22 “must read” msk US articles from 2022
Reviewing published articles on musculoskeletal ultrasound can keep you updated on the latest research and developments, identify areas for future research, and broaden your knowledge and understanding of the field. This can be helpful for clinical practice and continuing education.
The year 2022 brought lots of news in msk ultrasound science and here are some of the most important articles from my point of view. There are articles about artificial intelligence, elastography, color Doppler, dynamic scanning protocols of the joints, pediatric musculoskeletal ultrasonography, interventions, etc.
Journal: British Journal of Sports Medicine
Authors: Hall MM, Allen GM, Allison S, Craig J, DeAngelis JP, Delzell PB, Finnoff JT, Frank RM, Gupta A, Hoffman D, Jacobson JA, Narouze S, Nazarian L, Onishi K, Ray JW, Sconfienza LM, Smith J, Tagliafico A.
Ultrasound is a widely used tool for diagnostic imaging and procedures in musculoskeletal and sports medicine. However, the lack of standard terminology can make it difficult for professionals in different disciplines and subspecialties to communicate effectively. This can also be confusing for patients, insurance providers, and the general public. To address this issue, a consensus of standard terms has been developed to provide a clear reference for anyone working in musculoskeletal and sports ultrasound. The goal is to improve communication and consistency in clinical practice and the literature. The consensus covers common terminology encountered in musculoskeletal and sports ultrasound, with a focus on clinically relevant topics. It is intended to be user-friendly and addresses variations in terminology that are often found in everyday practice, scientific presentations, and the literature.
Consensus was reached (agreement by at least 80% of the group) on seven main topics: (1) general definitions, (2) equipment and transducer manipulation, (3) anatomical and descriptive terminology, (4) pathology, (5) procedural terminology, (6) image labeling, and (7) documentation.
Journal: Clinical Neurophysiology
Authors: Cipriano KJ, Wickstrom J, Glicksman M, Hirth L, Farrell M, Livinski AA, Esfahani SA, Maldonado RJ, Astrow J, Berrigan WA, Piergies AMH, Hobson-Webb LD, Alter KE.
This scoping review found that the use of shear wave elastography (SWE) to study musculoskeletal soft tissue and nerves in humans has been hampered by a lack of standardized data collection and reporting requirements. A search of seven literature databases identified 375 articles published between 2004 and 2020 that met the inclusion criteria, but the small size (n = 11-20) and youth (mean = 20-29 years) of the study participants, as well as the variety of equipment (n = 11 ultrasound systems, n = 18 ultrasound models, and n = 19 transducers) used, contributed to methodological heterogeneity. Only a small percentage of the articles (11%) used electromyography to confirm the absence of muscle activity, and just 8% reported the measurement depth. To make SWE a valid and reproducible tool for assessing tissue pathology, disease progression, and response to interventions in various musculoskeletal and nerve-related disorders, it is important to standardize data collection and reporting procedures.
Journal: Journal of Clinical Ultrasound: Sonography and other Imaging Techniques
Authors: Lyu S, Zhang Y, Zhang M, Jiang M, Yu J, Zhu J, Zhang B.
This study aimed to determine whether the method used to define regions of interest (ROIs) in ultrasound images would affect the performance of artificial intelligence (AI) algorithms in diagnosing carpal tunnel syndrome (CTS). Two ROI definitions were used: one including the hyperechoic epineurium and the other only including the hyperechoic medial edge of the median nerve. The study found that the observer consistency of ROI features varied depending on the definition used, with the first definition resulting in higher consistency. The performance of AI models also varied depending on the ROI definition, with models using the first definition performing better. Among the different AI algorithms tested, the Forest models performed the best, followed by the support vector machine and Logistic models. The AI models all performed better than an inexperienced radiologist. These findings suggest that the ROI definition used can influence the performance of AI algorithms and observer consistency in the diagnosis of CTS using ultrasound.
Journal: American Journal of Physical Medicine & Rehabilitation
Authors: Raja AE, Shustorovich A, Robinson DM, Alfonso K, Meyer R, Roemmich RT, Eng C, Wisniewski SJ, Cabahug P.
This study investigated the role of musculoskeletal ultrasound (MSKUS) in the residency selection process by surveying 666 applicants to physical medicine and rehabilitation programs at Johns Hopkins University, the Mayo Clinic, and Harvard/Spaulding Rehabilitation. Of the 180 respondents, 71% indicated that MSKUS presence at a program was “very important” or “absolutely essential” during the interview process, and 74% said exposure to MSKUS in residency was a significant factor when ranking programs. More than 92% of applicants said they were “likely” or “very likely” to use MSKUS in their future practice, and 83% would recommend a program with MSKUS to other candidates. These findings suggest that MSKUS may be an important consideration for applicants in selecting a residency program.
[ihc-hide-content ihc_mb_type=”show” ihc_mb_who=”1,2,3″ ihc_mb_template=”1″ ] Journal: American Journal of Physical Medicine & Rehabilitation Authors: Jačisko J, Mezian K, Güvener O, Ricci V, Kobesová A, Özçakar L. In this article, the authors describe a new approach to teaching musculoskeletal ultrasonography. The authors have created a collection of images, drawings, and multimedia videos that use mnemonic aids, pictures, and characteristic sounds to help novice sonographers understand and remember the topographic anatomy of the musculoskeletal system. This approach, called “entertainment education,” combines text and video to provide a clear and engaging explanation of procedures in musculoskeletal medicine. Journal: American Journal of Physical Medicine & Rehabilitation Authors: Ricci V, Chang KV, Güvener O, Mezian K, Kara M, Leblebicioğlu G, Stecco C, Pirri C, Ata AM, Dughbaj M, Jain NB, Özçakar L. Musculoskeletal ultrasound is a widely used tool among physiatrists in clinical practice, particularly for its ability to perform dynamic assessments. However, there is a lack of protocols detailing how to use ultrasound to examine the shoulder for various conditions. To address this gap, an international group of experts (EURO-MUSCULUS: European Musculoskeletal Ultrasound Study Group and USPRM: Ultrasound Study Group of ISPRM [International Society of Physical and Rehabilitation Medicine]) has created this protocol, which outlines how to use ultrasound to examine the shoulder using different maneuvers for various shoulder problems. The protocol includes videos of real-time patient exams alongside scans to enhance understanding. It is hoped that this resource, created by experts in musculoskeletal medicine, will help doctors perform more consistent and thorough examinations of the shoulder. Journal: American Journal of Physical Medicine & Rehabilitation Authors: Ricci V, Güvener O, Chang KV, Wu WT, Mezian K, Kara M, Leblebicioğlu G, Pirri C, Ata AM, Dughbaj M, Jain NB, Stecco C, Özçakar L. This protocol provides guidance on using ultrasound to examine the elbow for various conditions, using a combination of text and video. The videos show real-time patient exams alongside scans to enhance understanding. The protocol was created by a group of experts in musculoskeletal medicine (EURO-MUSCULUS: European Musculoskeletal Ultrasound Study Group and USPRM: Ultrasound Study Group of ISPRM [International Society of Physical and Rehabilitation Medicine]) and is intended to help doctors perform more consistent, thorough examinations of the elbow. Journal: American Journal of Physical Medicine & Rehabilitation Authors: Mezian K, Ricci V, Güvener O, Jačisko J, Novotny T, Kara M, Ata AM, Wu WT, Chang KV, Stecco C, Pirri C, Leblebicioğlu G, Özçakar L. This protocol outlines how to use ultrasound to examine the wrist and hand for different conditions, using a combination of text and video. The videos show real-time patient exams alongside scans, and they will be available on the journal’s website. This resource was created by a group of experts in musculoskeletal medicine and is intended to help doctors perform more consistent, thorough examinations. It is hoped that this innovative approach will improve the way people learn about these procedures. Journal: American Journal of Physical Medicine & Rehabilitation Authors: Mezian K, Ricci V, Güvener O, Jačisko J, Novotný T, Kara M, Chang KV, Naňka O, Pirri C, Stecco C, Dughbaj M, Jain NB, Özçakar L. This protocol details how to use ultrasound to examine the adult hip for various conditions, using a combination of text and video. The videos show real-time patient exams alongside scans and are designed to provide a more comprehensive understanding of the procedures. The text covers common conditions around the hip that can be effectively evaluated using dynamic ultrasound scanning in addition to static imaging. The protocol was created by a group of experts in musculoskeletal ultrasound and will be available on the journal’s website. It is hoped that this innovative approach will improve the way people learn about these procedures. Journal: Ultrasonography Authors: Son HM, Chai JW, Kim YH, Kim DH, Kim HJ, Seo J, Lee SM. Ultrasonography (US) is an effective tool for identifying the cause of metatarsalgia, a common foot condition. US has several advantages in the examination of the foot, including the ability to easily access superficial structures, perform dynamic assessments, and directly evaluate the pain site in real-time. By understanding the potential sources of pain associated with metatarsalgia, radiologists can use US more efficiently and accurately. This article reviews the various causes of metatarsalgia, including Morton’s neuroma, plantar plate injury, synovitis, tenosynovitis, bursitis, and metatarsal fractures, and discusses their characteristics as seen on US. Journal: Rheumatology and Immunology Research Authors: Kondo Y, Kaneko Y, Takeuchi T. In rheumatology, various imaging techniques, including musculoskeletal ultrasonography (MSUS) and magnetic resonance imaging (MRI), are used to diagnose inflammatory conditions. The availability of targeted therapies, such as biologic agents and JAK inhibitors, has increased the importance of early and accurate diagnosis of inflammatory rheumatic diseases. MSUS, a noninvasive, portable, convenient, and cost-effective imaging method, can detect subclinical inflammation and accurately determine the distribution and location of joint involvement in each joint. While a definitive diagnosis should be made using a combination of a patient’s history, clinical examination, laboratory testing, and additional procedures, MSUS can aid in the differential diagnosis of early inflammatory arthritis by providing additional information and guiding further investigation. This review aims to highlight the usefulness of MSUS in identifying the different types of early inflammatory arthritis. Journal: Ultrasound Quarterly Authors: Kim GW, Seo JH. Ultrasonography (US) is increasingly being used in interventions involving the lumbar spine, but some physicians who are more experienced with musculoskeletal US may have difficulty using only bony landmarks to guide these interventions. This study describes the use of color Doppler US to visualize the blood supply to the lumbar spine and identify vascular landmarks in addition to bony landmarks, which can facilitate more accurate and efficient lumbar spine interventions. Journal: Journal of Clinical Rheumatology Authors: Miller JB, Albayda J, Aucott JN. Ultrasonography can be used to detect inflammation and joint abnormalities in patients with postinfectious Lyme arthritis (PILA), even in cases with minimal clinical symptoms, according to a case series of five patients. The study found synovitis, effusions, enthesitis/tendinopathy, and bone erosions on ultrasound, which helped confirm the presence of ongoing inflammatory arthritis. The authors recommend systematic sonographic evaluation of patients with PILA to further assess pathology and treatment response. Journal: Journal of Hand Surgery Authors: Ratasvuori M, Sormaala M, Kinnunen A, Lindfors N. This research aimed to determine the effectiveness of using ultrasound to diagnose carpal tunnel syndrome (CTS). The study included 124 participants, 77 of whom had been diagnosed with CTS and 47 of whom served as controls. The researchers measured the cross-sectional area of the median nerve at two points: the forearm and the point where it enters the carpal tunnel. They then compared these measurements to the participants’ clinical symptoms and electroneuromyography results. The results showed that there was a strong connection between the cross-sectional area measurements taken with ultrasound and the results of electroneuromyography. The highest accuracy for diagnosis using ultrasound was found when the cross-sectional area measured between 8.5 and 12.5 millimeters squared, with a sensitivity of 87% and a specificity of 91% at a cut-off value of 11.5 millimeters squared. These findings suggest that ultrasound may be a useful, quick, and reliable tool for initially diagnosing CTS in patients who present with typical symptoms. Journal: Physiotherapy Theory and Practice Authors: Sillevis R, Shamus E, van Duijn A. This study compared the talar tilt test and the anterior drawer test for evaluating the length of the anterotalofibular (ATFL) and calcaneofibular (CFL) ligaments. A total of 47 healthy participants were included, and musculoskeletal ultrasound was used to measure the length of the ligaments during the tests. The results showed that the talar tilt test was more effective at lengthening the ATFL than the anterior drawer test, while both tests caused lengthening of the CFL. Therefore, the talar tilt test may be preferred for assessing ATFL length, while the long axis distraction test can be used to differentiate between ATFL and CFL laxity. Journal: Pediatric Radiology Authors: Tokaria R, Bie J, Fenlon E, Jaramillo D. Ultrasound is a useful diagnostic tool for examining the musculoskeletal system in children. Its high spatial resolution allows for clear visualization of superficial anatomy and real-time depiction of movement and blood flow, making it useful for quickly identifying a range of conditions. Tendons, specifically, are well-suited to evaluation using ultrasound, which can provide detailed information about their structure and function. This article reviews some common indications for using ultrasound to examine tendons in children and offers examples of the anatomy and pathology that may be encountered. Journal: Journal of Ultrasound in Medicine Authors: Romer C, Czupajllo J, Zessin E, Fischer T, Wolfarth B, Lerchbaumer MH. This study aimed to use shear wave elastography (SWE) to compare the stiffness of lower limb muscles and tendons in professional and semiprofessional female athletes and to create reference values for the use of SWE in preventative medicine for professional athletes. SWE was used to assess the stiffness of the Achilles tendon, soleus muscle insertion, patellar tendon, quadriceps tendon, and vastus medialis muscle in 24 professional and 24 semiprofessional female athletes. Results showed that median tendon and muscle stiffness was significantly higher in professional athletes for all assessed tissues except the patellar tendon. These findings suggest that SWE can be useful in diagnosing tendinopathy and injuries, and has potential applications in sports medicine, rehabilitation, and preventative medicine. Journal: European Radiology Authors: Sconfienza LM, Adriaensen M, Albano D, Allen G, Aparisi Gómez MP, Bazzocchi A, Beggs I, Bignotti B, Chianca V, Corazza A, Dalili D, De Dea M, Del Cura JL, Di Pietto F, Drakonaki E, Facal de Castro F, Filippiadis D, Gielen J, Gitto S, Gupta H, Klauser AS, Lalam R, Martin S, Martinoli C, Mauri G, McCarthy C, McNally E, Melaki K, Messina C, Mirón Mombiela R, Neubauer B, Olchowy C, Orlandi D, Plagou A, Prada Gonzalez R, Rutkauskas S, Snoj Z, Tagliafico AS, Talaska A, Vasilevska-Nikodinovska V, Vucetic J, Wilson D, Zaottini F, Zappia M, Obradov M. This study reviewed the effectiveness of image-guided interventional procedures for the shoulder using the Delphi method, in which 45 experts in musculoskeletal procedures from the European Society of Musculoskeletal Radiology (ESSR) participated. The researchers examined peer-reviewed papers published up to September 2018 and scored them according to their level of evidence. They found that 80% of the statements generated reached strong consensus, while 20% received broad consensus. The ESSR recommends further research on image-guided interventional procedures for the shoulder to improve treatment options and patient outcomes. Journal: European Radiology Authors: Sconfienza LM, Adriaensen M, Albano D, Aparisi Gómez MP, Bazzocchi A, Beggs I, Bignotti B, Chianca V, Corazza A, Dalili D, De Dea M, Del Cura JL, Di Pietto F, Drakonaki E, Facal de Castro F, Filippiadis D, Gielen J, Gitto S, Gupta H, Klauser AS, Lalam R, Martin S, Martinoli C, Mauri G, McCarthy C, McNally E, Melaki K, Messina C, Mirón Mombiela R, Neubauer B, Obradov M, Olchowy C, Orlandi D, Plagou A, Prada Gonzalez R, Rutkauskas S, Snoj Z, Tagliafico AS, Talaska A, Vasilevska-Nikodinovska V, Vucetic J, Wilson D, Zaottini F, Zappia M, Allen G. This study used the Delphi method to evaluate the effectiveness of image-guided interventional procedures for the elbow and wrist. A panel of 45 experts in musculoskeletal procedures reviewed published papers on the topic and reached consensus on 18 statements about clinical indications. Only one of these statements reached the highest level of evidence, which concerned the effectiveness of ultrasound-guided steroid wrist injections in reducing pain and improving clinical outcomes. The remaining 17 statements received strong consensus (94% agreement) from the panel, while one statement received broad consensus (6% agreement). The authors of the study recommend further research, in the form of large, prospective, randomized trials, to better understand the role of these procedures in clinical practice. Journal: European Radiology Authors: Sconfienza LM, Adriaensen M, Alcala-Galiano A, Allen G, Aparisi Gómez MP, Aringhieri G, Bazzocchi A, Beggs I, Chianca V, Corazza A, Dalili D, De Dea M, Del Cura JL, Di Pietto F, Drakonaki E, de Castro FF, Filippiadis D, Gitto S, Grainger AJ, Greenwood S, Gupta H, Isaac A, Ivanoski S, Khanna M, Klauser A, Mansour R, Martin S, Mascarenhas V, Mauri G, McCarthy C, McKean D, McNally E, Melaki K, Messina C, Mombiela RM, Moutinho R, Obradov M, Olchowy C, Orlandi D, González RP, Prakash M, Posadzy M, Rutkauskas S, Snoj Ž, Tagliafico AS, Talaska A, Tomas X, Vasilevska Nikodinovska V, Vucetic J, Wilson D, Zaottini F, Zappia M, Albano D. This study used the Delphi method to review the evidence on image-guided interventional procedures for the hip and generate a list of clinical indications. A panel of 53 experts in musculoskeletal procedures reviewed the published literature and reached strong consensus on 10 statements. The highest level of evidence was only reached for one of these statements. The authors of the study recommend further research, in the form of large, prospective, randomized trials, to better understand the role of these procedures in clinical practice. Journal: European Radiology Authors: Sconfienza LM, Adriaensen M, Albano D, Alcala-Galiano A, Allen G, Aparisi Gómez MP, Aringhieri G, Bazzocchi A, Beggs I, Chianca V, Corazza A, Dalili D, De Dea M, Del Cura JL, Di Pietto F, Drakonaki E, Facal de Castro F, Filippiadis D, Gitto S, Grainger AJ, Greenwood S, Gupta H, Isaac A, Ivanoski S, Khanna M, Klauser A, Mansour R, Martin S, Mascarenhas V, Mauri G, McCarthy C, McKean D, McNally E, Melaki K, Mirón Mombiela R, Moutinho R, Obradov M, Olchowy C, Orlandi D, Prada González R, Prakash M, Posadzy M, Rutkauskas S, Snoj Ž, Stefano Tagliafico A, Talaska A, Tomas X, Vasilevska-Nikodinovska V, Vucetic J, Wilson D, Zaottini F, Zappia M, Messina C. This study used the Delphi method to review the evidence on image-guided interventional procedures for the knee and generate a list of clinical indications. A panel of 53 experts in musculoskeletal procedures reviewed the published literature and reached strong consensus on 10 statements, with 100% agreement. Two of these statements reached the highest level of evidence. The authors of the study recommend the use of ultrasound guidance for intra-articular and patellar tendon procedures to increase their accuracy and effectiveness. Further research, in the form of prospective randomized studies, is needed to better understand the role of imaging guidance and assess the medications used for these procedures. Journal: European Radiology Authors: Sconfienza LM, Adriaensen M, Albano D, Alcala-Galiano A, Allen G, Aparisi Gómez MP, Aringhieri G, Bazzocchi A, Beggs I, Chianca V, Corazza A, Dalili D, De Dea M, Del Cura JL, Di Pietto F, Drakonaki E, Facal de Castro F, Filippiadis D, Gitto S, Grainger AJ, Greenwood S, Gupta H, Isaac A, Ivanoski S, Khanna M, Klauser A, Mansour R, Martin S, Mascarenhas V, Mauri G, McCarthy C, McKean D, McNally E, Melaki K, Messina C, Mirón Mombiela R, Moutinho R, Olchowy C, Orlandi D, Prada González R, Prakash M, Posadzy M, Rutkauskas S, Snoj Ž, Tagliafico AS, Talaska A, Tomas X, Vasilevska Nikodinovska V, Vucetic J, Wilson D, Zaottini F, Zappia M, Obradov M. This study used the Delphi method to review the evidence on image-guided interventional procedures for the foot and ankle and generate a list of clinical indications. A panel of 53 experts in musculoskeletal procedures reviewed the published literature and reached strong consensus on 16 statements, with 100% agreement. Four of these statements reached the highest level of evidence. The authors of the study recommend using ultrasound guidance to improve the effectiveness of interventional procedures for plantar fasciitis and Morton’s neuroma, specifically using platelet-rich plasma and corticosteroids, respectively. They caution that image-guided interventions should not be considered a first-line approach for treating Achilles tendinopathy.