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What is an ultrasound?

Ultrasound is an imaging modality that utilizes reflected pulses of high-frequency (ultrasonic) sound waves to assess and evaluate soft tissues, cartilage, bone surfaces, and fluid-containing structures.

Medial meniscus tear (unlabeled)

Medial meniscus tear (labeled)

What is the advantage of an ultrasound over other imaging modalities?

Ultrasound provides several advantages over other imaging modalities when it comes to musculoskeletal injuries. Using ultrasound, we are able to get “real time” imaging. This means that a physician or practitioner is able to immediately evaluate and describe findings while performing the exam at the location of pain or injury. This allows the practitioner to begin formulating a plan while at the bedside based on the diagnosis and imaging findings. In many cases ultrasound can be used to confirm the suspected diagnosis, often preventing the need for additional referral to undergo other imaging modalities.

Healing stress fracture of the fibula in a runner with leg pain

Ultrasound also gives you the ability to compare the opposite side of the body, comparing to presumed “normal” anatomy. “Comparing possible pathology on both sides is helpful in determining if the pathology is in fact, the pain generator. For example, on occasion, thickening of a tendon can be seen on both sides of the body regardless if symptomatic or not” (Gonzales). Possibly the biggest advantage of ultrasound with regard to sports medicine, is the ability to image during dynamic movement. It is common for athletes to have an injury, and only have pain with specific movements. With ultrasound, we are able to image the area of question while the patient is performing the movement that causes them pain, which allows the clinician to more accurately determine the direct source of the problem.

Is ultrasound safe?

Hematoma from a partially torn quadriceps muscle

The three most common imaging modalities used in musculoskeletal related injuries are MRI, X-ray, and ultrasound. While in certain situations, MRI and X-ray have limitations that prevent their utilization. For example, individuals with claustrophobia, large size, or certain metal or electronic implants cannot undergo MRI. X-ray and CT scan have the major risk concern of using radiation, which can over a person’s lifetime contribute to developing cancer. However, there are no contraindications for the use of ultrasound. It is entirely safe, and can be performed on any individual. There is no radiation risk, and no use of powerful magnets. Even people who have undergone previous surgeries where hardware was inserted are still able to have this imaging performed. One specific limitation of ultrasound compared to these other imaging modalities is the inability to visualize within a bone, as the sound waves reflect off of the bone, and do not penetrate prior to reflection.

What types of injuries is ultrasound commonly used for?

Needle aspiration of a wrist ganglion cyst

Ultrasound has a wide variability in its usefulness for musculoskeletal injury imaging. A skilled clinician can evaluate tendons (tendinitis, tendon tear or rupture), ligaments (tears or sprains), muscles (strain, contusion, tear, hematoma), enthuses (enthesitis, or problems with the attachment of tendons), bursae (bursitis or impingement), cysts or pockets of swelling (joint effusion, ganglion cyst), peripheral nerves (entrapment or neuroma), joints (including some meniscus injuries), bone contour (for fracture or benign bone growths such as osteochondroma), and cartilage (meniscus, osteochondritis dissecans, or OCD) for injury or abnormality.

Cortisone injection of the shoulder subacromial bursa, treating shoulder impingement and bursitis

That being said, ultrasound is a very user-dependent imaging modality, which particularly in the untrained clinician can easily overlook and miss injured tissue. For that reason, many clinicians, even those with broad training and experience may order advanced imaging, such as MRI or CT scan to better characterize certain conditions or ultrasound findings.





Dr. Minor joined SPARCC in November 2017 and brings with him two years of ultrasound training from Boston Children’s Hospital, as well as an additional two years of treating patients in Orange County (CA), where he also utilized ultrasound technology for diagnostic imaging and ultrasound-guided injections and procedures.


By: Sierra Patzke & Jon Minor, MD