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Musculoskeletal Ultrasound

Over the last several years the use of ultrasound in sports and orthopaedic medicine has grown rapidly.  When most people think of ultrasound, they immediately think of obstetricians looking at growing babies with fetal ultrasounds, or cardiologists doing echocardiograms to assess the heart.  But cutting-edge sports medicine physicians are starting to use ultrasound to diagnose injuries and to guide injections to make them more accurate and effective.

At Village Osteopath we use musculoskeletal ultrasound (MSKUS) to help diagnose injuries to muscles, ligaments, and joints.

Advantages of Diagnostic MSKUS

MSKUS has many significant advantages over x-rays, MRI, and CT scans. These include:

  • better resolution of soft tissue than MRI
  • convenient in-office service; no need to go to another facility
  • no exposure to ionizing radiation
  • no claustrophobia
  • the ability to perform a dynamic or “live” study; we can see the injured area move and look for evidence of injury
  • more cost-effective
  • ability to see inflammation
  • ability to guide injections

For example, MSKUS has been shown to be equal to or even better than MRI for looking at the rotor cuff.  Also, MSKUS allows the physician to look for signs of joint instability, unlike x-rays or MRI.

For example, look at the image to the right. This shows a normal appearing supraspinatus tendon, one of the muscles of the rotator cuff.  The tendon has a uniform smooth appearance, the overlying bursa has no fluid and the bursa walls are not thickened, and the cortex of the humeral head is smooth.

Now look at the image to the left of an abnormal rotator cuff.  The tears in the supraspinatus tendon are clearly visible.  There is also subtle loss of the normal convex curve of the upper surface of the tendon and overlying bursa, further indicating a tear in the tendon.  In addition, there is some thickening of the bursal walls, suggesting a chronic irritation, consistent with tendinosis and bursitis.



Ultrasound-Guided Injections

Dr. Nall discusses his success with ultrasound-guided injections at Village Osteopath:

One of the great advantages of MSKUS is the ability to use ultrasound to help the physician guide the needle when performing injections.  While many injections traditionally are performed “blind,” without the help of guidance, studies have shown the poor accuracy rate of blind injections.  Performing injections under ultrasound guidance helps insure accurate needle placement and medication delivery.  This improves both patient comfort and treatment efficacy. It also helps avoid placing the needle in nearby dangerous structures such as nerves, blood vessels, or other organs.

For example, a recent study looked at the accuracy of hip joint injections done with ultrasound guidance.  Ultrasound had a 97% accuracy rate.  When comparing injections given into the piriformis muscle (a muscle deep in the buttocks that sits on top of the sciatic nerve) between ultrasound and fluoroscopy (“live” x-ray), one study showed that ultrasound guidance achieved a 95% accuracy rate, whereas fluoroscopy was accurate only 30% of the time in guiding the needle correctly.

At Village Osteopath, we have extensive experience with ultrasound guidance, and we perform almost all of our injections under ultrasound.

Village Osteopath
15510 Herriman Blvd
Noblesville, IN 46060
(317) 491-5272
(317) 324-3183 (fax)