Musculoskeletal Ultrasound: A Tool for Improving Quality and Care – Gene Tekmyster, DO

Ultrasound imaging is a modality that uses sound waves to produce images of soft tissue structures such as muscles, tendons and ligaments. It is safe and painless. Ultrasound imaging, also called ultrasound scanning, sports ultrasound or sonography, involves the use of a small transducer probe with a gel that is placed directly on the skin. The sound waves are transmitted through the gel, into the body, then are reflected from the soft tissues and captured by the computer. These reflected waves are then transformed by the computer to make an image of what lies underneath the skin. Because ultrasound images are captured in real-time, they can show the structure and movement of the body’s internal organs as well as blood flowing through vessels.

It is useful in diagnosing sprains, strains and tears, and for the guidance of interventional procedures to ensure the best possible outcomes. Ultrasound is safe since it does not use radiation to generate images of the body. There are no known harmful effects of diagnostic ultrasound imaging. In addition, ultrasound is safe for those with metal implants.  It is quiet and more comfortable for claustrophobic patients and patients that are obese. The only limitation of this technology is that ultrasound waves cannot penetrate bone, thus limiting examination of certain body parts, such as the spinal canal.

There is a range of imaging choices relevant to athletic or overuse injuries with musculoskeletal ultrasound serving as an important tool in addition to X-rays, CT and MRI scans. Ultrasound images are typically used to help diagnose tendon tears, muscle tears, ligament sprains, nerve entrapments, fluid collections as well as many other musculoskeletal conditions. It is extremely helpful to diagnose injuries that are more likely to occur with movement or change in body position. This dynamic imaging ability is unique to ultrasound, which is why it is considered by many to be a frontline tool in regards to musculoskeletal and sports injuries. With an ultrasound, an experienced physician is able to isolate the problem as well as describe the severity of the condition. Ultrasound however is not limited to diagnostics as it can be, and often is, used to guide treatment to ensure safe and accurate delivery of medications.

Musculoskeletal ultrasound is extremely useful for interventional procedures, allowing immediate, real time visualization of the needle and the target structure. It allows the physician to be very accurate with injection of medication to the desired area of concern. The physician is able to change the injection approach in real time, if necessary, to avoid unintentional damage to vessels and nerves to ensure accuracy is achieved. With the ever growing cost of injectable medications, as well as increasing utilization of regenerative treatments such as Platelet Rich Plasma (PRP) and Stem Cells, it is incredibly necessary to confirm safe and accurate delivery. Not only is ultrasound helpful in guiding medication administration, but is also beneficial when it is necessary to aspirate or remove fluid from within the body. Fluid collections and cyst are very common and thus allowing for direct visualization of the needle when aspirating is necessary, whether it be for pain relief or for testing. Ultrasound ensures that this can happen.

Recent research studies have shown that musculoskeletal ultrasound provides improved treatment injection accuracy, better outcomes and compared to MRI, improved patient comfort and pain relief.

Not every injury needs an MRI scan and not every injection needs to be performed with an ultrasound, however we at the Orthopaedic and Sports Medicine Center continue to use the best and latest available technology, resources and guidelines to provide the best possible care.

Gene Tekmyster, DO

Chief Clinical Officer – The Orthopaedic & Sports Medicine Center, division of COS;

Interventional Spine Care, Regenerative and Sports Medicine;

Team Physician – US Ski and Snowboard;

Assistant Team Physician – University of Bridgeport;

Head Team Physician – Fairfield Warde High School;

Assistant Professor, Quinnipiac University – The Frank H. Netter, MD School of Medicine


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