Ultrasound is revolutionizing diagnosis of musculoskeletal conditions and the ability to precisely target nerves, joints, tendons, ligaments, and other structures for therapeutic intervention. For example, ultrasound guidance has revolutionized the safety and efficacy of nerve catheter placement, peripheral nerve ablation techniques, and peripheral nerve stimulation techniques.
Regenerative medicine with injection of stem cells, PRP, amniotic fluid extract, prolotherapy, and PRP is improving as a result of the highly accurate nature of ultrasound guided diagnosis and treatment of orthopedic diseases amenable to intervention by these modalities.
Sometimes ultrasound is a valuable tool that can diagnose conditions that cannot be diagnosed by MRI or X-ray. For example, in MRI one is told to hold still and the precise site of tenderness is not available to the person performing the imaging technique. However, with ultrasound, subtle tears and other problems can be diagnosed by having the patient move so that the precise area of injury can be visualized and its structural integrity evaluated dynamically. Ultrasound also has substantially higher resolution for shallow soft tissue than these other imaging modalities.
Ultrasound imaging uses sound waves to produce pictures of nerves, muscles, tendons, ligaments and joints throughout the body. It is used to help diagnose and treat chronic problems like arthritis and tendinosis, as well as acute conditions like sprains, strains, tears and other soft tissue injuries.
That said, it requires substantial expertise. Since ultrasound machines are so readily available, many practitioners try to use ultrasound but it requires a lot of time to become proficient. Dr. Fisk uses ultrasound exclusively (his partners focus more on fluoroscopy) and has a unique certification by the the American Society of Regional Anesthesia in Diagnostic and Therapeutic Ultrasound for Musculoskeletal and Neuropathic conditions.
Who should have a Musculoskeletal Ultrasound?
Anyone who has chronic pain in or around any of the joints of the extremities (hip, knee, ankle, foot, shoulder, elbow, wrist, hand) can benefit from evaluation by diagnostic ultrasound. Many conditions, including arthritis, tendinosis (often mislabeled as tendinitis), neuropathic pain, and ligament injuries are amenable to treatment via ultrasound guided injection therapy.
How does this help manage pain?
Specifically targeting the suspected site of pain is more effective than “blind” or anatomic based injections. Many studies and clinical experience suggests that having an expert who understands ultrasound based anatomy and can specifically guide a needle to the intended injection site markedly increases the chance of an effective treatment.
Dr. Zachary Fisk is ASRA board certified in ultrasound guided musculoskeletal and nerve pain management. This is a unique certification that most pain doctors do not achieve.