Musculoskeletal ultrasound (MSUS) has been around for quite sometime and has turned into an established imaging technique for the diagnosis and follow up of patients with rheumatic diseases — such as rheumatoid arthritis. MSUS generates pictures/imaging of muscles, tendons, ligaments, joints and soft tissue throughout the body.
From Radiology Info, MSUS helps diagnose the following:
- tendon tears, such as tears of the rotator cuff in the shoulder or Achilles tendon in the ankle
- abnormalities of the muscles, such as tears and soft-tissue masses
- bleeding or other fluid collections within the muscles, bursae and joints
One limitation however of this imagine procedure is that it has difficulty penetrating to the bones and so can only see the outer surface of bony structures. For imaging of the internals of the bones and joints, MRI comes in.
According to UK’s National Rheumatoid Arthritis Society:
Ultrasound is relatively inexpensive and safe, avoiding the exposure to radiation that is necessary for conventional x-rays, CT and MRI scans.
Traditionally, rheumatologists have referred patients to radiologists for all ultrasound examinations but recent developments have enabled them to conduct some scans themselves. The advent of portable ultrasound machines (figure 2) means that scans can be carried out at the bedside or in the outpatient clinic without the need for a second appointment in the x-ray department.
This speeds up the process of investigation and allows the rheumatologist to plan treatment without delay. Radiologists are expert at conducting detailed scans that often assist with a structural diagnosis. Rheumatologists tend to use ultrasound in a slightly different way. They may use it to guide them in carrying out difficult joint injections.
They also use it to detect subtle inflammation around tendons and small knuckle joints. This is important because clinical examination may not always identify inflammation, particularly in early arthritis. The earlier the diagnosis of rheumatoid arthritis, the better the chance of dampening down inflammation and preventing joint damage.
Well I guess it is always better to see a rheumatologist for this procedure…though the combined ‘reading’ or interpretation of both rheumatologist and radiologist alike would be a lot of help. Has anybody reading this underwent MSUS, let us know about it. Was the procedure helpful in the diagnosis?