The Ultrasound Analysis of the Most Important Musculoskeletal Issues

Visual presentation of common standard ultrasound imaging techniques in the Musculoskeletal area

Abstract

This work shows the most important standard sections of relevant questions in musculoskeletal (MSK) ultrasound of the wrist, elbow, shoulder, hip, knee and ankle. Exemplary images with descrip-tions of the sections and anatomical structures were created and the positioning of the patient explained. Several patient cases per region were also presented and explained in order to place the described procedures in a clinical context. The advantages and disadvantages of the imaging procedures were explained and compared. MSK ultrasound is particularly strong in the visualisation of superficial structures, whereby this form of imaging is superior to other imaging procedures in some cases. In addition, the detection of inflammation, for example, is not only possible via indirect signs (e.g. free fluid or abscess) compared to computer tomography. In addition, the hyperperfusion caused by inflammation can be visualised directly at the affected site using Doppler examination. Even in the case of functional restrictions such as shoulder impingement or tendon instability (see section 4.6.11: Patient case 19), which are difficult to visualise using other imaging techniques, the tissue can be viewed and moved in vivo using a dynamic examination. This can lead to a better understanding of the pathology and a more precise diagnosis. MSK sonography therefore proves to be a valuable addition to everyday clinical practice.

The focus of our work was the presentation of common standard ultrasound incisions in the MSK area. The intention to keep this guide clear and to cover the common pathologies is limited by the fact that not all sections could be covered. In a future work, further, less frequently used incisions could be shown in order to cover a broader spectrum of possible pathologies. For example, sections of the thorax (such as the thoracolumbar fascia or areas of the spine and lumbar region) could also be shown. A further question is whether MSK ultrasound can save or replace an MRI or CT examination in certain cases. As discussed in the introduction, this would be an advantage from the patient's point of view and in economic terms. Further studies investigating this aspect would be valuable.