Transcript - STFM Connect

Musculoskeletal
Ultrasound
Krishna Khanal, MD
SIU Sports Medicine Fellow
Emerging technology
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Diagnostic
Therapeutic/Interventional
Musculoskeletal Ultrasound
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Extension of physical exam.
Built in control.
Quick exam with quick answers.
Pain-free with no claustrophobia.
Dynamic examination.
Digital images to print, save, transport.
Is MSKUS Evidence Based?
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Retrospective study of 1,012 patients treated
by MSK and sports physicians over a 10month period by Sivan et al. concluded that the
use of clinic-based MSK US enables a onestop approach, reduces repeated hospital
appointments and improves quality of care.
Musculoskeletal Care. 2011;9(2):63-8
Improved Outcomes
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RCT by Sibbitt et al. in 148 painful joints were
randomized.
US guided had 43% reduction (p<0.001) in
procedural pain.
58% reduction (p<0.001) in absolute pain scores at
the 2 wks outcome.
75% reduction (p<0.001) in significant pain and 62%
reduction in non-responder rate.
Increased detection of effusion by 200% and volume
of aspirated fluid by 337%.
Journal of Rheumatology. 2009: 36(9):1892-902
MSKUS vs. MRI
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In a prospective study of 124 patients, US and
MRI had comparable accuracy for identifying
and measuring the size of full-thickness and
partial-thickness rotator cuff tears, with
arthroscopic findings used as the standard.
J Bone Joint Surg Am. 2004; 86-A(4):708-16
Advantages over other imaging
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Cost (10-20% the cost of MRI).
Portability
Patient friendly (Interactions)
No C/I
High resolution
Reproducibility (Follow the pathology)
Easy follow up with repeat tests and
measurement.
Doppler to screen for inflammation/vascularity.
Sports Medicine Applications
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Tendons
Muscles
Ligaments
Nerves
Joints
Cartilage
Anterior Shoulder Ultrasound
Ultrasound Cases
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Carpal tunnel syndrome
De Quervain’s Tenosynovitis
Intersection Syndrome
16 yo baseball pitcher w/ Elbow pain
Loose Bodies
Lymphadenitis/Phlebitis
Rotator Cuff Tear: Full
Thickness
Partial Thickness Tear
AC Joints
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Effusion w/ periarticular fluids/Joint Luxation
Percutaneous Tenotomy
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Calcific tendinopathy: 52 yo female
Left shoulder pain for years.
2 x 1.8 cm calcification within supraspinatus
for 7 yrs.
8 cortisone shots in the past: short-term relief.
Night pain, unable to lift arm overhead.
Doesnot want to have surgery.
ASA/Plavix, h/o cardiac stents.
Calcific tendonitis
Biceps Tendinosis
Hip Ultrasound
Hip Pathology
Foreign body
Quadriceps Muscle Rupture
Achilles Tendon
Plantar Fascia
Ultrasound Injections
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Shoulder Joint: Subacromial/deltoid, AC, SC, Biceps
Hip Joint: Greater Trochanteric, Iliopsoas, Ischial
Tuberosity
Knee Joint: Pre-patellar, Meniscus Cyst, Baker’s Cyst
CMC Joint, STT Joint
Lateral/Medial Epicondyle
FHL
Lateral Femoral Cutaneous Nerve
Tenotomy
PRP
Anatomic Anomalies
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Bifid Median Nerve and Artery
Thank you!