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Musculoskeletal Ultrasound


Earning accreditation in 2010, The Hirsh Center is one of only two Florida medical practices nationally accredited in musculoskeletal ultrasound. In fact, there are fewer than 70 accredited practices nationally. Our physicians are also individually credentialed in musculoskeletal ultrasound. In fact, Dr. Hirsh is a medical reviewer for the American Institute of Ultrasound in Medicine and teaches diagnostic and interventional ultrasound use to physicians nationally.

Research has concluded that treatments performed utilizing ultrasound are more effective. Procedures that can be performed under ultrasound guidance include joint aspirations and injections, decompression of cysts, and treatment of tendonitis and bursitis.

One of the greatest advantages of musculoskeletal ultrasound is its ability to help the physician guide the needle when performing injections. In recent years, medical specialists have learned that using ultrasound needle guidance is superior to the use of a blind technique. Nephrologists, surgeons, cardiologists, and of course, rheumatologists, have experienced far better results by utilizing ultrasound for needle guidance. Whether for a joint aspiration or a joint injection, using ultrasound guidance can decrease the incidence of procedural complications and improve the success rate, according to the medical literature.

Most physicians still use a “blind” technique, which uses surface anatomy to make a good guess as to where to place the needle. Even in the most experienced hands, this procedure has a variable success rate. Needle guidance can facilitate visualization of needle passage in ultrasound-guided joint, tendon and spine injections, as well as in nerve blocks which are frequently helpful in controlling acute and chronic pain.

At The Hirsh Center, we also use musculoskeletal ultrasound to help diagnose injuries to muscles, ligaments and joints. For diagnostic purposes, ultrasound has many significant advantages over x-rays, MRI and CT scans.

These include:

- better resolution of soft tissue than MRI
- convenient in-office service; no need to go to another facility
- no exposure to ionizing radiation
- no claustrophobia
- the ability to perform a dynamic or "live" study; we can see the injured area move in real time
- more cost-effective
- ability to see inflammation
- ability to guide injections

For example, ultrasound has been shown to be equal to or even better than MRI for looking at the rotor cuff. Also, musculoskeletal ultrasound allows the physician to look for signs of joint instability, unlike x-rays or MRI.

While Musculoskeletal Ultrasound has many advantages, there are some restrictions. Ultrasound cannot penetrate bone to "see" inside joints, so some cartilage and joint surfaces are not visualized as well. Musculoskeletal ultrasound is generally not as good as x-rays at looking at the overall structure of bones. Performing and interpreting musculoskeletal ultrasound takes months of training and practice. Therefore not many physicians utilize musculoskeletal ultrasound as a medical tool.

Rotator cuff Platelet-Rich Plasma injection

A 2009 NYU School of Medicine study published in The Journal of Rheumatology provides concrete evidence that using ultrasound for needle guidance does improve patient outcomes. In this study, 148 total joints were injected using either a blind technique or using ultrasound guidance. As compared with the conventional technique, ultrasound guidance resulted in a 43% reduction in pain experienced during the procedure. It also resulted in a 58.5% reduction in the patient’s pain at two weeks after the procedure. Ultrasound further increased the ability to detect joint fluid by 200% and increased the amount of fluid removed by 337%.

Ultrasound is an excellent tool that can be used to evaluate: effusions/synovial proliferation, joint surface irregularities/erosions, tenosynovitis, bursitis, enthesitis, tears of tendons, ligaments and muscles, peripheral nerve disorders, calcifications and osteophytes and loose joint bodies.