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The Age of the Ultrasound, and It’s Expanding Role in Sports Medicine

By Dr Kanaan , Wake Sports Medicine : Raleigh , NC

It’s indisputable that technology has, and is, changing the way that medicine is practiced across the globe. Every time a physician thinks that he or she has learned the next and greatest skill or procedure there is yet another technological advance that has arrived. While physicians are sometimes skeptical of the potential effects on patient care, reimbursements, and the implications that new skills have on their own base knowledge there is no doubt that patients latch on to these new technologies almost instantly. It seems akin to the visceral urge that consumers have to purchase the latest and greatest smartphone despite having a more than capable current model.
Ultrasound has been around a long time in the medical field, but with significant advancements in portability, cost, and resolution it is now finding its way out of the hospital, and into the direct hands of physicians. Fields like Radiology, OB-GYN, ER, and Anesthesia have for years used this technology both through the use of sonographers and through their own training, but within the last few years ultrasound has found its way into the musculoskeletal fields such as Orthopedics, Sports Medicine, and PM&R. Ultrasound not only allows direct visualization of needle placement for common injections, but allows the physician to perform more difficult injections that were once only performed under CT, or Fluoroscopic guidance.
The next question becomes why should ultrasound be used, and when. It really comes down to accuracy, patient satisfaction, and cost concerns. Not only can the physician perform targeted injections of specific joints, tendons, and nerves but every study that has ever been performed in the literature has proven ultrasound to be significantly more accurate than a blind injection. This matters for several reasons including unintended trauma to surrounding structures, the decision to consider an injection a failure, and the ability to place medications precisely where they have the greatest potential for maximal effect.
As for patients, they love it. Not only are they able to see the pathology that is being discussed in real time, but they often seem to enjoy seeing the needle hit its target. The ultrasound machine both becomes a point of care teaching tool and a well needed distracter for an otherwise unpleasant visit. Both in the literature, and anecdotally patients seem to experience less pain and discomfort and overall patient satisfaction seems to be higher when using point of care ultrasound. Not to mention the lack of radiation that a patient is subjected to with CT and Fluoroscopy.
And what of cost. Some would argue that guided injections are not needed , and that this ultimately drives up healthcare costs. The answer to this is far more complicated than comparing a blind injection to a guided injection. Take a hip injection for example. With ultrasound an intra-articular hip injection can be performed in an outpatient office visit for about 10% of the direct patient and total healthcare cost of a CT or Fluoroscopic guided injection. The same could be said for most other peripheral joints that might otherwise be performed with CT and Fluoroscopy. As for more common injections that might be performed blindly, the research is still currently performed. It is possible that if treatment failures decrease due to accuracy of injection long term costs to the patient and healthcare system will be decreased.
Regardless of the discussion for and against using point of care ultrasound, it is here to stay and will only grow in both the number of applications and in popularity among patients. In fact most US medical schools are either creating , or looking to create comprehensive ultrasound curriculums for their incoming students. It won’t be long before the physical exam portion of a physician’s note has an ultrasound finding section.

References:
1. Daley, Bajaj, Bisson, Cole. Improving Injection Accuracy of the Elbow, Knee, and Shoulder: Does Injection Site and Imaging Make a Difference? A Systematic Review Am J Sports Me. January 21, 2011
2. Bankhurst et al. Does sonographic needle guidance affect the clinical outcome of intraarticular injections? J Rheumatol 2009; 36(9): 1892–902.
3. https://www.aamc.org/newsroom/reporter/dec2012/323592/ultrasound.html

Dr. Matthew G. Kanaan


Dr. Kanaan is a sports medicine physician /specialist who received his medical residency training at Duke Medical Center. During his fellowship training at Duke Sports Medicine, Dr. Kanaan received special instruction in Musculoskelatal Ultrasound – a unique, state-of-the-art technology in the orthopedic field. While completing training in Primary Care Sports Medicine, Dr. Kanaan served as an assistant team physician for Duke Football, Basketball, and Lacrosse, as well as assisting with Elon University Football. Dr. Kanaan is an avid researcher, publishing many research projects to advance the field of sports medicine.