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What does a Musculoskeletal (MSK) Ultrasound tell you that an X-Ray or MRI does not?

Good question! This is something we hear quite often while performing an MSK Ultrasound…

Ultrasound is an especially useful adjunct to the clinical exam done by your physician. When used together with an x-ray, which may or may not be ordered alongside an ultrasound, it can aid in putting the pieces of a puzzle together to facilitate further management. What does this mean? Potentially more information for your physician which will ultimately guide the decisions used to structure your care. This has implications for pain management, intervention and/or rehabilitation.  

Why not just use MRI? Isn’t it the ‘gold standard’? 

Magnetic Resonance Imaging (MRI) has its advantages, which we won’t get into here, but it cannot always be done in a timely manner. One advantage of ultrasound is that it can usually be booked a lot sooner than an MRI. This is so important when you are in pain now!

Another significant advantage of an MSK ultrasound is that it can be done with dynamic movement, physical palpation correlation and if warranted, a comparison with the asymptomatic side. This results in an accurate diagnostic assessment. Finally, any patient can undergo an ultrasound without having to worry about contraindications such as having a pacemaker, a metal implant or contending with claustrophobia. Another very important advantage of ultrasound is that it does not expose patients to radiation. There is no risk to patients having an ultrasound. Radiation exposure should always be considered when imaging.

Of course, there are limitations to ultrasound when used for any purpose, but we will touch on some of the key MSK related limitations. 

  • Ultrasound cannot image deep into joints or past a bony cortex.  Without getting too much into the physics of it, ultrasound uses sound waves to display an image on the screen (which is pretty cool if you ask us!). Sound waves can only penetrate so far before they are impeded either by depth of a structure or poor reflection of a structure, such as in the case of bone. Sound waves cannot travel through bone but are reflected by the strong interface. So, for example, we cannot see behind that knee joint, through the ribs, or into the shoulder joint.  However, we can see the structures overlying bone such as tendons, ligaments, synovial lining, etc.
  • MSK ultrasound is highly operator dependent, so competency-based training, high quality mentoring and peer support are important for success and accuracy! Fortunately, Beam has the best MSK techs in the Calgary area!
  • Performing MSK ultrasound requires the ability to place the structural findings within the clinical context. This means, as we age our bodies may show normal signs of ‘wear and tear’.  So, a finding that may be more significant in a 20–30-year-old, may not be of clinical or surgical significance in an asymptomatic patient or a 70–80-year-old.  

This brings us back to another one of the MANY benefits of MSK ultrasound.  At Beam, we will ask you questions and adjust the exam accordingly for your benefit when our team deems it necessary and appropriate.  It really is such a dynamic examination with collaboration between patient, technologist and radiologist:

It is just one of the reasons why we love it!

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