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Int J Sports Phys Ther
Int J Sports Phys Ther
2159
International Journal of Sports Physical Therapy
2159-2896
NASMI Website: International Journal of Sports Physical Therapy

36793557
68184
10.26603/001c.68184
Invited Clinical Commentary
MSK Ultrasound - An IJSPT Perspective
Page Phil PT, PhD, ATC, CSCS, FACSM 1
Manske Robert C PT, DPT, Med, SCS, ATC, CSCS 2
Voight Michael PT, DHSC, SCS, OCS, ATC, CSCS, FAPTA 3
Wolfe Chris PT, DPT, OCS, Cert MDT 3
1 Doctor of Physical Therapy Program Franciscan University https://ror.org/02bcmdm86
2 Doctor of Physical Therapy Program Wichita State University https://ror.org/00c4e7y75
3 School of Physical Therapy Belmont University https://ror.org/033vjpd42
Corresponding Author: phillip.page@franu.edu
2 2 2023
2023
18 1 110
© The Author(s)
https://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (4.0) which permits non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

MSK ultrasound is a valuable imaging technique which has become increasingly popular in recent years. This efficient technique proves beneficial in a variety of ways. MSK ultrasound effectively streamlines the process by enabling practitioners to securely and accurately image and assess structures all in one simple step. By allowing healthcare providers to access critical information quickly and conveniently, MSK ultrasound can help identify conditions early when interventions are most effective. Moreover, it may be able to shorten diagnostic times and reduce costs through more cost-effective use of resources such as imaging and laboratory testing. Furthermore, MSK ultrasound can provide additional insights into musculoskeletal anatomy and help improve patient care and outcomes. In addition, utilizing this method reduces exposure to radiation and provides enhanced patient comfort with its quick scan duration. MSK ultrasound has a high potential to provide quick and accurate diagnosis of MSK disturbances when used correctly. As clinicians become more comfortable and familiar with this technology, we will continue to see its use expand for various MSK assessments. In this commentary we’ll explore how ultrasound can be used in physical therapy, specifically for musculoskeletal assessment. We’ll also look at some of the potential benefits and limitations of using ultrasound in PT practice.

MSK ultrasound
PT imaging
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pmcBackground

Point of Care Ultrasound (POCUS) is commonly used in various medical disciplines to assess structures quickly and conveniently such as the heart, lungs and bladder. Musculoskeletal (MSK) ultrasound (US) is quickly growing as a non-invasive and safe manner of assessing musculoskeletal structures (bones, muscles, tendons, ligaments) without the need for expensive or potentially harmful studies such as radiograph or MRI.

MSK-US provides clinicians with a “window” through the skin to examine different tissues including muscle, bone, tendon, and ligament. In addition to structural integrity, visualizing inflammation using MSK-US may support a physical therapy diagnosis and guide appropriate physical therapy interventions. While physical therapists (PTs) are familiar with “therapeutic” ultrasound, MSK-US is not widely used by PTs. The earliest publications of MSK-US use by PTs were in the 1980s, focusing on the quadriceps muscle to describe its size.1,2 In the 1990’s, researchers and clinicians at the University of Queensland identified the activity of the deep multifidus and transverse abdominus muscles in relation to other abdominal muscles in patients with lower back pain.3,4 They discovered that the multifidus was atrophied and the transverse abdominus muscle was delayed in activation in patients diagnosed with lower back pain; they subsequently used MSK-US to provide visualization of patients for real-time feedback during rehabilitation.5 More recently, researchers reported high levels of agreement when PTs using MSK-US were compared with radiologists on 40 cadaveric shoulders.6

“Rehabilitative” ultrasound imaging (RUSI) was the term initially used to describe its use in evaluating soft tissue structures during tasks.7 Since then, 4 categories of ultrasonography have been identified in physical therapy: diagnostic, rehabilitation, interventional, and research ultrasound.8 Because these categories were only recently described, the terminology used in the literature may not be consistent; therefore, this review will follow the descriptions provided by Whittaker et al.8 In general, POCUS consists of diagnostic, rehabilitative, and interventional US; research US is used for scientific purposes:

Diagnostic US: diagnosis and monitor pathology (haemarthrosis, sprains, strains, healing stage, lesions, disease)

Rehabilitative US: evaluate muscle and other soft tissue structure and function (including biofeedback) during physical tasks

Interventional US: guide percutaneous procedures involving ‘dry’ (acupuncture) or ‘wet’ needling (injection)

Research US: measurement; explore muscle and soft tissue structure and function; develop and evaluate screening tools and interventions

Diagnostic MSK Ultrasound

Although PTs do not make medical diagnoses, they evaluate pathoanatomic structures in making a physical therapy diagnosis. Identifying structural lesions beyond the physical therapy scope of practice (such as a fracture) allows the PT to refer patients to appropriate providers if needed quickly. MSK-US has been shown to be a cost-effective measure in diagnosing structural pathologies.9,10

For some MSK conditions ultrasound has been proven to be equal to or better than MRI for accurate diagnosis of meniscal injuries,11 ACL and PCL injuries,12 Achilles tendinopathy,13 peripheral nerve injuries,14 lateral epicondylitis,15 thumb ulnar collateral ligament injuries,16–27 identifying rotator cuff tears,16–27 and supraspinatus lesions.28,29 There are several types of MSK injuries that US may not be comparable to MRI that include distal biceps tendon avulsions,30 plantar plates.31 MSK-US has also been used for the evaluation of acute athletic injury.32,33

Interest is gaining in US’s ability to view muscles both statically and dynamically.34–40 Dynamic US protocols have been published by an international group of experts to help clinicians evaluate structures while recording video during real-time patient examination to improve their understanding of their diagnosis.41–44 Dynamic ultrasound allows for real-time visualization of structures as they move in relation to other structures. For example, the movement of adjacent fascial layers can be evaluated during active muscle contraction to assess fascial mobility. Muscle architecture can be examined under contraction or relaxation for deficits.

One of the more unique properties of MSK-US that can be used to assess musculoskeletal pathology is use of Doppler imaging of blood flow. This utilizes the Doppler effect which describes the change in frequency of the sound wave that is seen as an object moves closer to (toward) or farther (away) from the transducer. The amount of movement can be seen as the Doppler shift that can be picked up on an US image using color enhancement. In diagnostic US this is usually used to determine the presence or absence of blood flow, seen with issues like deep venous thrombosis after musculoskeletal injury to the lower,45–48 and upper extremities,49 or even vascular supply to joints).50 Color Doppler imaging is also useful in detecting effusions51 and musculoskeletal inflammation such as soft tissue hyperemia.52,53

Rehabilitative MSK Ultrasound

RUSI is used to provide real-time feedback for physical therapy patients. As mentioned previously, real-time US can be used for patient feedback in re-training activation of the transverse abdominus muscle in patients with lower back pain.5 RUSI has been used to assess muscle function in screening athletes for injury risk (Hides 2016, 2017).54,55 Other rehabilitation applications include pelvic health for urinary incontinence.56,57

Interventional MSK Ultrasound

Physical therapists can integrate MSK-US into their interventions to guide treatment. Silleves et al.58 reported a case of a runner with plantar fasciitis managed with MSK-US imaging to guide decision-making for optimal treatment location and progress. As dry needling has increased in popularity among PTs, the use of MSK-US to assist with needle placement has slowly grown59,60; however, the authors of one study suggested there is no additional benefit to using US-guided dry needling with PT in chronic neck pain patients.61

Typically, interventional MSK-US is performed by practitioners giving injections. While outside the scope of practice for most PTs, MSK-US provides for accurate placement of needles for injection of anti-inflammatory medication or during prolotherapy. Recently, the technique of “hydrodissection” has been introduced in musculoskeletal medicine.62–64 During hydrodissection, MSK-US is used to guide hypodermic needles into muscle and fascia to inject saline while breaking-up adhesions and facilitating fascial mobility.

Research MSK Ultrasound

MSK-US is also used as a measurement tool for soft tissues in research. In the past, instruments to measure muscle mass included bioelectrical impedance, dual X-ray absorptiometry, computed tomography, and magnetic resonance imaging. The use of MSK-US appears to be a simple, fast, safe, valid and reliable way to measure both muscle and tendon length and thickness.65–71 In addition to length and thickness, MSK-US can also be utilized to assess fascicle or pennation angles.72

Muscle thickness can be quantified to represent muscle contraction. A systematic review in 200973 suggested that MSK-US was a valid measure of trunk muscle activation and size during submaximal isometric contractions. Recently, fascia muscle thickness has been measured with MSK-US.74–76 Tissue stiffness can be measured as well, including tendon stiffness and overall tissue tension. Shear wave elastography, for example, has been shown to be a useful measure of quadriceps tendon and muscle stiffness.77–81 Pressure applied with the transducer is compared to the movement of the tissue on the ultrasound, and the tissue stiffness is quantified with a color map.

As stated previously, MSK-US can be used to quantify blood flow in arteries and resultant hyperemia of tissues. Many physical therapy interventions purport to increase blood flow to the treated area. Arterial blood flow can be quantified with MSK-US by vessel diameter and pulse flow during exercise or after interventions.82,83

MSK-US Technology

To perform musculoskeletal ultrasound, the therapist will require an ultrasound sonography device that includes an appropriate transducer. Generally, US transducers are classified as linear or curvilinear for superficial and deep tissue sonography, respectively. Some devices such as the Butterfly IQ (Burlington, MA) use a single transducer capable of both superficial and deep sonography. The transducer is the component that converts electrical energy into sound waves. Piezoelectric crystals within the transducer produce the piezoelectric effect that allows ultrasound waves to produce an image on the screen of the device. A soundwave is created that is sent to the tissue, which is returned to the transducer.

Various frequencies of sound waves are used depending on the depth of the tissue of interest. Most diagnostic US devices have pre-modulated settings depending on the target tissue. Musculoskeletal tissues are generally more superficial, thus using higher frequencies, while deeper structures, such as the abdominal organs require lower frequencies for best visualization. The sound waves are either reflected to the transducer, absorbed by the tissue, or refracted. Ultrasound waves that are reflected from tissue create an “echo” that returns to the transducer, where the echoes are electronically transformed into digital images at various shades of black and white. The level of reflection (and thus color) is known as “echogenicity”.

Ecogenicity

Ultrasonography measures the amount of echo from sound waves produced by the transducer at specific frequencies. Ultrasound “echogenicity” is defined as how bright musculoskeletal structures appear on an ultrasound image relative to other structures. Musculoskeletal tissues viewed on US will be either normal or pathologic tissues, and each displays a varying level of echogenicity. Structures run the gamut from hyperechoic (brighter) or hypoechoic (less bright) on imaging. Structures that are viewed as hyperechoic or echogenic are high in collagen content such as bones, normal healthy tendons, or certain calcifications in soft tissues. Nerves are hyperechoic and appear as a ‘starry night’ pattern on cross-section. A hypoechoic structure is one where the viewed structures appear darker (less white than hyperechoic structures). These structures could include fat, masses, cysts, or inflammation. A structure that is totally black is termed anechoic and usually represents fluid. For example, blood vessels appear as round, black circles in cross-section. Lastly, a structure is termed isoechoic when used to describe similar echogenicity of surrounding tissue. Table 1 provides an ‘echogenicity’ scale of tissues and Figure 1 is a general schematic of different layers of tissue viewed with ultrasound.

135798 Table 1. Musculoskeletal ultrasound echogenicity spectrum

Anechoic	Black	Fluid	Blood vessels or swelling/inflammation	
Hyaline Cartilage	At end of long bones, surrounded by bright white periosteum	
Hypoechoic	Grayscale	Fat	Hazy streaks below skin	
Muscle	Fasciculated/ speckled hypoechoic with hyperechoic striations, encased by bright fascia	
Tendon	Linear striated hyperechoic at ends of muscle inserting into bone (fibrillated in long-axis)	
Hyperechoic	White	Nerve	Hyperechoic “starry night” appearance	
Ligament	Linear Striated hyperechoic surrounding ends of bones at joints	
Cartilage	Articular cartilage at end of bones includes anechoic periosteum	
Fascia	Bright white, surrounding muscles	
Bone	Bright white line with acoustic shadow at bottom of image	

135799 Figure 1. Schematic representation of echogenicity of various structures with musculoskeletal ultrasound.

Skin

Subcutaneous fat

Superficial fascia

Deep muscular fascia

Muscle

Deep muscular fascia

Nerve

Vein (smaller) and Artery

Tendon

Ligament

Bone

Hyaline cartilage

Articular cartilage / joint space

Sonography Technique

Generally, a gel is used to promote transmission of sound waves to and from the tissues. This is done to couple the transducer with the body part so that air is not located between the skin and device. When air is introduced between the patient and the transducer the sound waves are more easily reflected away from the structures of importance resulting in a poorer image. Ultrasound gel pads can also be used as an interface between the transducer and bony prominences to minimize artifact.

Clinicians must have a keen knowledge of regional anatomy and palpation skills to ensure proper position of the transducer over the target tissue. The transducer should be held perpendicular to the skin with the indicator directed proximal and/or lateral; this standard positioning orients the examiner with the image. Most commonly, MS-US views can be viewed in either a short axis (transverse) or long axis (longitudinal). The short axis (SAX) is performed through the transverse plane of the intended tissue, while the long axis (LAX) is performed along the longitudinal length of the tissue (See Figure 2). When possible, it is best to visualize both to get an accurate representation of the entire tissue.

135800 Figure 2. Ultrasound transducer position in the transverse short axis (left image) and in the longitudinal long axis (right image)

Proper technique and adequate technology are essential for an accurate diagnosis. Improper technique can lead to artifacts, which can lead to an inaccurate diagnosis. A unique artifact in MSK-US is “anisotropy” where tissues of fibrillar structure, such as tendons and ligaments, have reduced ecogenicity based on the angle of the transducer. This can result in mistaken interpretation of pathological defects.

Education & Training

Although access to diagnostic ultrasound equipment has improved in cost and convenience, the ability to perform and interpret MSK-US requires training and experience. The use of MSK-US in PT practice is supported by the American Physical Therapy Association (APTA) and is generally not prohibited by state regulations; however, reimbursement may be denied unless the PT is credentialed to perform diagnostic ultrasound as a certified and registered MSK sonography practitioner (RSMK-certified).

Several companies provide education and training on MSK-US including virtual and hands-on courses, while some manufacturers such as Butterfly IQ (Burlington, MA) provide instructional videos. SonoSim (Santa Monica, CA) provides an affordable and portable POCUS simulation that includes a ‘dummy’ transducer to provide both didactic and psychomotor skills needed for MSK-US. Several excellent textbooks are available specific to MSK-US as well.84–86

Conclusion

Physical therapists have an opportunity to embrace technology and integrate MSK-US into their practice. Emerging research continues to support its use in PT for a variety of patients, including diagnosis, treatment, and research.
==== Refs
Measurement of quadriceps muscle wasting by ultrasonography Rheumatology Young A. Hughes I. Russell P. Parker M. J. Nichols P. J. R. 1980
19 3 141 148 1462-0324 10.1093/rheumatology/19.3.141 10.1093/rheumatology/19.3.141
Measurement of quadriceps cross–sectional area by ultrasonography: a description of the technique and its applications in physiotherapy Physiotherapy Practice Stokes Maria Young Archie 1 1986
2 1 31 36 0266-6154 10.3109/09593988609027039 10.3109/09593988609027039
Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain Spine Hides J. A. Stokes M. J. Saide M. Jull G. A. Cooper D. H. 1 1994
19 2 165 172 0362-2436 10.1097/00007632-199401001-00009 10.1097/00007632-199401001-00009
Delayed postural contraction of transversus abdominis in low back pain associated with movement of the lower limb Journal of Spinal Disorders Hodges Paul W. Richardson Carolyn A. 2 1998
11 1 46 56 0895-0385 10.1097/00002517-199802000-00008 10.1097/00002517-199802000-00008
Use of real-time ultrasound imaging for feedback in rehabilitation Manual Therapy Hides Julie A Richardson Carolyn A Jull Gwendolen A 8 1998
3 3 125 131 1356-689X 10.1016/s1356-689x(98)80002-7 10.1016/s1356-689x(98)80002-7
An interexaminer agreement and reliability study on cadavers with musculoskeletal ultrasound of the shoulder performed by physiotherapists and radiologists compared with dissection Musculoskeletal Science and Practice Duijn E.A.H.D. Roy van S. Karel Y.H.J.M Provyn S. Pouliart N. 8 2022
60 102569 2468-7812 10.1016/j.msksp.2022.102569 10.1016/j.msksp.2022.102569 35533597
Rehabilitative Ultrasound Imaging Symposium San Antonio, TX, May 8-10, 2006 Journal of Orthopaedic & Sports Physical Therapy Teyhen Deydre 8 2006
36 8 A1 3 0190-6011 10.2519/jospt.2006.0301 10.2519/jospt.2006.0301
Imaging with ultrasound in physical therapy: What is the PT’s scope of practice? A competency-based educational model and training recommendations British Journal of Sports Medicine Whittaker Jackie L Ellis Richard Hodges Paul William OSullivan Cliona Hides Julie Fernandez-Carnero Samuel Arias-Buria Jose Luis Teyhen Deydre S Stokes Maria J 25 4 2019
53 23 1447 1453 0306-3674 10.1136/bjsports-2018-100193 10.1136/bjsports-2018-100193 31023858
Cost-effectiveness of on-site musculoskeletal ultrasound in an outpatient rheumatology clinic Rheumatology Acebes Carlos Rubio Laura Román Almudena Herrero Antonio Arcos Javier 2021
60 4 1832 1838 1462-0324 10.1093/rheumatology/keaa678 10.1093/rheumatology/keaa678 33123731
Economics of musculoskeletal ultrasound Current Radiology Reports Bureau Nathalie J. Ziegler Daniela 20 6 2016
4 8 44 2167-4825 10.1007/s40134-016-0169-5 10.1007/s40134-016-0169-5 27398265
Diagnostic accuracy of point-of-care knee ultrasound for evaluation of meniscus and collateral ligaments pathology in comparison with MRI Acta Radiologica Elshimy Ahmed Osman Ahmed M Awad Mohamed El Sayed Abdel Aziz Mohamed M 1 12 2021
2841851211058280 0284-1851 10.1177/02841851211058280 10.1177/02841851211058280
Efficiency of knee ultrasound for diagnosing anterior cruciate ligament and posterior cruciate ligament injuries: a systematic review and meta-analysis Skeletal Radiology Lee Sun Hwa Yun Seong Jong 10 5 2019
48 10 1599 1610 0364-2348 10.1007/s00256-019-03225-w 10.1007/s00256-019-03225-w
Multimodal ultrasound versus mri for the diagnosis and monitoring of achilles tendinopathy: a prospective longitudinal study Orthopaedic Journal of Sports Medicine Gatz Matthias Bode Daniela Betsch Marcel Quack Valentin Tingart Markus Kuhl Christiane Schrading Simone Dirrichs Timm 1 4 2021
9 4 23259671211006824 2325-9671 10.1177/23259671211006826 10.1177/23259671211006826 33912619
Performance evaluation of high-resolution ultrasound versus magnetic resonance imaging in diagnosing peripheral nerve pathologies Indian Journal of Radiology and Imaging Nischal Neha Gupta Saurabh Lal Kanhaiya Singh Jatinder Pal 1 2021
31 1 43 48 0971-3026 10.1055/s-0041-1729130 10.1055/s-0041-1729130 34376930
Ultrasonography versus magnetic resonance imaging in detecting and grading common extensor tendon tear in chronic lateral epicondylitis PloS One Bachta Artur Rowicki Krzysztof Kisiel Bartłomiej Żabicka Magdalena Elert-Kopeć Sylwia Płomiński Janusz Tłustochowicz Witold Maliborski Artur 27 7 2017
12 7 e0181828 1932-6203 10.1371/journal.pone.0181828 10.1371/journal.pone.0181828 28749994
Evaluation of supraspinatus muscle tears by ultrasonography and magnetic resonance imaging in comparison with surgical findings The Egyptian Journal of Radiology and Nuclear Medicine Abd-ElGawad Ehab A. Ibraheem Mohammed A. Fouly Ezzat H. 12 2013
44 4 829 834 0378-603X 10.1016/j.ejrnm.2013.08.001 10.1016/j.ejrnm.2013.08.001
The detection of full thickness rotator cuff tears using ultrasound The Journal of Bone and Joint Surgery. British Volume Al-Shawi A. Badge R. Bunker T. 7 2008
90 7 889 892 0301-620X 10.1302/0301-620x.90b7.20481 10.1302/0301-620x.90b7.20481 18591598
Physician training ultrasound and accuracy of diagnosis in rotator cuff tears Bulletin of the Hospital for Joint Disease (2013) Day Michael Phil M. McCormack Richard A. Nayyar Samir Jazrawi Laith 9 2016
74 3 207 211 2328-5273 PMID: 27620544
Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: a meta-analysis American journal of roentgenology de Jesus Joseph O. Parker Laurence Frangos Andrea J. Nazarian Levon N. 6 2009
192 6 1701 1707 0361-803X 10.2214/ajr.08.1241 10.2214/ajr.08.1241 19457838
Diagnostic accuracy of ultrasonography for rotator cuff tears: a systematic review and meta-analysis Orthopaedic Journal of Sports Medicine Farooqi Ali S. Lee Alexander Novikov David Kelly Ann Marie Li Xinning Kelly John D. IV Parisien Robert L. 1 10 2021
9 10 23259671211035104 2325-9671 10.1177/23259671211035106 10.1177/23259671211035106 34660823
Accuracy of ultrasonography (US) and magnetic resonance imaging (MRI) in detection of rotator cuff tears in district general hospital Polish Journal of Radiology Elmorsy Ahmed Keightley Andrew Flannery Mark 2017
82 634 637 1899-0967 10.12659/pjr.903004 10.12659/pjr.903004 29657628
Accuracy of office-based ultrasonography of the shoulder for the diagnosis of rotator cuff tears The Journal of Bone and Joint Surgery (American) Iannotti Joseph P. Ciccone J Buss D D 1 6 2005
87 6 1305 1311 0021-9355 10.2106/jbjs.d.02100 10.2106/jbjs.d.02100
Characterization of rotator cuff tears: Ultrasound versus magnetic resonance imaging Orthopedics Okoroha Kelechi R. Mehran Nima Duncan Jonathan Washington Travis Spiering Tyler Bey Michael J. Van Holsbeeck Marnix Moutzouros Vasilios 1 2017
40 1 e124 e130 0147-7447 10.3928/01477447-20161013-04 10.3928/01477447-20161013-04
Detection of rotator cuff tears: the value of MRI following ultrasound European Radiology Rutten Matthieu J. C. M. Spaargaren Gert-Jan van Loon Ton de Waal Malefijt Maarten C. Kiemeney Lambertus A. L. M. Jager Gerrit J. 2010
20 2 450 457 0938-7994 10.1007/s00330-009-1561-9 10.1007/s00330-009-1561-9 19727754
A comparative assessment between high-resolution ultrasonography and field magnetic resonance imaging in supraspinatus tear cases and its arthroscopic correlation Cureus Sabharwal Tushar Khanduri Sachin Khan Shahla Husain Mushahid Singh Anchal Khan Ahmad Umar Abbas Syed Zain Singh Harshika 11 9 2019
11 9 e5627 2168-8184 10.7759/cureus.5627 10.7759/cureus.5627 31700730
Detection and quantification of rotator cuff tears. Comparison of ultrasonographic, magnetic resonance imaging, and arthroscopic findings in seventy-one consecutive cases The Journal of Bone and Joint Surgery-American Volume Teefey Sharlene A. Rubin David A. Middleton William D. Hildebolt Charles F. Leibold Robert A. Yamaguchi Ken 4 2004
86 4 708 716 0021-9355 10.2106/00004623-200404000-00007 10.2106/00004623-200404000-00007 15069134
US depiction of partial-thickness tear of the rotator cuff. Radiology van Holsbeeck M T Kolowich P A Eyler W R Craig J G Shirazi K K Habra G K Vanderschueren G M Bouffard J A 11 1995
197 2 443 446 0033-8419 10.1148/radiology.197.2.7480690 10.1148/radiology.197.2.7480690
Sensitivity and specificity of ultrasonography in diagnosing supraspinatus lesions: a prospective accuracy diagnostic study Sao Paulo Medical Journal Yazigi Junior João Alberto Nicolao Fábio Anauate Matsunaga Fabio Teruo Archetti Netto Nicola Matsumoto Marcelo Hide Tamaoki Marcel Jun Sugawara 13 8 2018
136 4 292 297 1806-9460 10.1590/1516-3180.2018.0069170418 10.1590/1516-3180.2018.0069170418
The effectiveness of diagnostic tests for the assessment of shoulder pain due to soft tissue disorders: a systematic review Health Technology Assessment Dinnes J Loveman E McIntyre L Waugh N 10 2003
7 29 iii,1 166 1366-5278 10.3310/hta7290 10.3310/hta7290
Magnetic resonance imaging versus ultrasound in diagnosis of distal biceps tendon avulsion Orthopaedics & Traumatology: Surgery & Research Lynch Jonathan Yu Charles C. Chen Chaoyang Muh Stephanie 9 2019
105 5 861 866 1877-0568 10.1016/j.otsr.2019.01.021 10.1016/j.otsr.2019.01.021
Role of magnetic resonance imaging versus ultrasound for detection of plantar plate tear Journal of Orthopaedic Surgery and Research Duan Xin Li Lang Wei Dai-Qing Liu Ming Yu Xi Xu Zhao Long Ye Xiang Zhou 21 1 2017
12 1 14 1749-799X 10.1186/s13018-016-0507-6 10.1186/s13018-016-0507-6 28109309
Diagnostic musculoskeletal ultrasound for the acute evaluation and management of soccer players Current Sports Medicine Reports Bailowitz Zachary Visco Christopher J. Christen Kevin Ahmad Christopher S. 10 2021
20 10 525 530 1537-8918 10.1249/jsr.0000000000000890 10.1249/jsr.0000000000000890
Ultrasound of sports injuries of the musculoskeletal system: gender differences Journal of Ultrasound Robotti Guido Draghi Ferdinando Bortolotto Chandra Canepa Maria Grazia 4 3 2020
23 3 279 285 1876-7931 10.1007/s40477-020-00438-x 10.1007/s40477-020-00438-x 32130686
Measurement of transversus abdominis activation in chronic low back pain patients using a novel standardized real-time ultrasound imaging method Ultrasound Flavell Carol A Marshman Laurence G Gordon Susan J 2019
27 1 31 37 1742-271X 10.1177/1742271x18785403 10.1177/1742271x18785403 30774696
Measurement of muscle contraction with ultrasound imaging Muscle & Nerve Hodges P.W. Pengel L.H.M. Herbert R.D. Gandevia S.C. 19 5 2003
27 6 682 692 0148-639X 10.1002/mus.10375 10.1002/mus.10375
Ultrasonographic assessment of human skeletal muscle size European Journal of Applied Physiology Reeves Neil D. Maganaris Constantinos N. Narici Marco V. 1 1 2004
91 1 116 118 1439-6319 10.1007/s00421-003-0961-9 10.1007/s00421-003-0961-9
Human calf muscle responses during repeated isometric plantarflexions Journal of Biomechanics Maganaris Constantinos N. Baltzopoulos Vasilios Sargeant Anthony J. 1 2006
39 7 1249 1255 0021-9290 10.1016/j.jbiomech.2005.03.011 10.1016/j.jbiomech.2005.03.011
Automated semi-real-time detection of muscle activity with ultrasound imaging Medical & Biological Engineering & Computing Sosnowska Anna J. Vuckovic Aleksandra Gollee Henrik 16 8 2021
59 9 1961 1971 0140-0118 10.1007/s11517-021-02407-w 10.1007/s11517-021-02407-w 34398417
Dynamic measurement of pennation angle of gastrocnemius muscles during contractions based on ultrasound imaging Biomedical Engineering Online Zhou Yongjin Li Ji-Zhou Zhou Guangquan Zheng Yong-Ping 2012
11 1 63 1475-925X 10.1186/1475-925x-11-63 10.1186/1475-925x-11-63 22943184
Sonomyography: monitoring morphological changes of forearm muscles in actions with the feasibility for the control of powered prosthesis Medical Engineering & Physics Zheng Y.P. Chan M.M.F. Shi J. Chen X. Huang Q.H. 6 2006
28 5 405 415 1350-4533 10.1016/j.medengphy.2005.07.012 10.1016/j.medengphy.2005.07.012 16115790
EURO-MUSCULUS/USPRM Dynamic ultrasound protocols for shoulder American Journal of Physical Medicine & Rehabilitation Ricci Vincenzo Chang Ke-Vin Güvener Orhan Mezian Kamal Kara Murat Leblebicioğlu Gürsel Stecco Carla Pirri Carmelo Ata Ayşe Merve Dughbaj Muhammad Jain Nitin B. Özçakar Levent 2022
101 3 e29 e36 1537-7385 10.1097/phm.0000000000001833 10.1097/phm.0000000000001833 34923500
EURO-MUSCULUS/USPRM Dynamic ultrasound protocols for elbow American Journal of Physical Medicine & Rehabilitation Ricci Vincenzo Güvener Orhan Chang Ke-Vin Wu Wei-Ting Mezian Kamal Kara Murat Leblebicioğlu Gürsel Pirri Carmelo Ata Ayşe Merve Dughbaj Muhammad Jain Nitin B. Stecco Carla Özçakar Levent 2022
101 6 e83 e92 1537-7385 10.1097/phm.0000000000001915 10.1097/phm.0000000000001915 34930863
EURO-MUSCULUS/USPRM Dynamic ultrasound protocols for (adult) hip American Journal of Physical Medicine & Rehabilitation Mezian Kamal Ricci Vincenzo Güvener Orhan Jačisko Jakub Novotný Tomáš Kara Murat Chang Ke-Vin Naňka Ondřej Pirri Carmelo Stecco Carla Dughbaj Muhammad Jain Nitin B. Özçakar Levent 9 6 2022
101 11 e162 e168 1537-7385 10.1097/phm.0000000000002061 10.1097/phm.0000000000002061 35687784
EURO-MUSCULUS/USPRM Dynamic ultrasound protocols for wrist and hand American Journal of Physical Medicine & Rehabilitation Mezian Kamal Ricci Vincenzo Güvener Orhan Jačisko Jakub Novotny Tomas Kara Murat Ata Ayşe Merve Wu Wei-Ting Chang Ke-Vin Stecco Carla Pirri Carmelo Leblebicioğlu Gürsel Özçakar Levent 19 4 2022
101 9 e132 e138 1537-7385 10.1097/phm.0000000000002005 10.1097/phm.0000000000002005
Efficiency of deep venous thrombosis prevention in proximal femur fractures Acta Ortopédica Brasileira Garcia João Vitor DA Cruz Takata Vinicius Diaz Luis Eduardo Plumacher Dada Neto Francisco Santana Marcos Vinicius Felix Dobashi Eiffel Tsuyoshi 2022
30 6 e256947 1809-4406 10.1590/1413-785220223006e256947 10.1590/1413-785220223006e256947 36561477
Defining the role of risk stratification and duplex ultrasound in the diagnosis of acute lower extremity deep vein thrombosis Journal of Vascular Surgery: Venous and Lymphatic Disorders Schafer Kristin Goldschmidt Eric Oostra Drew Kaminski Brian Mattin Mike Lurie Fedor 9 2022
10 5 1021 1027 2213-333X 10.1016/j.jvsv.2022.02.017 10.1016/j.jvsv.2022.02.017 35307609
Preoperative incidence and risk factors of deep vein thrombosis in patients with an isolated patellar fracture BMC musculoskeletal disorders Yang Weijie Wang Haicheng Wei Qun Ding Kai Jia Yuxuan Li Chao Zhu Yanbin Chen Wei 3 3 2022
23 1 204 1471-2474 10.1186/s12891-022-05163-6 10.1186/s12891-022-05163-6 35241054
Preoperative risk factors for deep vein thrombosis in knee osteoarthritis patients undergoing total knee arthroplasty Journal of Orthopaedic Science Xiong Xiaojuan Cheng Bo 1 2023
28 1 180 187 0949-2658 10.1016/j.jos.2021.09.016 10.1016/j.jos.2021.09.016
Emergency department point-of-care ultrasound for upper extremity deep venous thrombosis ED POCUS for upper extremity DVT International Journal of Emergency Medicine Tan Gregory Ng Mingwei 4 11 2021
14 1 66 1865-1372 10.1186/s12245-021-00391-4 10.1186/s12245-021-00391-4 34736403
Vascular supply of the metacarpophalangeal joint Frontiers in Medicine Baksa Gabor Czeibert Kalman Sharp Veronika Handschuh Stephan Gyebnar Janos Barany Laszlo Benis Szabolcs Nyiri Gabor Mandl Peter Petnehazy Ors Balint Peter Vince 20 10 2022
9 1015895 2296-858X 10.3389/fmed.2022.1015895 10.3389/fmed.2022.1015895 36341235
Identification of knee effusions with ultrasound: a comparison of three methods Clinical Journal of Sport Medicine Cushman Daniel M. Ross Brendon Teramoto Masaru English Joy Joyner James R. Bosley Justin 2022
32 1 e19 e22 1050-642X 10.1097/jsm.0000000000000823 10.1097/jsm.0000000000000823 32032167
Detection of soft-tissue hyperemia: value of power Doppler sonography. American journal of roentgenology Newman J S Adler R S Bude R O Rubin J M 8 1994
163 2 385 389 0361-803X 10.2214/ajr.163.2.8037037 10.2214/ajr.163.2.8037037 8037037
Power Doppler sonography in the assessment of musculoskeletal fluid collections. American journal of roentgenology Breidahl W H Newman J S Taljanovic M S Adler R S 6 1996
166 6 1443 1446 0361-803X 10.2214/ajr.166.6.8633460 10.2214/ajr.166.6.8633460 8633460
Association between altered motor control of trunk muscles and head and neck injuries in elite footballers – An exploratory study Manual Therapy Hides Julie A. Mendis M. Dilani Franettovich Smith Melinda M. Miokovic Tanja Cooper Andrew Low Choy Nancy 8 2016
24 46 51 1356-689X 10.1016/j.math.2016.05.001 10.1016/j.math.2016.05.001 27317504
Predicting football injuries using size and ratio of the multifidus and quadratus lumborum muscles Scandinavian Journal of Medicine & Science in Sports Hides J. A. Stanton W. R. 2017
27 4 440 447 0905-7188 10.1111/sms.12643 10.1111/sms.12643 28271614
The use of perineal ultrasound to quantify levator activity and teach pelvic floor muscle exercises International Urogynecology Journal Dietz H. P. Wilson P. D. Clarke B. 6 2001
12 3 166 168; discussion 168 0937-3462 10.1007/s001920170059 10.1007/s001920170059
Effects of adding ultrasound biofeedback to individualized pelvic floor muscle training on extensibility of the pelvic floor muscle and anterior pelvic organ prolapse in postmenopausal women Contrast Media & Molecular Imaging Gu Xiaoning Yang Min Liu Fang Liu Dongmei Shi Fuwen 23 6 2022
2022 4818011 1555-4317 10.1155/2022/4818011 10.1155/2022/4818011 35833069
The management of plantar fasciitis with a musculoskeletal ultrasound imaging guided approach for instrument assisted soft tissue mobilization in a runner: a case report International Journal of Sports Physical Therapy Sillevis Rob Shamus Eric Mouttet Brittany 4 2020
15 2 274 286 2159-2896 10.26603/ijspt20200274 10.26603/ijspt20200274 32269861
A new treatment modality in piriformis syndrome: Ultrasound guided dry needling treatment Ağrı - The Journal of The Turkish Society of Algology Bağcıer Fatih Tufanoğlu F H 2020
32 3 175 176 1300-0012 10.14744/agri.2019.92170 10.14744/agri.2019.92170
Ultrasound guided dry needling: Relevance in chronic pain Journal of Postgraduate Medicine Vas LC 2022
68 1 1 9 0022-3859 10.4103/jpgm.jpgm_710_21 PMID: 35073681 PMCID: PMC8860112 35073681
Dry needling combined with guideline-based physical therapy provides no added benefit in the management of chronic neck pain: a randomized controlled trial Journal of Orthopaedic & Sports Physical Therapy Stieven Fábio Franciscatto Ferreira Giovanni Esteves Wiebusch Matheus de Araújo Francisco Xavier da Rosa Luis Henrique Telles Silva Marcelo Faria 8 2020
50 8 447 454 0190-6011 10.2519/jospt.2020.9389 10.2519/jospt.2020.9389 32272030
Fascial hydrodissection for chronic hamstring injury Current Sports Medicine Reports Courseault Jacques Kessler Eric Moran Alexandra Labbe Andre 11 2019
18 11 416 420 1537-8918 10.1249/jsr.0000000000000650 10.1249/jsr.0000000000000650
Effectiveness of hydro-dissection of the piriformis muscle plus low-dose local anesthetic injection for piriformis syndrome: a report of 2 cases American Journal of Case Reports Kaga Mihiro Ueda Takeshi 2022
23 e935346 1941-5923 10.12659/ajcr.935346 10.12659/ajcr.935346 35124689
First case of occipital neuralgia treated by fascial hydrodissection American Journal of Case Reports Kaga Mihiro 3 5 2022
23 e936475 1941-5923 10.12659/ajcr.936475 10.12659/ajcr.936475 35578561
Hamstring muscle architecture assessed sonographically using wide field of view: A reliability study PloS One Cronin Kevin Foley Shane Cournane Seán De Vito Giuseppe Delahunt Eamonn 10 11 2022
17 11 e0277400 1932-6203 10.1371/journal.pone.0277400 10.1371/journal.pone.0277400 36355813
Validity and reliability of rectus femoris ultrasound measurements: Comparison of curved-array and linear-array transducers Journal of Rehabilitation Research and Development Hammond Kendra Mampilly Jobby Laghi Franco A. Goyal Amit Collins Eileen G. McBurney Conor Jubran Amal Tobin Martin J. 2014
51 7 1155 1164 0748-7711 10.1682/jrrd.2013.08.0187 10.1682/jrrd.2013.08.0187 25437305
Thickness of biceps and quadriceps femoris muscle measured using point-of-care ultrasound as a representation of total skeletal muscle mass Journal of Clinical Medicine Hogenbirk Rianne N. M. Viddeleer Alain R. Hentzen Judith E. K. R. van der Plas Willemijn Y. van der Schans Cees P. de Bock Geertruida H. Kruijff Schelto Klaase Joost M. 8 11 2022
11 22 6606 2077-0383 10.3390/jcm11226606 10.3390/jcm11226606 36431082
A rapid point-of-care ultrasound marker for muscle mass and muscle strength in older adults Age Ageing Madden Kenneth M Feldman Boris Arishenkoff Shane Meneilly Graydon S 2021
50 2 505 510 0002-0729 10.1093/ageing/afaa163 10.1093/ageing/afaa163 32909032
The reliability and validity of ultrasound to quantify muscles in older adults: a systematic review Journal of Cachexia, Sarcopenia and Muscle Nijholt Willemke Scafoglieri Aldo Jager-Wittenaar Harriët Hobbelen Johannes S.M. van der Schans Cees P. 12 7 2017
8 5 702 712 2190-5991 10.1002/jcsm.12210 10.1002/jcsm.12210 28703496
The value of the peroneus brevis tendon cross-sectional area in early diagnosing of peroneus brevis tendinitis: The peroneus brevis tendon cross-sectional area Medicine (Baltimore) Park Jiyeon Kim Yun-Hong Choi Won-Jun Cho Hyung Rae Hong Uk Jin Yi Jungmin Choi Young-Soon Lim Young Su Kim Young Uk 28 10 2022
101 43 e31276 0025-7974 10.1097/md.0000000000031276 10.1097/md.0000000000031276
Association of muscle strength with muscle thickness and motor unit firing pattern of vastus lateralis muscle in youth athletes International Journal of Sports Physiology and Performance Yoshimura Akane Kunugi Shun Hirono Tetsuya Nojima Hiroya Ueda Saeko Holobar Aleš Mita Yukiko Watanabe Kohei 1 12 2022
17 12 1725 1731 1555-0265 10.1123/ijspp.2022-0094 10.1123/ijspp.2022-0094
Do intramuscular temperature and fascicle angle affect ultrasound echo intensity values? Medicine & Science in Sports & Exercise Pinto Matheus Daros Pinto Ronei Silveira Nosaka Kazunori Blazevich Anthony John 9 11 2022
1530-0315 10.1249/mss.0000000000003082 10.1249/mss.0000000000003082
Rehabilitative ultrasound imaging is a valid measure of trunk muscle size and activation during most isometric sub-maximal contractions: a systematic review Australian Journal of Physiotherapy Koppenhaver Shane L. Hebert Jeffrey J. Parent Eric C. Fritz Julie M. 2009
55 3 153 169 0004-9514 10.1016/s0004-9514(09)70076-5 10.1016/s0004-9514(09)70076-5 19681737
Ultrasound imaging of the superficial fascia in the upper limb: arm and forearm Diagnostics Pirri Carmelo Pirri Nina Guidolin Diego Macchi Veronica De Caro Raffaele Stecco Carla 4 8 2022
12 8 1884 2075-4418 10.3390/diagnostics12081884 10.3390/diagnostics12081884 36010234
Ultrasound imaging of brachial and antebrachial fasciae Diagnostics Pirri Carmelo Guidolin Diego Fede Caterina Macchi Veronica De Caro Raffaele Stecco Carla 2 12 2021
11 12 2261 2075-4418 10.3390/diagnostics11122261 10.3390/diagnostics11122261 34943498
Inter- and intra-rater reliability of ultrasound measurements of superficial and deep fasciae thickness in upper limb Diagnostics Pirri Carmelo Pirri Nina Porzionato Andrea Boscolo-Berto Rafael De Caro Raffaele Stecco Carla 9 9 2022
12 9 2195 2075-4418 10.3390/diagnostics12092195 10.3390/diagnostics12092195 36140596
Heterogeneity of passive elastic properties within the quadriceps femoris muscle–tendon unit European Journal of Applied Physiology Coombes Brooke K. Ziegenfuss Brandon David Michael Badya Rohitha van den Hoorn Wolbert Hug François Tucker Kylie 2018
118 1 213 221 1439-6319 10.1007/s00421-017-3763-1 10.1007/s00421-017-3763-1 29147849
Relationships between quadriceps tendon elasticity and knee flexion angle in young healthy adults Medicina Ebihara Bungo Mutsuzaki Hirotaka Fukaya Takashi 15 2 2019
55 2 53 1648-9144 10.3390/medicina55020053 10.3390/medicina55020053 30781444
An 8-week resistance training protocol is effective in adapting quadriceps but not patellar tendon shear modulus measured by Shear Wave Elastography PloS One Mannarino Pietro Matta Thiago Torres da Oliveira Liliam Fernandes de 16 4 2019
14 4 e0205782 1932-6203 10.1371/journal.pone.0205782 10.1371/journal.pone.0205782 30990803
Real-time sonoelastography of the patellar and quadriceps tendons: pattern description in professional athletes and healthy volunteers. Medical Ultrasonography Ozcan Ayse Nur Sirin Tan Sinan Tangal Nuray Gulden Cıracı Saliha Kudas Savas Bektaser Suleyman Bulent Arslan Halil 18 9 2016
18 3 299 304 2066-8643 10.11152/mu.2013.2066.183.ays 10.11152/mu.2013.2066.183.ays
Reliability of quantitative point shear-wave ultrasound elastography on vastus medialis muscle and quadriceps and patellar tendons Medical Ultrasonography Zardi Enrico Maria Franceschetti Edoardo Giorgi Chiara Palumbo Alessio Franceschi Francesco 17 2 2019
21 1 50 55 2066-8643 10.11152/mu-1712 10.11152/mu-1712
Blood vessel diameter measurement by ultrasound Physiological Measurement Li S McDicken W N Hoskins P R 1 8 1993
14 3 291 297 0967-3334 10.1088/0967-3334/14/3/007 10.1088/0967-3334/14/3/007
Ultrasound Doppler estimates of femoral artery blood flow during dynamic knee extensor exercise in humans Journal of Applied Physiology Rådegran G. 1 10 1997
83 4 1383 1388 8750-7587 10.1152/jappl.1997.83.4.1383 10.1152/jappl.1997.83.4.1383
Atlas of musculoskeletal ultrasound anatomy Bradley Mike O'Donnell Paul Cambridge University Press Cambridge, UK ; New York 2010
9780521728096 10.1017/cbo9780511691782 10.1017/cbo9780511691782
Atlas of musculoskeletal ultrasound of the extremities Rawat Mohini SLACK Incorporated Thorofare, NJ 2020
Thorofare, NJ 9781630916046
Introduction to musculoskeletal ultrasound: getting started Strakowski Jeffrey A. Demos Medical New York 2016
9781620700655 10.1891/9781617052309 10.1891/9781617052309
