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Sports Medicine and Musculoskeletal Ultrasound

Nilesh Shah, M.D., Medical Director and Fellowship Director, Summa Center for Sports Health, Orthopaedic Focus Winter 2010

Unknown to many, ultrasound offers better spatial resolution than MRI. Newer machines, technology and probes are the major differences that offer spatial resolution of 150 microns versus 450 microns with MRI. This method of imaging is fast and allows for convenient side-to-side comparison.

The Summa Center for Sports Health and Summa Orthopaedics and Sports Medicine have offered ultrasound technology to patients since 2008. Staff physicians have used this technology to conduct numerous diagnostic studies of the shoulder, ankle and knee.

Diagnostic ultrasound has also proven to be especially valuable after surgery because metallic implants can cause signal degradation on MRI.

More than 100 ultrasound-guided interventions have been performed across Summa Health System since 2008, including injections of the hip joint, bicep tendon, mid-foot, first metatarsal-phalangeal joint, subtalar joint, carpal tunnel, glenohumeral joint and others.

If this form of ultrasound technology were not available to patients, many of these joint injections would have been conducted using fluoroscopic guidance, which is far more expensive. Patients would also encounter ionizing radiation that is not present with ultrasound guidance.

Tendon injections and percutaneous tenotomies have also been performed with ultrasound guidance, including those of the medial and lateral epicondyle, patellar tendon and Achilles tendon.  Ultrasound is also used in all whole blood and platelet-rich plasma tendon injections.

Other tendon injections, like the flexor hallucis longus, that otherwise would not be available to clinicians without risk of complications are made available with the use of ultrasound. The posterior tibial artery and vein and tibial nerve are readily seen with ultrasound and the needle can be directly guided to the tendon without compromising the neurovascular bundle.

Musculoskeletal ultrasound is also being used as a teaching modality in the primary care sports medicine fellowship at the Summa Center for Sports Health. Approximately 30 percent of sports medicine fellowships use musculoskeletal ultrasound in their fellowship clinics*.

The use of musculoskeletal ultrasound is a newer modality for diagnosis and performance of musculoskeletal procedures in the United States. Summa Health System is a leader in making this cost-effective, accurate and versatile modality available to patients throughout Northeast Ohio.

*January 2009 survey of primary care sports medicine fellowships supplied to the American Medical Society for Sports Medicine