Seeing With Sound

There are many ways technology continues to impact the delivery of healthcare and more specifically the ability to see inside the body. While not a new phenomenon, advances in technology, specifically in ultrasonography, have made imaging modalities such as musculoskeletal ultrasound imaging more readily available for practitioners such as Physical Therapists. Let's take a quick look into what and how ultrasound is used at Westside Dance Physical Therapy to assist and direct the management of musculoskeletal injury.

We can summarize musculoskeletal ultrasound imaging as a modality that sends and receives inaudible high frequency sound waves to and from the body to create images of the underlying anatomical structures.

Ultrasound systems have become smaller and portable with the ability to accurately assess anatomy. Pictured here is the portable ultrasound called the Butterfly iQ.

The applications used by Physical Therapists include the following:

• Rehabilitative ultrasound imaging

• Diagnosing and monitoring pathology (diagnostic US)

• Guiding percutaneous procedures involving ‘dry’ (ex. acupuncture/dry needling) (interventional US)

• Undertaking research (research US)

The majority of musculoskeletal ultrasound applications at Westside Dance Physical falls within the diagnostic and rehabilitative domains.

Diagnostic ultrasound involves examining the effects of acute or chronic injury, lesion or disease on joint/bone surfaces, muscle, tendon, ligament, bursa, vessels, nerves to inform rehabilitation. Ultrasound can not penetrate into bone and has limited scope into the joint thus making it ideal for the superficial structures below the surface of the skin.

• Musculoskeletal ultrasound has been used as a point of care/on-site tool at the New York City Ballet to assess acute injuries to bone (fractures) and ligaments (sprains) as well as track changes to soft tissue and bony stress injuries.

• We use ultrasound along with the history and physical examination and never as a stand alone test to dictate management of an injury

Rehabilitative ultrasound seeks to evaluate the morphology and function of muscle and soft tissue during movement (exercises or other physical tasks). The goal is to assist in the application of therapeutic interventions aimed at improving neuromuscular function.

• A point of interest has been on examining the relationship of muscle characteristics (see below) around the trunk on recovery and outcomes in those experiencing low back pain.

• Muscle characteristics include muscle fiber angle, thickness, contraction, changes in structure and composition, effects over time with aging or surgery.

If you are interested in how this might be helpful in understanding your condition please reach out to us. We are excited to have a Physical Therapist on staff, Dirk Hartog, PT, DPT, RMSK who is Registered in Musculoskeletal Sonography (RMSK) through the Alliance for Physician Certification and Advancement (APCA).

Stay Healthy!

- Westside Dance Physical Therapy Team

Resources

1. Whittaker JL, Ellis R, Hodges PW, et al. Imaging with ultrasound in physical therapy: What is the PT’s scope of practice? A competency-based educational model and training recommendations. Br J Sports Med. doi:10.1136/bjsports-2018-100193.

2. Potter CL, Claims MC, Stokes M. Use of ultrasound imaging by physiotherapists: A pilot study to survey use, skills and training. Manual Therapy. 17 (2012) 39 - 46.

3. Monaco R. Sports Ultrasound: a fundamental skill for sports medicine fellows moving forward. Br J Sports Med 2015;49:141 - 142.

4. Smith J, Finnoff JT. Physical Medicine and RehabilitationDiagnostic and Interventional Musculoskeletal Ultrasound: Part 1. Fundamentals. Vol. 1, 64-75, January 2009