Musculoskeletal Ultrasound Krishna Khanal, MD SIU Sports Medicine Fellow

Emerging technology Diagnostic Diagnostic Therapeutic/Interventional Therapeutic/Interventional

Musculoskeletal Ultrasound Extension of physical exam. Extension of physical exam. Built in control. Built in control. Quick exam with quick answers. Quick exam with quick answers. Pain-free with no claustrophobia. Pain-free with no claustrophobia. Dynamic examination. Dynamic examination. Digital images to print, save, transport. Digital images to print, save, transport.

Is MSKUS Evidence Based? Retrospective study of 1,012 patients treated by MSK and sports physicians over a 10- month period by Sivan et al. concluded that the use of clinic-based MSK US enables a one- stop approach, reduces repeated hospital appointments and improves quality of care. Retrospective study of 1,012 patients treated by MSK and sports physicians over a 10- month period by Sivan et al. concluded that the use of clinic-based MSK US enables a one- stop approach, reduces repeated hospital appointments and improves quality of care. Musculoskeletal Care. 2011;9(2):63-8

Improved Outcomes RCT by Sibbitt et al. in 148 painful joints were randomized. RCT by Sibbitt et al. in 148 painful joints were randomized. US guided had 43% reduction (p<0.001) in procedural pain. US guided had 43% reduction (p<0.001) in procedural pain. 58% reduction (p<0.001) in absolute pain scores at the 2 wks outcome. 58% reduction (p<0.001) in absolute pain scores at the 2 wks outcome. 75% reduction (p<0.001) in significant pain and 62% reduction in non-responder rate. 75% reduction (p<0.001) in significant pain and 62% reduction in non-responder rate. Increased detection of effusion by 200% and volume of aspirated fluid by 337%. Increased detection of effusion by 200% and volume of aspirated fluid by 337%. Journal of Rheumatology. 2009: 36(9):

MSKUS vs. MRI In a prospective study of 124 patients, US and MRI had comparable accuracy for identifying and measuring the size of full-thickness and partial-thickness rotator cuff tears, with arthroscopic findings used as the standard. In a prospective study of 124 patients, US and MRI had comparable accuracy for identifying and measuring the size of full-thickness and partial-thickness rotator cuff tears, with arthroscopic findings used as the standard. J Bone Joint Surg Am. 2004; 86-A(4):708-16

Advantages over other imaging Cost (10-20% the cost of MRI). Cost (10-20% the cost of MRI). Portability Portability Patient friendly (Interactions) Patient friendly (Interactions) No C/I No C/I High resolution High resolution Reproducibility (Follow the pathology) Reproducibility (Follow the pathology) Easy follow up with repeat tests and measurement. Easy follow up with repeat tests and measurement. Doppler to screen for inflammation/vascularity. Doppler to screen for inflammation/vascularity.

Sports Medicine Applications Tendons Tendons Muscles Muscles Ligaments Ligaments Nerves Nerves Joints Joints Cartilage Cartilage

Anterior Shoulder Ultrasound

Ultrasound Cases Carpal tunnel syndrome Carpal tunnel syndrome

De Quervain’s Tenosynovitis

Intersection Syndrome

16 yo baseball pitcher w/ Elbow pain

Loose Bodies

Lymphadenitis/Phlebitis

Rotator Cuff Tear: Full Thickness

Partial Thickness Tear

AC Joints Effusion w/ periarticular fluids/Joint Luxation Effusion w/ periarticular fluids/Joint Luxation

Percutaneous Tenotomy Calcific tendinopathy: 52 yo female Calcific tendinopathy: 52 yo female Left shoulder pain for years. Left shoulder pain for years. 2 x 1.8 cm calcification within supraspinatus for 7 yrs. 2 x 1.8 cm calcification within supraspinatus for 7 yrs. 8 cortisone shots in the past: short-term relief. 8 cortisone shots in the past: short-term relief. Night pain, unable to lift arm overhead. Night pain, unable to lift arm overhead. Doesnot want to have surgery. Doesnot want to have surgery. ASA/Plavix, h/o cardiac stents. ASA/Plavix, h/o cardiac stents.

Calcific tendonitis

Biceps Tendinosis

Hip Ultrasound

Hip Pathology

Foreign body

Quadriceps Muscle Rupture

Achilles Tendon

Plantar Fascia

Ultrasound Injections Shoulder Joint: Subacromial/deltoid, AC, SC, Biceps Shoulder Joint: Subacromial/deltoid, AC, SC, Biceps Hip Joint: Greater Trochanteric, Iliopsoas, Ischial Tuberosity Hip Joint: Greater Trochanteric, Iliopsoas, Ischial Tuberosity Knee Joint: Pre-patellar, Meniscus Cyst, Baker’s Cyst Knee Joint: Pre-patellar, Meniscus Cyst, Baker’s Cyst CMC Joint, STT Joint CMC Joint, STT Joint Lateral/Medial Epicondyle Lateral/Medial Epicondyle FHL FHL Lateral Femoral Cutaneous Nerve Lateral Femoral Cutaneous Nerve Tenotomy Tenotomy PRP PRP

Anatomic Anomalies Bifid Median Nerve and Artery Bifid Median Nerve and Artery

Thank you!