Summer
2019

In Sports Medicine, many injuries and conditions involve damage to the soft tissues of the musculoskeletal system. As a result, ultrasound (US) is quickly becoming an invaluable tool in the clinic due to its ability to quickly evaluate muscles, ligaments, tendons and nerves for structural tears or overuse tissue abnormalities. A few common examples include the overuse tendon condition of tendinopathy (Tennis Elbow, Golfers Elbow, Jumper’s Knee, etc.), rotator cuff tears, cystic masses (such as baker’s or ganglion cysts), ligament tears, and peripheral nerve compressions.

US Versus MRI

US compares well to MRI in the ability to accurately diagnose many soft tissue conditions. Its use in the clinic can sometimes save patients the hassle and expense of scheduling an MRI and the point of care information US provides often helps in developing a treatment plan.

Interestingly, management of peripheral neuropathies is another area where US can be helpful. US is increasingly being used in clinic to diagnose and treat peripheral neuropathies that may be a result of blunt trauma, instability, compression, or stretch injuries to the nerves that can occur with exercise or activities.

It is important to note that US has limitations in evaluating most bone-related pathology. US provides very limited diagnostic information beneath osseous surfaces. Consequently, it’s an inferior imaging modality for most fractures, intra-osseous pathology or pathology obscured by bone such as the cruciate ligaments in the knee or labral tears in the shoulders/hips.

US as a Guidance Tool

In addition to its diagnostic applications, US is used to help improve many procedures by increasing their safety and often increasing their effectiveness. Ultrasound guidance is frequently used to facilitate aspirations, diagnostic and therapeutic injections of joints and tendon sheaths, tenotomies, and nerve hydrodissections.

Tenex Procedure Treats Scar Tissue

One unique intervention worth mentioning that utilizes US is Tenex. The Tenex procedure is used to treat tendinopathies and is typically done in the office setting under local anesthesia. Diagnostic US is used to guide a special needle to very specific, abnormal regions of painful tendons to debride scar tissue thereby facilitating tendon healing. This procedure is covered by insurance and is commonly used to treat conditions such as lateral and medial epicondylitis, patellar tendinosis, Achilles tendinosis and plantar fasciitis. Tenex is minimally invasive and has short recovery times of often less than six weeks. This makes it a very attractive non-operative option for patients struggling with various chronic tendinopathies.

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Written By: Ryan Hudson MD