MSK Ultrasound in OEM
Musculoskeletal ultrasound (MSK US) is an increasingly valuable tool in the evaluation and management of patients with joint, muscle, tendon, and ligament injuries. Its portability, real-time imaging capabilities, and cost-effectiveness make it a practical choice for occupational and environmental medicine (OEM) clinicians.
Why Use MSK Ultrasound?
MSK US is well-suited for diagnosing common musculoskeletal conditions seen in clinical practice:
Joint Effusions: Ultrasound is excellent for identifying effusions, whether anechoic or echogenic, depending on the fluid’s composition and age.
Tendon Injuries: It’s highly accurate in detecting disruptions in structures like the Achilles tendon and knee extensors.
Shoulder Dislocations: With a sensitivity of 99.1% and specificity of 99.9%, ultrasound is a reliable and fast option for confirming dislocations, while also minimizing radiation exposure and reducing costs.
Rotator Cuff Injuries: While it requires experience, MSK US can match the diagnostic accuracy of MRI for evaluating the rotator cuff.
Fractures: Studies consistently show that ultrasound performs well in identifying fractures, particularly in pediatric forearm injuries and adult ankle fractures, with sensitivities and specificities often above 90%.
How to Optimize Image Acquisition
To maximize the diagnostic utility of MSK US, proper technique is essential:
Use the Right Equipment: A high-frequency linear transducer provides the resolution needed for superficial structures.
Scan in Two Planes: Imaging in orthogonal planes ensures a thorough evaluation.
Dynamic Imaging: Movement of the affected limb and comparison with the contralateral side can help identify subtle abnormalities.
Improve Acoustic Windows: Techniques like using a water bath or standoff pads can enhance imaging of superficial structures, such as the fingers or toes.
Demonstration of point-of-care ultrasound (PoCUS) in diagnosing a distal radius fracture.
Recognizing Common Pathology
MSK US offers a detailed look at musculoskeletal structures, allowing for the identification of:
Effusions: These appear as fluid collections that can range from anechoic to echogenic.
Tendon Injuries: Normal tendons show parallel fibrillar patterns, while tears are visible as disruptions or hypoechoic areas.
Muscle Pathology: Healthy muscle appears hypoechoic with echogenic striations. Tears or hemorrhages disrupt this normal pattern.
Bone Fractures: The cortical bone is bright and echogenic on ultrasound, with fractures appearing as defects or interruptions in this surface.
A) a displaced distal radius fracture and B) proper alignment post-reduction. The distal radius appears on the left side of the screen.
Distal radius fracture: Pre-reduction (left) and post-reduction (right).
MSK Ultrasound in OEM Practice
In OEM settings, where workplace injuries often require rapid assessment and intervention, MSK US can streamline care. It allows for quick, bedside evaluations that can guide clinical decision-making, minimize delays, and reduce unnecessary referrals or imaging studies. For conditions like rotator cuff tears, fractures, or joint effusions, MSK US provides actionable insights in real time.
Integrating MSK US into routine practice not only enhances patient care but also aligns with the goals of OEM by reducing downtime and improving overall workplace health outcomes. For clinicians already familiar with ultrasound or those looking to expand their skills, MSK US is a versatile and powerful addition to the diagnostic toolkit.
Reference
Chartier LB, Bosco L, Lapointe-Shaw L, Chenkin J. Use of point-of-care ultrasound in long bone fractures: a systematic review and meta-analysis. Canadian Journal of Emergency Medicine. 2017;19(2):131-142. doi:10.1017/cem.2016.397
Gottlieb M, Holladay D, Peksa GD. Point-of-care ultrasound for the diagnosis of shoulder dislocation: A systematic review and meta-analysis. The American Journal of Emergency Medicine. 2019;37(4):757-761. doi:10.1016/j.ajem.2019.02.024