When people hear the word ultrasound, often their first thought is the use of ultrasound for pregnancies. However, the capability of ultrasound technology spans a variety of medical fields! Many of our doctors at APEX Orthopedics & Sports Medicine implement ultrasound in orthopedics as a highly effective yet less expensive mechanism for musculoskeletal imaging.
Ultrasound, which uses sound waves, helps doctors find and target the source of pain for a more accurate diagnosis. Doctors can also use ultrasound as a guide for injections, which greatly increases the efficacy of a procedure by ensuring a nearly 100% accuracy rate for the injection.
Although musculoskeletal ultrasound technology comes with an array of benefits, many physicians in the Kansas City area have not dedicated themselves to the hundreds of hours of training it takes to implement ultrasound for precise orthopedic care. Because of that, APEX is leading the way in orthopedic treatments, and we will continue to remain above the curve. Read on to learn more about musculoskeletal ultrasound and its applications.
How does musculoskeletal ultrasound technology work?
An ultrasound machine consists of three main components:
(2) Video display screen
(3) Attachable transducer (probe)
The transducer is a small handheld device (similar to a microphone) that sends out high-frequency sound waves. Those waves run through the body then bounce back for the transducer to pick up. This process is very similar to how boats and submarines use sonar technology for travel.
From there the computer creates an image based on the pitch (frequency), volume (amplitude), and how long it takes for the signal to return to the transducer. Ultrasound technology also considers the structure it’s analyzing, including the tissues the sound travels through.
Ultrasounds in orthopedics have two main uses:
(1) For diagnostic imaging
(2) For procedural guidance
As a result, musculoskeletal ultrasound comes with many benefits for both patient and doctor, including:
- No radiation, making ultrasound a safe option
- Saves money compared to MRIs
- Results in instant, on-the-spot feedback
- Ability to do side-by-side comparisons
- Makes injections more accurate and limits human error
- Completely non-invasive
- Widely available
- Alternative for severely claustrophobic patients or those with metal
From the diagnostic side, ultrasound is outstanding for diagnosing soft tissue and some bony conditions, and often has a higher resolution than an MRI. Ultrasound has an advantage over MRIs and CT scans because of its higher resolution and the physician may perform dynamic scans–such as moving the shoulder during imaging–to ensure he or she understands the behavior of the muscles and joints.
Also, when physicians notice an abnormality on ultrasound, they can press on it to detect pain or move the affected structure in real time during the scan, whereas with an MRI, they could see something but not know if it’s the problem. These sono-palpitation and dynamic scan techniques are unique to ultrasound in diagnosing orthopedic conditions.
Many people don’t realize that ultrasound is also somewhere in between four and ten times less expensive than an MRI, but in some instances, it is also more effective. In addition, it can be helpful when a doctor can’t order an MRI due to the patient having a pacemaker or some other metal in their body.
Athletes need to get back on the field quickly. If an MRI shows a normal exam yet the athlete still has pain, that deters them from receiving appropriate treatment and returning to play. For this reason, ultrasound is particularly useful because there’s no room for error in diagnostics and injection accuracy.
Our sports medicine physician Dr. Khadavi uses ultrasound technology when working with a wide scope of professional athletes: men and women’s soccer, including SportingKC; Kansas City Ballet; Big XII; Swope Park Rangers; and more.
For example, he has a variety of NFL players who will fly in if they are not finding answers with their own physicians. He has found that oftentimes the ultrasound will find the underlying issue that MRIs failed to pick up.
Once you have a precise diagnosis, deciding on the right treatment is a lot easier for all patients. A few common conditions that may be diagnosed via musculoskeletal ultrasound include:
- Rotator cuff tears
- Hip bursitis
- Patellar tendonitis
- Ganglion cysts
- Ligament tears in the foot and ankle
- Tears in the knee
- Tennis elbow
- And more
What to expect during an ultrasound diagnostic scan
Your provider will place a water-based ultrasound gel over the skin to prep the area. Using the transducer, your provider will scan the area and apply slight pressure. Throughout the process, you shouldn’t expect any pain unless the area was already sensitive to touch. In some instances, a physician may move your joints or press against an abnormality to discover how it reacts and the underlying cause.
After your scan, your provider will wipe away excess gel, and you will be free to go about the rest of your day. Any leftover gel will dry. If you have any questions about getting an ultrasound scan, you can always contact our office for more information.
Musculoskeletal ultrasounds for procedural guidance
Between diagnostic ultrasound and ultrasound’s use in procedural guidance, it’s hard to argue which one is more important in the use of this technology. However, as more and more studies emerge, doctors are learning that without using some sort of image guidance for an injection, a lot of their injections are missing their mark.
For example, glenohumeral injections in the shoulder miss their mark about 50% of the time without ultrasound imaging. But musculoskeletal ultrasound technology makes almost all injections approximately 99% accurate. For you as an orthopedic patient, that means whenever you’re getting an injection—whether it be cortisone, PRP, or stem cell—you will have peace of mind knowing the injection hits the target on the first time around.
Ultrasound is more accurate, and it also decreases the level of risk. Going back to the glenohumeral injection example, if a doctor doesn’t use ultrasound, there’s a high chance that the needle will puncture your cartilage (either labrum or hyaline cartilage). For the hip, if a doctor doesn’t use ultrasound, there’s a chance he or she could puncture your femoral artery or nerve, which could lead to severe consequences. Therefore, ultrasound makes the process much safer and less painful and risky.
You could argue that a few injections don’t need ultrasound guidance, such as a knee injection on a slender patient, but physicians are quickly discovering that even those patients could benefit from guided injections from a cost-effectiveness, pain, and risk standpoint. As a result, the best practice is probably to implement ultrasound for injection-guidance as often as possible.
Ultrasound-guided injections at APEX Orthopedics
At APEX Orthopedics, Dr. Khadavi has utilized guided injections in his practice since 2010, and he performs ultrasound scans to optimize his diagnoses. Despite what you might have guessed, ultrasound will not drive up your medical bill. Dr. Khadavi believes it’s not about the money, but rather about doing what’s right for the patient.
APEX is leading the way among orthopedic groups in Kansas City with a forward thinking modality for our image guidance, injections, and diagnostics. Four out of seven of our physicians routinely use ultrasound, all of whom were either trained by Dr. Khadavi or took a course on their own. With the help of this technology, our doctors are more accurate and provide better outcomes for our patients.
Other orthopedic groups in the area use ultrasound to a lesser extent than we do. The main reason is because community physicians tend to lag behind those who are teachers and at the cutting edge. That is why we strive to always be on the forefront of new technology to ensure our patients get the best treatment each and every time.
Limitations of musculoskeletal ultrasound
Compared to an ultrasound, an MRI will show a better resolution for any structure that is deeper than 3 to 4 inches and any structure that is within a joint. An example is the meniscus and ACL within the knee joint. In these cases, an ultrasound shows very little information, which means a physician has to turn to an MRI for better images. Similarly, a physician can view the labrum in the shoulder (the cartilage inside the joint) better with an MRI (arthrogram). However, for tendon, ligament, muscle, and other relatively superficial soft tissues, ultrasound remains the imaging modality of choice.
At APEX, if we know what structure we’re looking at, we choose the modality that works best. After a physical exam and understanding patient history, we usually know the diagnosis. We simply use imaging tools to verify it.
Get to know Dr. Khadavi at APEX Orthopedics & Sports Medicine
Dr. Khadavi is the only physician in the Kansas City area who is triple board certified in Sports Medicine, Physical Medicine and Rehabilitation, and Musculoskeletal Ultrasound (RMSK). He not only specializes in regenerative medicine, he is also a field leader who teaches best practices to other physicians across the country.
As a result, patients receive treatments that are most likely to work in comparison to other alternatives. With the help of APEX’s private practice model, Dr. Khadavi ensures each patient receives the most value that doesn’t involve hidden fees or outlandish pricing.
The core of his success lies in proper diagnosis. An appointment with Dr. Khadavi includes the highest quality technology to pinpoint a patient’s underlying musculoskeletal conditions. From there, he can better understand whether his advanced regenerative medicine techniques would be the best solution.
For a thorough evaluation with Dr. Khadavi or his physician’s assistant Stephanie Shull, call us at 913-642-0200 or schedule an appointment today.