Three of us are deep in training for musculoskeletal diagnostic ultrasound. It’s tough, but good. The toughness comes from the need to translate what’s on the ultrasound screen into what we know of anatomy and then identify any pathology. At times it feels overwhelming and frustrating (yesterday I tried to take an image of my own biceps tendon – it took me an hour despite the fact I know exactly where it is on my arm, and in a textbook – but not in the storm over Stornoway on my ultrasound screen!!)
So why are we bothering with diagnostic ultrasound?
Because the good bit is really good….
First and foremost — it is completely safe as it uses sound waves not Xray or magnetic fields and can be used on most patients with joint strains, sprains and injuries.
Osteopaths and physiotherapists are thoroughly trained in clinical diagnosis–for shoulder pain our thought process goes something like this:
- Can you raise your arm above 90 degrees without pain (and can you rotate it both ways once there?
- Was the onset of pain and restriction gradual or acute?
- Was it precipitated by a trauma – and what sort?
- Is the pain deep but vague at the top of the humerus or can you put your finger on it?
- Are your pain and stiffness improving or worsening?
- Does it respond to anti-inflammatory medication?
We work through the possibilities of rotator cuff tear or tendinopathy, adhesive capsulitis / frozen shoulder and subacromial subdeltoid bursitis versus less common pathologies.
Without an ultrasound scan, we would prescribe treatment or exercise as appropriate and monitor the progression of your symptoms (revising our diagnosis and management if your symptoms didn’t change as expected).
Ultrasound diagnosis takes the guessing out of this. We know straight away if you’ve got a rotator cuff tendinopathy, rotator cuff tear or fluid in your bursa (and whether that is coming from the joint or is an inflamed structure due to subacromial impingement). We can tell if the problem is inflammatory, healing, calcified or torn. We can often see new fractures (particularly avulsion fractures), and old ones.
The same goes for every joint in your arm or leg – trochanteric bursitis, or glute tendinopathy; lax ankle ligaments or AITFL tear; hip arthritis or partial rectus femoris tendon tear….
How good is that? Certainty in diagnosis is a super rewarding for patients. You stop worry and we can predict your recovery trajectory, be specific with treatment and prescribe exercise really accurately. It feels like its worth the massive effort we’re making!