How to Read MSK Ultrasound of the Shoulder

Musculoskeletal Ultrasound is a type of medical imaging which rapidly been used instead of MRI (when indicated) for high performance athletes on professional teams and the US Olympic Teams. This change in preference has occurred for a few reasons. Over the course of this article we will be reviewing some positives and negatives in the use of Musculoskeletal Ultrasound.

NOTE** If you don't care about my story just skip on through to the bullet points.

First I'll tell you my experience with Musculoskeletal Ultrasound in Orange County and how I came to find the technology in the first place. In 2013, Dr Levon Nazarian MD presented Musculoskeletal Ultrasound to a group of sport doctors at the Olympic Training Center in Colorado Springs. It was at this demonstration I became fascinated with Musculoskeletal Ultrasound... the clarity, accuracy and simplicity of the imagine blew me away. Dr Nazarian was able to scan not only one shoulder but the second one to compare in just a matter of minutes. The patient looked comfortable and relaxed as Dr Nazarian instructed her to perform some motions with the arm, which also moved the soft tissue on an image.

Looking back the feeling I had about the images on the screen was probably analogous to how parents-to-be feel about seeing their unborn child on the same Ultrasound screen. I'm still amazed by the ease of being able to bring a dynamic/ movement related imaging study into a small office such as mine... it really does bring sports doctors the ability to diagnosis even complex conditions which would be missed without the use of imaging. As you can imaging I bought one and have not been disappointed.

You might say why not just refer the patient out for an Ultrasound, as I normally would for an X-ray or MRI... the reason is simple... I could not find a good, educated Musculoskeletal Ultrasound Technician in Orange County.

As I came to learn Sonographers are as specialized as doctors. A shoulder specialist may not know anything about the foot. Emergency Room staff may not remember the complexity of the musculoskeletal system as someone who works with it everyday. Soon I can across Mike Jablon at Orthopedic Ultrasound in San Clemente. When we spoke I could see his passion for small details of the musculoskeletal system, which I soon found were not overlooked on his imaging reports. Passion for the musculoskeletal system is not something taught... it grows on you with each case you see and I could see Mike and I had something in common... so I learned from him.

The following are some reasons taken from an article by the great Levon Nazarian MD that I will reference at the end of the article. Although I will be explaining my own words these are direct points from the article... just trying to spread the good word doc!

1. There are no contraindications to Musculoskeletal Ultrasound.

In certain situations you are not allowed to use X-ray or MRI. Some negatives surrounding X-ray are: radiation exposure, how much radiation is allowed per year, pregnancy, and more. X-rays are used for some conditions but two more useful tools for soft tissues, such as muscle and tendon, are MRI and Musculoskeletal Ultrasound.

MRI is great because there is no radiation transferred to the patient and the doctor can see much more details in the soft tissues, muscle, tendon, and cartilage. Its even great for finding fractures missed on X-ray examination. MRI machine are made of large magnets, which can present some issues. Patients with pacemakers, metal, and other implants cannot undergo MRI examination but from a clinical standpoint it is hard to ignore how much detail can be found in MRI and it is a very valuable piece of imaging.

Musculoskeletal Ultrasound is safe and can be done on anyone. There is no radiation, no magnet and is commonly done on pregnant women... which demonstrates how safe it can be.

2. Musculoskeletal Ultrasound can have MORE detail than an MRI

Validation of this statement would make us go into physics and things uninteresting to most people. Support can be found in our supporting references but is dependent upon what type of Musculoskeletal Ultrasound transducer is being used and what type of MRI we are comparing to.

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