The musculoskeletal system is a vast and complex network of bones, joints, nerves, muscles, ligaments, tendons and other tissues. All of these components must work seamlessly together to provide the body with the shape, support, stability and movement it needs for everyday living. If pain develops or an injury occurs, a physician may order a medical imaging test, such as a musculoskeletal ultrasound, to gain a better understanding of the issue and determine the best way to address it. For instance, if tendon damage is suspected, an ultrasound exam can allow the physician to visualize the problem and determine if the tissue is intact or torn.

How Does Ultrasound Work?

Ultrasound imaging technology works similarly to the sound navigation and ranging (sonar) systems used by oceanographers, fishermen and bats. When a sound wave strikes an object, the sound wave will bounce back (echo). By measuring the resulting echoes, it is possible to determine how far away the object is as well as its size, shape and consistency. A musculoskeletal ultrasound, or MSK ultrasound, uses sound waves to create high-resolution, real-time pictures of the body’s intricate internal structures.

What Does an Ultrasound Procedure Involve?

To prepare for a musculoskeletal ultrasound test, the patient will be asked to sit or lie comfortably on an examination table, and the technician will apply a warm gel to the patient’s skin over the injury site. The technician will then glide a handheld scanning device (transducer) over the gel. The transducer will transmit high-frequency sound waves (pings), then recapture the pings as they bounce off the body’s internal tissues.

Using the echoes, a computer in the connected ultrasound machine will calculate the location and density of each musculoskeletal component being examined, then translate that information into real-time images displayed on a nearby video monitor. Specifically, the images will be created based on the loudness (amplitude), pitch (frequency) and time it takes for the ultrasound signals to return to the transducer. The computer will also take into account the type of tissue the sound is traveling through.

A musculoskeletal ultrasound test is quick and well tolerated by most patients. The entire process can usually be completed within approximately 30 minutes. After the exam, the resulting images will be interpreted by a radiologist, who will prepare a detailed report for the physician who requested the ultrasound. The physician will then discuss the results with the patient and explain the next steps.

What Is MSK Ultrasound Used for?

A physician may use a musculoskeletal ultrasound exam to evaluate the following types of injuries and conditions (whether confirmed or suspected):

• A strained muscle
• A sprained ligament
• Bursitis
• Tendinitis
• Tendinopathy
• A torn muscle, ligament or tendon
• Plantar fasciitis
• An entrapped nerve
• Inflammation or fluid buildup in a joint
• A cyst
• A soft tissue mass or tumor
• A foreign body, such as a splinter or glass shard, in a soft tissue

In addition to assessing sports-related injuries such as rotator cuff tears and overuse injuries such as carpal tunnel syndrome, a musculoskeletal ultrasound may be used to diagnose a suspected degenerative condition, such as osteoarthritis. This is important because, with an early diagnosis and appropriate treatment, it may be possible to slow the progression of osteoarthritis.

What Are the Advantages of Ultrasound?

When used for medical imaging, a key advantage of ultrasound is that unlike other imaging technologies—including X-ray, computed tomography (CT) and positron emission tomography (PET)—ultrasound does not expose the patient to ionizing radiation, and no contrast dye injections are needed for heightened image clarity.

Additionally, unlike magnetic resonance imaging (MRI), ultrasound does not use strong magnetic fields, so it is safe for patients with cardiac pacemakers and metallic implants. And because an ultrasound exam is not performed in a tightly enclosed space, it does not cause claustrophobia and therefore may be a practical alternative for a patient who cannot tolerate a traditional MRI.

Another advantage of using this safe, noninvasive test for evaluating musculoskeletal injuries is that the patient is not required to remain completely still during the procedure. While focusing on the precise injury site, the technician can use dynamic imaging to evaluate the effect of certain bodily movements on the patient’s pain. The technician can also use the ultrasound’s Doppler effect to track moving substances, such as blood flowing through the patient’s veins and arteries.

A musculoskeletal ultrasound test can provide a unique and highly detailed analysis of an injury site, including several views, which can be especially helpful if pain and other symptoms are triggered or worsened by movement. Oftentimes, a physician will order multiple imaging tests that complement each other, such as ultrasound and MRI, during the diagnostic process.

Due to the many advantages of MSK ultrasound, this advanced imaging modality is frequently used for evaluating and diagnosing traumatic, inflammatory and degenerative musculoskeletal conditions. Because it provides real-time imaging, it can also be used for guiding minimally invasive procedures, such as needle biopsies and fluid aspirations. In addition to athletes, the test is suitable for a wide range of patients, including pregnant women, older adults and infants.

Talk With a Specialist

If you have questions about musculoskeletal ultrasound or would like to consult with an experienced sports medicine doctor, contact Florida Medical Clinic Orlando Health at 813-979-6978 to request an appointment at our New Tampa office, which is conveniently located at 15285 Amberly Drive.

About W. Andrew Sprouse, MD

Dr. Sprouse is a primary care physician and sports medicine specialist who believes in exercise as medicine. His specialties include the prevention, diagnosis and treatment of non-surgical musculoskeletal injuries sustained during athletic activities, and he has extensive expertise in musculoskeletal ultrasound. By allowing for a safe, detailed and noninvasive assessment of joints, nerves, muscles, ligaments and tendons, this advanced imaging technique can lead to a fast and accurate diagnosis.