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What is Diagnostic Ultrasound?

Jeannine Noble

Physical therapists are recognized and respected for being creative, innovative, and forward thinking. Utilizing objective testing and clinical reasoning, physical therapists have the ability to assess and treat a wide range of musculoskeletal conditions presented by their patients. What if a tool was available to increase diagnostic accuracy, potentially decreasing rehab time and overall healthcare costs? Fortunately, this tool is available now and is called Diagnostic Musculoskeletal Ultrasound.

What is the Difference Between Therapeutic Ultrasound and Diagnostic Ultrasound?

When referring to ultrasound it’s important to distinguish between therapeutic ultrasound and diagnostic ultrasound. Although both utilize sound waves, therapeutic ultrasound uses high frequency waves to modify or destroy tissue while diagnostic ultrasound uses those same waves to create images of structures within the body, helping to diagnose medical issues.

Physical therapists have incorporated therapeutic ultrasound into their practices since the 1950s. It has been a “standard of care” modality to treat musculoskeletal conditions, although in recent years it has been used less as newer and more effective modalities have been discovered.

Diagnostic musculoskeletal ultrasound (MSK ultrasound) is relatively new to the physical therapy world and to private practice in general. When I first started performing MSK ultrasound in 2000, there were only a handful of resources available to assist in learning this amazing new skill. Fortunately, I was lucky enough to work with a handful of forward-thinking physicians who were as excited about this new modality as I was. I would sit in their offices with an ultrasound machine and a backpack full of anatomy books and perform ultrasound scans on patients. It was challenging, but extremely rewarding to see muscles, tendons, and other soft tissue move in real time and provide the objective visualization that the physicians needed to make a diagnosis. Very few physicians were accepting of this new technology in 2000, but the patients loved it. And over the years MSK ultrasound has gained respect as a valuable diagnostic tool.

How Can PTs Utilize Diagnostic Musculoskeletal Ultrasound?

As a diagnostic tool, MSK ultrasound is invaluable. When properly trained, physical therapists can visualize many pathologies and therefore make more accurate diagnoses and treatment plans. Common areas that are scanned with musculoskeletal ultrasound include shoulder, elbow, hand/wrist, knee, hip, and foot/ankle.

There are some limitations in each of these, such as, anterior labrum in the shoulder, anterior cruciate ligament, and intraarticular abnormalities. But soft tissues that are superficial to bone can be accurately scanned and visualized with ultrasound.

Benefits of Incorporating Diagnostic Musculoskeletal Ultrasound into A Practice

There are a wide variety of benefits from incorporating musculoskeletal ultrasound into a practice:

1) First and foremost, is the ability to diagnose and treat patients more accurately. Musculoskeletal ultrasound can be an extension of your objective exam, taking your clinical skills to the next level.

2) Having diagnostic ultrasound available for your patients will set you apart from almost every other practitioner.

3) Diagnostic ultrasound serves as a powerful patient education tool. When you can demonstrate to a patient in real time what is a likely cause of their pain, the percentage of their compliance to your treatment increases.

4) For physical therapists who are licensed to perform dry needling, ultrasound can improve the accuracy and safety when needling.

What Equipment is Needed for Diagnostic Ultrasound?

Performing diagnostic musculoskeletal ultrasound requires an ultrasound machine, gel, and plenty of paper towels. Today, there are a variety of ultrasound machines available to fit the ultrasound users’ needs. The units most familiar to us are the “workhorse” machines seen in hospitals and imaging centers that are used for OB/GYN, abdominal and cardiac scans.

In the early 2000s, ultrasound manufacturers began producing portable ultrasound units. Along with a significant decrease in size, there was also a huge drop in price, making these “laptop” machines affordable to more practices throughout the world. Physicians now had the ability to perform ultrasound scans and guided injections in the office setting. But it didn’t stop there.

With advances in technology, handheld ultrasound machines are now available at an affordable price. These pocket-sized scanners use a cell phone or tablet for the screen and allow access to ultrasound literally anywhere. You can learn more about a small variety of handheld ultrasound devices on our Ultrasound Devices page.

How Do I Start Learning MSK Ultrasound?

Aeyr has created a Roadmap to RMSK® that will guide you through the necessary steps to achieve your goals from the basics of ultrasound, through introduction and advanced musculoskeletal ultrasound, all the way to achieving the Registered in Musculoskeletal® (RMSK®) Sonography credential.

Our online on-demand courses are designed by PTs for PTs. They include Virtual Live Labs, peer-mentorship, interactive knowledge checks, and image review sessions to keep you involved and most importantly practicing your skills. Our course features are designed to meet you and support you on your roadmap to becoming an MSK expert.

In addition, Aeyr is accredited by the California Medical Association (CMA) to provide continuing medical education for physicians. With our courses you can earn up to 22 CME credits all while learning a new instrumental skill.

The Registered in Musculoskeletal® (RMSK®) Sonography credential is awarded through the Alliance for Physician Certification and Advancement (APCA). This is a highly specialized certification that has only been achieved by 542 medical professionals in the United States, including physical therapists. The process to becoming certified takes approximately 2 years and requires the applicant to complete 150 peer mentored exams and to pass an arduous exam. While this may seem daunting, Aeyr will guide you through this process, starting with our basic MSK course then moving to advanced skills and registry review.

Is it Difficult to Learn Diagnostic Musculoskeletal Ultrasound?

Like any other valuable skill, there is a learning curve in the beginning that is steep. But the key to becoming an expert is to learn how to scan correctly from the start and then practice, practice, practice! Friends, family and patients all have extremities for you to scan. They’ll love it and you’ll become proficient with a modality that will benefit you and your practice.

No matter where you are on your journey, Aeyr is prepared to meet you and your needs. Whether it’s just becoming acquainted with diagnostic ultrasound and taking our Introduction to Musculoskeletal Ultrasound Upper and Lower Extremities Courses or diving into our full RMSK® Roadmap and adding on our Advanced Musculoskeletal Ultrasound Courses this Spring and Summer, our team I here to help you learn and incorporate ultrasound into your practice to improve patient care.

Jeannine Noble