12 yrs ago as I was interviewing for residency training spots, I recall a program director saying that he wanted to start teaching his trainees how to read bedside echo (cardiac ultrasound) to improve the care his hospital gave. His feeling was that after a century of teaching trainees to examine hearts with a stethoscope, it was time to start teaching non-cardiologists how to examine the heart with more modern technology. This was a novel way of thinking at that time, and it’s how I think of musculoskeletal conditions as well.
Musculoskeletal ultrasound is an exciting modality for all of us who see patients with various joint, tendon, and ligament problems. It’s actually not new. It’s been used for around 20 yrs in Europe, but it’s really taken off in this country the last several years.
Here’s how I use msk ultrasound:
It helps me diagnosis new msk problems as they arise. Using my physical exam and a patient’s described complaints, I can look directly at an injured site with ultrasound. I can move an injured limb through various motions and see how it responds with ultrasound. This dynamic exam gives me a real time view of what’s happening.
Ultrasound also helps me gauge how bad an injury is, and how likely it is to progress. Certain findings in a rheumatoid joint such as significant swelling and inflammation can predict the chance of progressive destructive disease. If you have a rotator cuff tear, I can gauge your response to treatment with ultrasound. I can tell if it’s worsening, if it’s improving, and these sorts of findings help me in determining whether more aggressive treatment is required.
The goal is to give the best care for every patient. Ultrasound helps me maximize the care I provide to my patients.