Diagnostic Ultrasound
Diagnostic ultrasound for musculoskeletal conditions has been around for many years. Technology has improved significantly over recent years and ultrasound scans have become increasingly popular as a first line of investigation in musculoskeletal medicine. Accurate diagnosis is key to implementing the most effective treatment regime for your recovery and diagnostic ultrasound can provide an effective adjunct in this process.
Common things we scan for are:
Joint Swelling: possibly related to trauma or joint disease eg osteoarthritis.
Tendon Pathology: egachilles, patella and rotator cuff (shoulder) tendons and the tendons involved in tennis elbow and golfer’s elbow.
Ligament Injuries: e.g. sprained ankle
Abdominal Muscle Contraction: “core” muscle activation biofeedback
Guided Injection Therapies: for bursitis and capsulitis (inflammation of a joint capsule)
Why are ultrasound scans useful in musculoskeletal medicine:
It is safe to have ultrasound in the presence of metalwork e.g. fracture fixations or joint replacement. It is also safe around implants eg pacemakers, which sometimes prohibit MRI imaging. There is no problem with claustrophobia as there can be for MRI.
Ultrasound can have excellent resolution of superficial tissues, even better than some MRIs. This means that subtle changes such as the early stages of tendon injuries or small tears eg of the rotator cuff, can be seen with ultrasound and missed on some MRIs.
One of the problems interpreting images, be they ultrasound or MRI, is what is considered normal? Not every detail on imaging is clinically significant. Ultrasound allows for a quick comparison of the other limb to see if pathology seen in the symptomatic limb is present or absent on an asymptomatic limb.
We call this dynamic imaging. Sometimes being able to move a body part, and see on screen how the tissues change, adds useful information that can be missed on a static x-ray and MRI, e.g. shoulders may pinch/impinge with a specific movement.
The patient is not exposed to ionizing radiation like x-rays and CT scans. There are no known harmful effects of ultrasound when properly administered.
It’s always nice to know the injection you receive has gone where you wanted. Ultrasound allows us to see exactly where the injection is going. There is evidence that ultrasound injections are more effective than landmark guided injections.
What are the shortcomings of ultrasound scan
The quality of the images is highly dependent on the skill and experience of the person performing the exam and their anatomical knowledge.
Results are difficult to interpret and require experienced clinicians.
There is no statutory register of clinicians or required standard of training in musculoskeletal sonography. You could buy a machine, do a 1 day course and set up in business providing scans (but please don’t!). When looking for a clinician, CASE accreditation is a good place to start. CASE is an organization that exists to accredit sonographic courses delivered in the UK to ensure the highest standards are met.
The deeper the tissue we want to see, the less detail we can pick up. For larger patients or particularly deep structures, alternative imaging is sometimes recommended.
The sound waves reflect off bone so we cannot see inside joints and although we can see the edge of cartilage at some points of a joint, ultrasound is not the best way of imaging for cartilage injuries e.g. meniscal injuries in the knee.
Your Physiotherapist
Ed Stephens is clinical director at the Grosvenor Physiotherapy Clinic and is a highly specialised physiotherapist, trained in the use of diagnostic ultrasound to help diagnose muscle, tendon, ligament and joint problems.
He has been using ultrasound in his clinical practice almost daily for the past 7 years and intermittently for 4 years before that. He has done numerous post graduate courses in sonography, including at the centre for ultrasound studies in Bournemouth, gaining his CASE accreditation 6 years ago. This involved a series of academic exercises in science and instrumentation and case studies as well as attaining a logbook of supervised scans and finally a day long practical exam on patients overseen by a radiologist.
Arrange a scan
If you would like to arrange an ultrasound scan or would like more information please call us on 01638 667606 or email us.
Please note we are unfortunately not able to provide CD discs of scans taken from our machines. Also, we recommend use of ultrasound provided in clinic as an accessible first line of assessment. If required, we can refer on for MRI or further investigation at a local private hospital.
