft tissues (such as splinters or glass)
Advantages of MSK Ultrasound over other imaging modalities.
It has numerous advantages over other imaging modalities such as being cost-effective, non ionizing and a form of dynamic study (you can move the injured area while viewing it). It’s a useful tool for the Chiropractor during their clinical examination to help facilitate patient management.
It also provides an opportunity to educate the patient and demonstrate the normal movement of tissues.
Limitations
MSK ultrasound also has some significant limitations. It can’t image deep into joints or past a bony cortex, due to sounds waves not being able to penetrate through bone.
The use of ultrasound is limited in larger patients, due to rapid weakening of sounds waves, ultimately meaning that if you are trying to visualise a deep structure, little energy is reflected back to the transducer.
The use of MSK ultrasound is also highly operator dependent, with the potential for misinterpretation of images with artefacts (potentially misleading images) such as anisotropy*.
There is therefore the need for competency based training and ongoing continued professional development (CPD).
*Anisotropy in ultrasound examination is an angle-generated artefact. It is produced in tissue that contains multiple, parallel linear sound interfaces (e.g., tendons, ligaments) that lead to the preferential reflection of the beam in one direction.
At Bristol Chiropractic Sports and Family Clinic we do not currently have a Diagnostic Ultrasound machine, however we do have the ability to refer out for Diagnostic imaging when necessary. If you'd like to know more about diagnostic ultrasound for assessing one of your concerns, please get in touch with the clinic via and ask for Chiropractor Gareth who is a qualified Diagnostic Ultrasound Practitioner and the author of this post.
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