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Ultrasound used to diagnose muscle injuries

Haley O'Brien

An ultrasound is not commonly associated with muscle injuries, but it’s a large part of what Dr. Charles Stevens does as a physical therapist.

At Mobile Therapy Services in Dallas, he uses Registered Musculoskeletal (RMSK) Ultrasound to see what X-Rays, MRIs, and CT Scans cannot show.

“When people come in, they may have pain in their shoulder, or weakness in their shoulder,” Stevens said. "I can scan the rotator cuff on an ultrasound and see in real time how are the rotator cuff tendons moving.”

The ultrasound can pick up signs of inflammation in joints and muscles, and helps diagnose orthopedic issues, like muscle tears, strains, and arthritis.

“The benefit of diagnostic ultrasound is the patient can move,” he said. “If she externally rotates her shoulder, we’re seeing another one of the rotator cuff tendons, and we can sweep through that tendon footprint. If there’s any pathology, we want to see that at two different angles. And if we turn the probe 90 degrees, and now we’re looking at the rotator cuff footprint.”

Dr. Matthew McElroy, a sports medicine physician at Geisinger in Danville, says he uses ultrasound with about 90 percent of his patients.

“It’s real time, so patients come in and would like to know what’s wrong with them without having to come on a separate visit for imaging,” McElroy said. “We can use it to give them an accurate diagnosis the day we see them, and sometimes save the patient not just time, but money because they don’t have to get an MRI often.”

That’s not always the case. Sometimes the musculoskeletal ultrasound is used in conjunction with other testing methods. Stevens says ultrasound offers a unique point of view that other imaging methods cannot, sometimes leading to an earlier diagnosis.

“We have found people with infected total joint replacements, whether it’s a knee or a hip; that has changed some of their medical care,” Stevens said. “If we didn’t have this modality, that person could’ve gone on longer and ended up in the hospital with sepsis and other crazy complexities from that condition.”

Stevens says he uses the diagnosis to create a treatment plan and monitor a patient's progress, or he refers the patient to a specialist.

“Foot drop, where people have weakness and difficulty moving their toes towards their shin, about 20 percent of that condition is caused by a ganglion cyst, pressing on the common peroneal nerve behind the knee, so I have found that in several people and it has changed their medical care,” he said. “I can’t take that cyst out, but we can refer that patient to the accurate provider and get them care, and it prevents the fall, hospitalization, and a cascade of events.”

A 2022 study from the National Library of Medicine shows that the use of RMSK ultrasound is growing among physical therapists.

“It really has changed the practice, because it helps me to be more apt at what I do, take more efficient, more competent care of patients, and I see it to be probably an ever-growing part of what we do for people who have musculoskeletal injuries,” McElroy said.

WVIA News found that just 23 physicians state-wide are certified.

“The specificity, the resolution of the image and the quality of the scans we can get, it’s only getting better,” McElroy said. “I think it’s probably going to change the way people are cared for, it already has, but it’ll continue to go that way because it’s less expensive, it’s timely, and it’s accuracy is as good as an MRI for many of the things that we need it to be.”