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Diagnostic Ultrasound

Ultrasound is an imaging method that uses high-frequency sound waves to produce real-time and dynamic images of the body. Ultrasounds are painless and do not use any ionizing radiation. Ultrasound is increasingly being used to assist Sports Medicine Physicians to perform evaluations and injections of different muscles, tendons, ligaments, joints and nerves. While a MRI is still the imaging modality of choice for some structures, ultrasound can provide greater detail of superficial structures than a MRI. Real time, point of care ultrasound, can assist in the diagnosis and treatment of acute and chronic orthopedic injuries. Ultrasound can give a clear picture of soft tissue injuries that do not show up well on x-rays, and can be an alternative to an MRI for patients who are claustrophobic, have cardiac pacemakers or otherwise cannot get an MRI. Although ultrasound is frequently used to identify injuries or abnormalities, ultrasound is also used when performing injections into the knee, shoulder and hip.

Conditions that can be diagnosed with ultrasound:

  • Rotator cuff tears
  • Tennis elbow/Golfer’s elbow
  • Jumper’s knee
  • Quadriceps and Patellar tendon ruptures
  • Achilles tendon injuries
  • Plantar Fasciitis
  • Muscle strains
  • Ligament sprains (Knee MCL sprain)
  • Tendonitis
  • Bursitis

Interventional Orthopedics and Guided Injections

Ultrasound guided platelet rich plasma injection for tennis elbow targeting a small tear in the tendon.

Traditionally, injections were given "blind". Despite good intentions, even in the most experienced hands injections performed without imaging are not 100% accurate and there is no guarantee of successfully hitting the target. In some joints accuracy is as low as 30%-40%. Ultrasound is a highly accurate method to guide orthopedic injections and procedures.

Ultrasound-guided injections are performed much in the same way as traditional injections, but the ultrasound allows the physician to visualize the target and see if the needle and medication is exactly where you need it to be.

Numerous studies have shown ultrasound-guided injections to be superior overall to “blind” injections. Ultrasound also decreases the amount of pain associated with the procedure, minimizes the risk of injury to the adjacent structures, and provides the best chance of a positive outcome.

Ultrasound can provide real-time feedback and can help guide injections in and around tendons, joints and nerves. The use of ultrasound improves the accuracy of the injection of corticosteroids, hyaluronic acid or other therapies such as Platelet Rich Plasma (PRP), Prolotherapy, Stem Cells or Lipogems. Ultrasound can also be used diagnostically to help determine which structures are generating pain.

Precise placement of the regenerative injection (PRP or Stem Cells) or Tenex microtip requires a level of expertise and skill to target the diseased tissue. Dr. Sussman has both the expertise in musculoskeletal ultrasound and in minimally invasive procedures that are rarely found in traditional orthopedic practices.

CAN ANYONE PERORM MSK ULTRASOUND?

Currently any physician can purchase an ultrasound machine and bill for diagnostic and interventional ultrasound without having received any training. A lack of defined training standards is problematic and not all physicians performing MSK Ultrasounds are adequately trained.

WHAT ARE THE ADVANTAGES OF ULTRASOUND GUIDED INJECTIONS?

Ultrasound guided injections have the advantage of giving “real time” feedback. The physician is able to watch the needle in real time as it enters the desired target. This assures that the medication is accurately injected at the intended site.

Ultrasound guided injections have been shown to be less painful than blind injections, and visualizing the surrounding structures minimizes the risk of injuring adjacent structures.

HOW ARE ULTRASOUND-GUIDED INJECTIONS PERFORMED?

Ultrasound-guided injections are performed much in the same way as traditional injections.

HOW DO I PREPARE FOR AN ULTRASOUND-GUIDED JOINT INJECTION?

Before your appointment day:

  • You do not need to do anything special before a joint injection. You may eat and drink as normal.

On the day of your appointment:

  • Please tell your physician if you are allergic to any medications.
  • It may be best to wear comfortable clothing with easy access to the joint being injected.

WHY BSB & OCPN?

Dr. Sussman is only 1 of 10 physicians in Massachusetts to be certified in musculoskeletal (RMSK) ultrasound

by the American Registry of Diagnostic Medical Sonographers (ARDMS), and he is published in peer-review journals on the use of ultrasound-guided injections in orthopedics.

The Orthopedic Care Physician Network (OCPN) is one of only 5 practices in all of New England that is accredited by the American Institute of Ultrasound Medicine (AIUM). AIUM accreditation sets nationally-recognized standards in the performance and interpretation of diagnostic ultrasound examinations.