Update on musculoskeletal ultrasonography

Abstract

Rheumatologists are increasingly utilising MUS in both the research setting and in clinical practice. Factors such as improvements in image quality and decreasing cost of machines have made MUS more accessible in the routine clinical care setting.

Musculoskeletal ultrasonography is an attractive tool, as it is portable and can be used in the outpatient clinic, allowing multiple joints to be imaged in a single visit. In contrast to conventional radiography, it allows multiplanar imaging of soft tissue structures, such as tendons and synovium, as well as providing information about articular integrity. As MUS does not require ionising radiation or contrast agents, it can be used repeatedly to monitor temporal changes. However, as with all imaging techniques, there are technical limitations which, to some extent,may vary between machines; access to some joints may be limited, and the quality of image obtained may depend on the size of joint and the frequency of the MUS transducer employed.

Whilst MUS shows much promise in aiding and optimising the practice of rheumatology, there is still a relative paucity of evidence to fully demonstrate the utility of MUS. In addition, a number of practical issues need addressing. These include educational aspects relating to the competence of physicians performing MUS, confirming MUS definitions of pathology, establishing validity and reliability, and further understanding the utility of this modality in managing rheumatological diseases. Work is underway to address many of these issues.

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