Musculoskeletal ultrasound- what is it

Musculoskeletal ultrasound is a non-invasive, accurate imaging modality that can prove useful in diagnosis of a variety of musculoskeletal injuries and disorders.

Advantages of musculoskeletal ultrasound over MRI include:
-dynamic nature of the study possible unlike MRI which helps provide more details pertaining to the abnormality as the scans can be performed while moving the area of interest through a range of motion.
– Comparison with the opposite side/limb is easier & retains the image quality of the area of interest. Simultaneous MR evaluation of control and affected limb is more time consuming and yet less informative with MRI
– Provides greater opportunity of clinical interaction between patient and radiologist
-Musculoskeletal interventional ultrasound can also help treat unlike MRI

A wide variety of conditions can be evaluated with musculoskeletal ultrasound:
• Tendon and ligament injuries and tears
• Lumps & bumps in relation to muscles/joints/nerves
• Joint fluid
• Peripheral nerve compression problems
• Rheumatology & Joint problems

These are some of the interesting cases that I have  recently seen in my routine practice of Musculoskeletal ultrasound:

Case 1: Patient with pain in left hand with suspicion of median nerve involvement on NCV: Ultrasound clearly depicts  evidence of assymetric median nerve swelling in carpal tunnel

Case 2: Young female with pain and swelling in left wrist & hand: USG shows assymetric synovial thickening at left ulnocarpal joint. Diagnosed later as ankylosing spondylitis on further workup

The use of US in diagnostic and therapeutic interventional proceudres enhances the accuracy of needle placement in spaces that are difficult to enter on the basis of external landmarks alone and improves clinical outcomes.

Many USG guided interventional procedures may be performed:

  • Joint aspiration/injections
  • Synovial and mass biopsies
  • Barbotage for calcific tendinitis
  • Tendonsheath & Peritendoninous injections
  • Hydro-dissection techniques & Hydrodilatation for adhesive capsulitis
  • Regenerative medicine procedures including PRP & dry needling

Following are some of the interventional muscculoskeletal procedures that I have  performed recently:

Case 1: USG guided barbotage for calcific tendinitis of subscapularis muscle

Case 2: Synovial biopsy for Erosive arthritis of shoulder:

Biopsy showed presence  of granulomas suggesting tubercular etiology- patient on ATT

Case 3: Diagnostic block for confirmation of piriformis syndrome in a case of large disc bulge at L4-5 region with only unilateral symptoms. Pain disappeared after injection of local anaesthetic in piriformis muscle on symptomatic side confirming diagnosis of piriformis syndrome. Patient counselled for active stretching excercises and on follow up. Can be taken for steroid/botox injection if symptoms worsen

 

Dr. Anuj Thakral

Dr. Anuj Thakral started his informal medical training at home...

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