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Musculoskeletal Ultrasound

Over the last several years the use of ultrasound in sports and orthopedic medicine has grown rapidly. Cutting-edge sports medicine physicians now use ultrasound both to help diagnose injuries and to guide injections to make them more accurate and effective.

At Oklahoma Sports & Orthopedics Institute, we use musculoskeletal ultrasound (MSKUS) to help diagnose injuries to muscles, ligaments, tendons and joints. Dr. Madhavarapu and Dr. Boehm have extensive training in MSKUS.

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 identify inflammation 
  • Ability to guide injections 
  • No contraindications

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

Ultrasound-Guided Injections
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 ultrasound or fluoroscopic guidance, studies have shown the poor accuracy rate of these blind injections. Performing injections under ultrasound guidance helps ensure 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.

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 (deep in the buttocks near 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 OSOI, Dr. Madhavarapu and Dr. Boehm have extensive training and experience with ultrasound guidance and needle placement for many musculoskeletal procedures.

Pitfalls of MSKUS

What can MSKUS not do?  While MSKUS has many great advantages, there are some restrictions, including:

  • Unlike MRI, ultrasound cannot penetrate bone to "see" inside joints, so cartilage and joint surfaces are not visualized well 
  • MSKUS is generally not as good as x-ray and CT scan at looking at bones 
  • Performing and interpreting MSKUS takes a lot of training and practice, more than x-rays and MRI