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Facilitated MSK US examination
This document discusses how musculoskeletal ultrasound can improve the diagnosis and management of musculoskeletal conditions compared to traditional approaches. It provides examples of evaluating shoulder impingement and lower extremity injuries. Musculoskeletal ultrasound allows visualization of pathology and dynamic examination of injuries. It facilitates a combined clinical and sonographic examination to evaluate injuries more accurately than clinical tests alone. This leads to fewer additional imaging tests, clearer diagnoses, and better directed treatment plans.
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Facilitated MSK US examination
- 1. www.usask.ca Musculoskeletal Ultrasound: Moving youforward … faster Patrick Ling, MD, MPH, CCFP(EM), FCFP, RMSK Associate Professor, Family Medicine April 3, 2016 1st Annual SONO Symposium
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- 3. www.usask.ca Traditional Approach toDiagnosis and Management of MSK Condition 1. Patient presents with a painful condition 2. History and physical 3. Tests a. Special tests b. Imaging 4. Treat the condition
- 4. www.usask.ca Eg: Shoulder ImpingementPain • Patient presents with painful shoulder – impingement type symptoms • History, Perform clinical tests • Inspect, palpate, ROM • Special tests • Impingement tests (Neer, Hawkins, Jobe) • tests: xray? Ultrasound? • Management: NSAIDS, activity modification, PT, cold compresses? referral?
- 5. www.usask.ca Differential Diagnosis • RotatorCuff tear (acute, chronic) • Subacromial bursitis • Rotator cuff tendinosis • Labral pathology • Internal impingement • Referred pain • Scapulothoracic dysfunction • Adhesive capsulitis • Calcific tendinopathy • Osteoarthritis (glenohumeral, acromioclavicular)
- 6. www.usask.ca Clinical Tests • NeerImpingement Sign Sens 80%, spec 50% +LR 1.7 • Painful arc Sens 75%, spec 65% +LR 2.25
- 7. www.usask.ca Clinical Tests • HawkinsKennedy (sens 60%, spec 60%, +LR 1.6)
- 8. www.usask.ca More Clinical Tests •Jobe ‘empty can’ • Cross body adduction • Drop arm test • Lag test (RC integrity) • Lift off test (RC integrity) • O’brien’s, Crank (labral testing) • Speed’s, Yergason (bicep injuries) • Anterior load and shift, apprehension, drawer, sulcus test (instability)
- 9. www.usask.ca More Tests • Ultrasound •‘use dependant’ • MRI • Availability • Treatment ‘test ’ – trial of physical therapy • Costs, time, clarity on diagnosis • Test of time
- 10. www.usask.ca Further Complexity andConfusion • Which clinical test? • Which imaging test? • Reliability (inter-rater reliability)
- 11. www.usask.ca Facilitated Ultrasound Examination “Sono – Exam “ • Combination of clinical examination and sonographic examination • Ability to visualize the pathology • Ability to do dynamic examination, impingement testing • Ability to comparative contralateral exams (if applicable)
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- 13. www.usask.ca Anterior shoulder Pain generators:bicep tendon, tenosynovitis, anterior portion of SASD, subcoracoid bursa, pectoral major tendon
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- 16. www.usask.ca Impingement • Bursal • Bony •compression
- 17. www.usask.ca Rotator Cuff integrity •Dynamic stress imaging
- 18. www.usask.ca On Field Assessment •Shoulder posterior dislocation (Mackenzie 2013)
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- 20. www.usask.ca Assessment of LigamentousLaxity • MCL valgus stress test (Kleinbaum, 2008) • Ankle lateral ligaments (Gun 2013)
- 21. www.usask.ca MCL – LCLdynamic • Dynamic imaging • Valgus/varus stress • Laxity • Ligamentous tears
- 22. www.usask.ca Anterolateral Talofibular Ligament ATFLtears • Laxity • Instability • Important for prognosis & management
- 23. www.usask.ca More Information • AMSSM– Position Papers 2014
- 24. www.usask.ca More Information • AmericanRegistry for Diagnostic Medical Sonography • American Institute of Ultrasound in Medicine
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