Musculoskeletal Ultrasound

Ultrasound is a diagnostic procedure used to get clear pictures of internal body structures and diagnose abnormalities. It is a painless procedure that uses high-frequency sound waves to get the images of the internal body organs. Musculoskeletal Ultrasound is a special type of ultrasound that allows seeing the joints, muscles, tendons, nerves, and blood vessels in the vicinity of joints. It helps to diagnose muscle sprains, muscle tears, arthritis, nerve issues, and other conditions related to the musculoskeletal system.

Why is Musculoskeletal Ultrasound a unique procedure?

The musculoskeletal ultrasound is a unique procedure as it allows you to get high-resolution images of different parts of the body while producing movements. It helps to pinpoint the area of pain and damage and, with the help of dynamic imaging(1), makes it possible to observe the effects of motion on the damaged area. In addition, you can also observe the blood flowing through your arteries and veins by using the Doppler Effect.

Musculoskeletal Ultrasound for enthesitis in seronegative spondyloarthropathies:

Seronegative spondyloarthropathies (SpA) is a broad terminology coined to describe several inflammatory arthritis-related conditions. It affects several body parts, including entheses, spine, skin, joints, eyes, and GIT(2). The SpA is classified into axial seronegative arthritis and peripheral seronegative arthritis.

Axial seronegative arthritis affects the spine and sacroiliac joints, while peripheral seronegative arthritis affects other joints like finger joints, wrist, ankle, etc. Peripheral arthritis is usually asymmetric and affects ankles and knees most commonly(3).

Entheses are commonly affected in SpA. These are the sites where tendons and ligaments make connections with the bones. Connective tissue at these locations is commonly affected.

The SpA is diagnosed based on both laboratory and radiographic techniques. Family history is also important in diagnosis. Autoimmune and inflammatory markers are useful to assess the condition as inflammatory markers are usually raised in this clinical scenario.

Table 1

Comparison of ultrasound scoring systems for enthesopathy

GUESS: Glasgow ultrasound enthesitis score, MASEI: Madrid sonography enthesitis index, GRAPPA US: Proposed enthesitis. score by the GRAPPA ultrasound working group, OMERACT US: Proposed enthesitis score by the OMERACT ultrasound enthesitis working group

 

However, it’s usually difficult to confirm it by general diagnostic procedures. Several ultrasound scoring systems are developed(4) to improve the accuracy of diagnosis by using radiographic techniques. According to the current medical literature, musculoskeletal ultrasound is a valuable technique to confirm seronegative spondyloarthropathy.

How is the procedure performed?

• The procedure of the ultrasound is simple. You will be asked to sit or lie down on a bench or table. You will be asked to expose the examination area and may need to change to a gown for the procedure.

• The gel is placed on the examination area during the procedure, and the transducer transfers high-frequency sound waves. Gel maintains the contact between the transducer and your skin and removes the possibility of air entrapment which may block the passage of the sound waves.

• The Sonographer will move the transducer to the examination area and may ask you to produce the movements to observe the changes on the video monitor.

• After the procedure, the Sonographer will remove the gel, and you’re free. Any portion of the gel that remains evaporates quickly(5).

References:

1. Motamedi D, Bauer AH, Patel R, Morgan TA. Problem Solved: Integral Applications of Musculoskeletal Ultrasound. J Ultrasound Med. 2021 Aug;40(8):1693–704.

2. Duba AS, Mathew SD. The Seronegative Spondyloarthropathies. Prim Care. 2018 Jun;45(2):271–87.

3. Sakhrekar R, Hadgaonkar S, Hadgaonkar M, Sancheti P, Shyam A. Achondroplasia with seronegative spondyloarthropathy resulting in recurrent spinal stenosis : A case report. Surg Neurol Int [Internet]. 2021;12(354):354. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459356/

4. Kaeley GS. Enthesitis in psoriatic arthritis (Part 2): imaging. Rheumatology (Oxford). 2020 Mar 1;59(Suppl 1):i15–20.

5. Radiological Society of North America (RSNA), American College of Radiology (ACR). Musculoskeletal ultrasound [Internet]. Radiologyinfo.org. Available from: https://www.radiologyinfo.org/en/info/musculous

PREPARING FOR YOUR ULTRASOUND

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