Introduction to MSK Ultrasound

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Dr. Peter Rippey, MD, CAQSM

PCSM Fellowship Program Director

Associate Professor of Family Medicine

University of South Alabama

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Dr. Rippey is talking about Musculoskeletal Ultrasounds and everything that goes into doing an ultrasound on someone. Ultrasounds are the new stethoscope!! Ultrasounds can be big with a huge machine or tiny ones that can be carried in your pocket. They are very expensive and can be very pricey depending on size.

Physics of Ultrasound:

* Sound is a pressure wave propagating through a medium

* Frequency is one positive and negative pressure change cycle/s or Hz

* Human hearing 20-20,00 Hz

* Ultrasound is anything >20,000 Hz

Tissue Types:

*Tendon: Alternating hyper and hypoechoic lines, In LAX-wood grain, In SAX-end of a brush

*Patellar

*Muscle: Hypoechoic muscle fibers, separated by fibro adipose septa, LAX pennate, SAX Starry Night Lights

*Ligament: Intermediate echogenicity, Dynamic allows us to look for the stress of the ligaments

*Bone: Hyperochic with acoustic shadowing, Increasingly is used to assess for fractures, Erosions from RA are visible on us prior to x-ray

*Nerve: Similar to tendons but less tightly packed, Hypoechoic fascicles, surrounded by hyperechoic epineurium, Honeycomb Pattern

Indications/Uses:

*Evaluation of joint and extremity pain

*Evaluation of peripheral nerves

*Evaluation of masses

*Evaluation of rheumatologic conditions

*Image-guided injections/aspiration/procedures

Limitations:

*Operator dependent/training

*Limited field of view

*Cannot see inside joints/past bone cortex

*Other providers may not be able to interpret

Benefits:

*Anyone can be scanned

*Cost

*Dynamic Imagining

*Ability to intervene at the same time as the diagnosis

*Side-to-side comparison

*Available

*Point of Care (helps speed things up)

*Doppler (blood flow)

*Superior resolution over MRI

In Conclusion, I have learned many new things today with Dr. Rippey. He has talked about Musculoskeletal Ultrasounds. We first learned about the physics of ultrasounds, then the types of tissues you can look at using the ultrasound machine, and finally the uses, benefits, and limitations you receive from an ultrasound. It has come a long way over the years and getting more useful each day.