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Common indications for musculoskeletal / joint ultrasound

Diagnostic musculoskeletal / joint ultrasound

Evaluation of patients with musculoskeletal symptoms:

  • Joint (articular) pain and/or swelling and/or effusion and/or tenderness
  • Peri-articular pain and/or swelling and/or tenderness
  • Enthesal symptoms (sites where tendon and ligament attach to bone)
  • Non-traumatic or posttraumatic regional musculoskeletal symptoms (e.g. pain, swelling, clicking) without clear localization
  • Currently asymptomatic patients with prior established articular or peri-articular symptoms
  • Articular or peri-articular symptoms in cases with difficult physical examination

Evaluation of regional neuropathic pain / suspected peripheral nerve entrapment:

  • Median nerve at forearm and wrist (Carpal tunnel)
  • Radial nerve at forearm
  • Ulnar nerve at elbow (Cubital tunnel) and wrist (Guyon’s canal)
  • Posterior tibial nerve at ankle
  • Interdigital nerves (Morton’s neuroma)
  • Peroneal nerve at fibular head

Evaluation of localized or diffuse muscle weakness

Monitoring drug efficacy, activity of joint inflammation (synovitis), progression of joint damage
in arthritis patients

  • Patients with inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis)
  • Patients with crystal induced arthropathies (gout, CPPD)
  • Patients with degenerative joint disease (osteoarthritis)

List of common ultrasound-guided procedures

  • Joint aspiration
  • Non-synovial fluid aspiration (abscess, cyst)
  • Aspiration of tophaceous mass
  • Injections of medications into joints (steroid, viscous supplements)
  • Injections of medications into tendon sheets, peritendons, perientheses
  • Perineural injections (e.g. carpal tunnel, cubital tunnel, etc.)
  • Injection of Dupyuptren’s lesions
  • Needle tenotomy
  • Barbotage /removal of calcium deposits
  • Synovial biopsy
  • Foreign body removal
  • A1 pulley resection

What musculoskeletal / joint pathologies can be detected with ultrasound?

B-mode examination

  • Joint effusion, hemarthrosis
  • Synovial thickening
  • Damage to menisci (knees) and labral (shoulders, hips) joint structures
  • Erosions of cortical bone
  • Osteophytes
  • Enthesophytes
  • Avulsion fractures
  • Chondrocalcinosis (aka CPPD deposition in TFC, intrinsic wrist ligaments, and femoral cartilage)
  • Sodium urate deposits (tophi, “double contour” sign)
  • Retinaculum and tendon pulley thickening, tears
  • Tendon abnormalities (tears, tendonopathy, calcifications, impingement, subluxations)
  • Fascial pathology (plantar, palmar)
  • Ligament pathology (tears, sprains)
  • Bursitis
  • Loose and foreign bodies
  • Cystic lesions, hematoma, abscess

Dynamic B-mode examination

  • Impingement of tendons and bursa (e.g. rotator cuff)
  • Subluxation and determining cause of the clicking /snapping of tendons (e.g. biceps, peroneus, iliotibial band or iliopsoas, extensor carpi ulnaris)
  • Subluxation of nerves (e.g. ulnar nerve at elbow)
  • Ligament tears and sprains (wrist, knee, ankle)

Power Doppler examination

  • Synovial hyperemia / synovitis
  • Tendon sheet hyperemia /tenosynovitis
  • Tendon and ligament hyperemia / tendinitis
  • Soft tissue hyperemia / cellulitis, panniculitis
  • Enthesal hyperemia /enthesitis