Musculoskeletal ultrasound (US) research is expanding due to increased clinical utility of sonography.
Study Design:
Clinical review.
Level of Evidence:
Level 4.
Results:
Ultrasound is widely applied in musculoskeletal imaging and sports medicine. The real-time capabilities and favorable cost profile of US make it ideal for use in diagnosis of musculoskeletal conditions. The enthusiasm for the use of US in musculoskeletal imaging has led to an increase in US research to broaden its applications.
Conclusion:
Several recent advances have been made in conventional and novel US imaging techniques, quantitative US imaging, and US-guided interventions.
AdlerRSJohnsonKMFealyS. Contrast-enhanced sonographic characterization of the vascularity of the repaired rotator cuff: utility of maximum intensity projection imaging. J Ultrasound Med. 2011;30:1103-1109.
2.
AlfredsonH. Midportion Achilles tendinosis and the plantaris tendon. Br J Sports Med. 2011;45:1023-1025.
3.
AntonakakisJGTingPHSitesB. Ultrasound-guided regional anesthesia for peripheral nerve blocks: an evidence-based outcome review. Anesthesiol Clin. 2011;29:179-191.
4.
ArtsIMOvereemSPillenS. Muscle ultrasonography: a diagnostic tool for amyotrophic lateral sclerosis. Clin Neurophysiol. 2012;123:1662-1667.
5.
BarrRG. Elastography in clinical practice. Radiol Clin North Am. 2014;52:1145-1162.
BoesenMEllegaardKBoesenL. Ultrasound Doppler score correlates with OMERACT RAMRIS bone marrow oedema and synovitis score in the wrist joint of patients with rheumatoid arthritis. Ultraschall Med. 2012;33:E166-E172.
8.
BrownJMYablonCMMoragYBrandonCJJacobsonJA. US of the peripheral nerves of the upper extremity: a landmark approach. Radiographics. 2016;36:452-463.
9.
BruynGAHanovaPIagnoccoA. Ultrasound definition of tendon damage in patients with rheumatoid arthritis. Results of a OMERACT consensus-based ultrasound score focussing on the diagnostic reliability. Ann Rheum Dis. 2014;73:1929-1934.
10.
BubnovRYevseenkoVSemenivI. Ultrasound guided injections of platelets rich plasma for muscle injury in professional athletes. Comparative study. Med Ultrason. 2013;15:101-105.
11.
CadetERAdlerRSGalloRA. Contrast-enhanced ultrasound characterization of the vascularity of the repaired rotator cuff tendon: short-term and intermediate-term follow-up. J Shoulder Elbow Surg. 2012;21:597-603.
12.
CasatiADanelliGBaciarelloM. A prospective, randomized comparison between ultrasound and nerve stimulation guidance for multiple injection axillary brachial plexus block. Anesthesiology. 2007;106:992-996.
13.
CassSP. Ultrasound-guided nerve hydrodissection: what is it? A review of the literature. Curr Sports Med Rep. 2016;15:20-22.
14.
ChenDZCongRZhengMJ. Differential diagnosis between pre- and postganglionic adult traumatic brachial plexus lesions by ultrasonography. Ultrasound Med Biol. 2011;37:1196-1203.
15.
ChenXMCuiLGHePShenWWQianYJWangJR. Shear wave elastographic characterization of normal and torn Achilles tendons: a pilot study. J Ultrasound Med. 2013;32:449-455.
ClendenenSGreengrassRWhalenJO’ConnorMI. Infrapatellar saphenous neuralgia after TKA can be improved with ultrasound-guided local treatments. Clin Orthop Relat Res. 2015;473:119-125.
18.
CoombesBKBissetLVicenzinoB. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet. 2010;376:1751-1767.
19.
CosgroveD. Ultrasound contrast agents: an overview. Eur J Radiol. 2006;60:324-330.
20.
D’AgostinoMAWakefieldRJBerner-HammerH. Value of ultrasonography as a marker of early response to abatacept in patients with rheumatoid arthritis and an inadequate response to methotrexate: results from the APPRAISE study [published online November 20, 2015]. Ann Rheum Dis. doi:10.1136/annrheumdis-2015-207709.
21.
De MarchiAPreverEBCavalloF. Perfusion pattern and time of vascularisation with CEUS increase accuracy in differentiating between benign and malignant tumours in 216 musculoskeletal soft tissue masses. Eur J Radiol. 2015;84:142-150.
22.
De ZordoTLillSRFinkC. Real-time sonoelastography of lateral epicondylitis: comparison of findings between patients and healthy volunteers. AJR Am J Roentgenol. 2009;193:180-185.
23.
DistelLMBestTM. Prolotherapy: a clinical review of its role in treating chronic musculoskeletal pain. PM R. 2011;3(6 suppl 1):S78-S81.
24.
DougadosMJousse-JoulinSMistrettaF. Evaluation of several ultrasonography scoring systems for synovitis and comparison to clinical examination: results from a prospective multicentre study of rheumatoid arthritis. Ann Rheum Dis. 2010;69:828-833.
25.
DragooJLWasterlainASBraunHJNeadKT. Platelet-rich plasma as a treatment for patellar tendinopathy: a double-blind, randomized controlled trial. Am J Sports Med. 2014;42:610-618.
26.
DrakonakiEEAllenGMWilsonDJ. Real-time ultrasound elastography of the normal Achilles tendon: reproducibility and pattern description. Clin Radiol. 2009;64:1196-1202.
27.
DrakonakiEEAllenGMWilsonDJ. Ultrasound elastography for musculoskeletal applications. Br J Radiol. 2012;85:1435-1445.
28.
DrakonakiEEKhoJSSharpRJOstlereSJ. Efficacy of ultrasound-guided steroid injections for pain management of midfoot joint degenerative disease. Skeletal Radiol. 2011;40:1001-1006.
29.
EngebretsenLSteffenKAlsousouJ. IOC consensus paper on the use of platelet-rich plasma in sports medicine. Br J Sports Med. 2010;44:1072-1081.
30.
FaderRRMitchellJJChadayammuriVPHillJWolcottML. Percutaneous ultrasound-guided hydrodissection of a symptomatic sural neuroma. Orthopedics. 2015;38:e1046-e1050.
31.
FalyarCRAbercrombieCBeckerRBiddleC. Intrathecal spread of injectate following an ultrasound-guided selective C5 nerve root injection in a human cadaver model. AANA J. 2016;84:80-84.
32.
FerreroGFabbroEOrlandiD. Ultrasound-guided injection of platelet-rich plasma in chronic Achilles and patellar tendinopathy. J Ultrasound. 2012;15:260-266.
33.
FitzpatrickJBulsaraMZhengMH. The effectiveness of platelet-rich plasma in the treatment of tendinopathy: a meta-analysis of randomized controlled clinical trials [published online June 6, 2016]. Am J Sports Med. doi:10.1177/0363546516643716.
34.
ForsbergFRoRJPotoczekM. Assessment of angiogenesis: implications for ultrasound imaging. Ultrasonics. 2004;42:325-330.
35.
FosterTEPuskasBLMandelbaumBRGerhardtMBRodeoSA. Platelet-rich plasma: from basic science to clinical applications. Am J Sports Med. 2009;37:2259-2272.
36.
GalianoKObwegeserAABodnerG. Real-time sonographic imaging for periradicular injections in the lumbar spine: a sonographic anatomic study of a new technique. J Ultrasound Med. 2005;24:33-38.
37.
GamradtSCGalloRAAdlerRS. Vascularity of the supraspinatus tendon three months after repair: characterization using contrast-enhanced ultrasound. J Shoulder Elbow Surg. 2010;19:73-80.
38.
GofeldMBristowSJChiuSCMcQueenCKBollagL. Ultrasound-guided lumbar transforaminal injections: feasibility and validation study. Spine (Phila Pa 1976). 2012;37:808-812.
39.
GrassiWFilippucciEBusilacchiP. Musculoskeletal ultrasound. Best Pract Res Clin Rheumatol. 2004;18:813-826.
40.
GuillinRBotchuRBianchiS. Sonography of orthopedic hardware impingement of the extremities. J Ultrasound Med. 2012;31:1457-1463.
41.
GuillodoYMadouasGSimonTLe DauphinHSarauxA. Platelet-rich plasma (PRP) treatment of sports-related severe acute hamstring injuries. Muscles Ligaments Tendons J. 2016;5:284-288.
42.
GutierrezMDi MatteoARosemffetM. Short-term efficacy to conventional blind injection versus ultrasound-guided injection of local corticosteroids in tenosynovitis in patients with inflammatory chronic arthritis: a randomized comparative study. Joint Bone Spine. 2016;83:161-166.
43.
HaberHPSinisNHaerleMSchallerHE. Sonography of brachial plexus traction injuries. AJR Am J Roentgenol. 2006;186:1787-1791.
44.
HamiltonBTolJLAlmusaE. Platelet-rich plasma does not enhance return to play in hamstring injuries: a randomised controlled trial. Br J Sports Med. 2015;49:943-950.
45.
HillJCMillanIS. Validation of musculoskeletal ultrasound to assess and quantify muscle glycogen content. A novel approach. Phys Sportsmed. 2014;42(3):45-52.
46.
HongJPLewHLLeeCHTangSF. Ultrasound-guided injection for the treatment of carpal tunnel syndrome. Am J Phys Med Rehabil. 2015;94:e119-e120.
47.
HousnerJAJacobsonJAMiskoR. Sonographically guided percutaneous needle tenotomy for the treatment of chronic tendinosis. J Ultrasound Med. 2009;28:1187-1192.
48.
IagnoccoACeccarelliFPerriconeCValesiniG. The role of ultrasound in rheumatology. Semin Ultrasound CT MR. 2011;32:66-73.
49.
IagnoccoANaredoEWakefieldR. Responsiveness in rheumatoid arthritis. A report from the OMERACT 11 ultrasound workshop. J Rheumatol. 2014;41:379-382.
50.
JacobsonJA. Fundamentals of Musculoskeletal Ultrasound. Philadelphia, PA: Saunders/Elsevier; 2007:345.
51.
JacobsonJARubinJYablonCMKimSMKalume-BrigidoMParameswaranA. Ultrasound-guided fenestration of tendons about the hip and pelvis: clinical outcomes. J Ultrasound Med. 2015;34:2029-2035.
52.
JeeHLeeJHKimJParkKDLeeWYParkY. Ultrasound-guided selective nerve root block versus fluoroscopy-guided transforaminal block for the treatment of radicular pain in the lower cervical spine: a randomized, blinded, controlled study. Skeletal Radiol. 2013;42:69-78.
53.
KangSYangSNKimSHByunCWYoonJS. Ultrasound-guided cervical nerve root block: does volume affect the spreading pattern [published online March 23, 2016]?Pain Med. doi:10.1093/pm/pnw027.
54.
KaracaLOralAKantarciM. Comparison of the superb microvascular imaging technique and the color Doppler techniques for evaluating children’s testicular blood flow. Eur Rev Med Pharmacol Sci. 2016;20:1947-1953.
55.
KlauserADemharterJDe MarchiA. Contrast enhanced gray-scale sonography in assessment of joint vascularity in rheumatoid arthritis: results from the IACUS study group. Eur Radiol. 2005;15:2404-2410.
KlauserASMiyamotoHTameggerM. Achilles tendon assessed with sonoelastography: histologic agreement. Radiology. 2013;267:837-842.
58.
KlauserASPeetronsP. Developments in musculoskeletal ultrasound and clinical applications. Skeletal Radiol. 2010;39:1061-1071.
59.
KotBCZhangZJLeeAWLeungVYFuSN. Elastic modulus of muscle and tendon with shear wave ultrasound elastography: variations with different technical settings. PLoS One. 2012;7(8):e44348.
60.
KwonDRParkGYKwonJG. The change of intrinsic stiffness in gastrocnemius after intensive rehabilitation with botulinum toxin A injection in spastic diplegic cerebral palsy. Ann Rehabil Med. 2012;36:400-403.
61.
KwonDRParkGYLeeSUChungI. Spastic cerebral palsy in children: dynamic sonoelastographic findings of medial gastrocnemius. Radiology. 2012;263:794-801.
62.
LabrosseJMCardinalELeducBE. Effectiveness of ultrasound-guided corticosteroid injection for the treatment of gluteus medius tendinopathy. AJR Am J Roentgenol. 2010;194:202-206.
63.
LiddleADRodriguez-MerchanEC. Platelet-rich plasma in the treatment of patellar tendinopathy: a systematic review. Am J Sports Med. 2015;43:2583-2590.
64.
LinHYWongPKHoWPChuangTYLiaoYSWongCC. Clavicular hook plate may induce subacromial shoulder impingement and rotator cuff lesion—dynamic sonographic evaluation. J Orthop Surg Res. 2014;9:6.
65.
LoizidesAPeerSPlaiknerMDjurdjevicTGruberH. Perfusion pattern of musculoskeletal masses using contrast-enhanced ultrasound: a helpful tool for characterisation?Eur Radiol. 2012;22:1803-1811.
66.
LoizidesAWidmannGFreuisTPeerSGruberH. Optimizing ultrasound-guided biopsy of musculoskeletal masses by application of an ultrasound contrast agent. Ultraschall Med. 2011;32:307-310.
67.
LuDTchelepiH. Ultrasound fusion: role in interventional musculoskeletal radiology. Ultrasound Q. 2015;31:219-220.
68.
MaYLiGLiJRenWD. The diagnostic value of superb microvascular imaging (SMI) in detecting blood flow signals of breast lesions: a preliminary study comparing SMI to color Doppler flow imaging. Medicine (Baltimore). 2015;94:e1502.
69.
MachadoPSegalSLyshchikAForsbergF. A novel microvascular flow technique: initial results in thyroids. Ultrasound Q. 2016;32:67-74.
70.
MartinJABiedrzyckiAHLeeKS. In vivo measures of shear wave speed as a predictor of tendon elasticity and strength. Ultrasound Med Biol. 2015;41:2722-2730.
71.
MartinoliCBianchiSGandolfoNValleMSimonettiSDerchiLE. US of nerve entrapments in osteofibrous tunnels of the upper and lower limbs. Radiographics. 2000;20(spec no):S199-S213. Erratum in: Radiographics. 2000;20:1818.
72.
MasciLSpangCvan SchieHTAlfredsonH. How to diagnose plantaris tendon involvement in midportion achilles tendinopathy—clinical and imaging findings. BMC Musculoskelet Disord. 2016;17:97.
73.
MauritsNMBollenAEWindhausenADe JagerAEVan Der HoevenJH. Muscle ultrasound analysis: normal values and differentiation between myopathies and neuropathies. Ultrasound Med Biol. 2003;29:215-225.
74.
MautnerKColbergREMalangaG. Outcomes after ultrasound-guided platelet-rich plasma injections for chronic tendinopathy: a multicenter, retrospective review. PM R. 2013;5:169-175.
75.
MaxwellNJRyanMBTauntonJEGilliesJHWongAD. Sonographically guided intratendinous injection of hyperosmolar dextrose to treat chronic tendinosis of the Achilles tendon: a pilot study. AJR Am J Roentgenol. 2007;189:W215-W220.
76.
McShaneJMNazarianLNHarwoodMI. Sonographically guided percutaneous needle tenotomy for treatment of common extensor tendinosis in the elbow. J Ultrasound Med. 2006;25:1281-1289.
77.
McShaneJMShahVNNazarianLN. Sonographically guided percutaneous needle tenotomy for treatment of common extensor tendinosis in the elbow: is a corticosteroid necessary?J Ultrasound Med. 2008;27:1137-1144.
78.
MillerTTReinusWR. Nerve entrapment syndromes of the elbow, forearm, and wrist. AJR Am J Roentgenol. 2010;195:585-594.
79.
MisawaSNotoYShibuyaK. Ultrasonographic detection of fasciculations markedly increases diagnostic sensitivity of ALS. Neurology. 2011;77:1532-1537.
80.
MiyamotoHHalpernEJKastlungerM. Carpal tunnel syndrome: diagnosis by means of median nerve elasticity—improved diagnostic accuracy of US with sonoelastography. Radiology. 2014;270:481-486.
81.
MoscaMJRodeoSA. Platelet-rich plasma for muscle injuries: game over or time out?Curr Rev Musculoskelet Med. 2015;8:145-153.
82.
MulvaneySW. Ultrasound-guided percutaneous neuroplasty of the lateral femoral cutaneous nerve for the treatment of meralgia paresthetica: a case report and description of a new ultrasound-guided technique. Curr Sports Med Rep. 2011;10:99-104.
83.
NakamuraMIkezoeTKobayashiT. Acute effects of static stretching on muscle hardness of the medial gastrocnemius muscle belly in humans: an ultrasonic shear-wave elastography study. Ultrasound Med Biol. 2014;40:1991-1997.
84.
NaredoECaberoFBeneytoP. A randomized comparative study of short term response to blind injection versus sonographic-guided injection of local corticosteroids in patients with painful shoulder. J Rheumatol. 2004;31:308-314.
85.
NaredoED’AgostinoMAWakefieldRJ. Reliability of a consensus-based ultrasound score for tenosynovitis in rheumatoid arthritis. Ann Rheum Dis. 2013;72:1328-1334.
86.
NwawkaOKMillerTT. Ultrasound-guided peripheral nerve injection techniques [published online June 24, 2016]. AJR Am J Roentgenol. doi:10.2214/AJR.16.16378.
87.
NwawkaOKMillerTTJawetzSTSaboeiroGR. Ultrasound-guided perineural injection for nerve blockade: does a single-sided injection produce circumferential nerve coverage [published online May 7, 2016]?J Clin Ultrasound. doi:10.1002/jcu.22364.
88.
OhrndorfSHenschANaumannL. Contrast-enhanced ultrasonography is more sensitive than grayscale and power Doppler ultrasonography compared to MRI in therapy monitoring of rheumatoid arthritis patients. Ultraschall Med. 2011;32(suppl 2):E38-E44.
89.
OoiCCRichardsPJMaffulliN. A soft patellar tendon on ultrasound elastography is associated with pain and functional deficit in volleyball players. J Sci Med Sport. 2016;19:373-378.
90.
OoiCCSchneiderMEMalliarasPChadwickMConnellDA. Diagnostic performance of axial-strain sonoelastography in confirming clinically diagnosed Achilles tendinopathy: comparison with B-mode ultrasound and color Doppler imaging. Ultrasound Med Biol. 2015;41:15-25.
91.
ParkYAhnJKSohnY. Treatment effects of ultrasound guide selective nerve root block for lower cervical radicular pain: a retrospective study of 1-year follow-up. Ann Rehabil Med. 2013;37:658-667.
92.
PeltzCDHaladikJADivineGSiegalDvan HolsbeeckMBeyMJ. Shear wave elastography: repeatability for measurement of tendon stiffness. Skeletal Radiol. 2013;42:1151-1156.
93.
ReachJSEasleyMEChuckpaiwongBNunleyJA2nd. Accuracy of ultrasound guided injections in the foot and ankle. Foot Ankle Int. 2009;30:239-242.
94.
RossiLAMolina RómoliARBertona AltieriBABurgos FlorJAScordoWEElizondoCM. Does platelet-rich plasma decrease time to return to sports in acute muscle tear? A randomized controlled trial [published online April 16, 2016]. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-016-4129-7.
95.
RyanMWongARabagoDLeeKTauntonJ. Ultrasound-guided injections of hyperosmolar dextrose for overuse patellar tendinopathy: a pilot study. Br J Sports Med. 2011;45:972-977.
96.
RyanMWongATauntonJ. Favorable outcomes after sonographically guided intratendinous injection of hyperosmolar dextrose for chronic insertional and midportion Achilles tendinosis. AJR Am J Roentgenol. 2010;194:1047-1053.
97.
SconfienzaLMSilvestriECimminoMA. Sonoelastography in the evaluation of painful achilles tendon in amateur athletes. Clin Exp Rheumatol. 2010;28:373-378.
TagliaficoASerafiniGLacelliFPerroneNValsaniaVMartinoliC. Ultrasound-guided treatment of meralgia paresthetica (lateral femoral cutaneous neuropathy): technical description and results of treatment in 20 consecutive patients. J Ultrasound Med. 2011;30:1341-1346.
100.
TanSKudasSOzcanAS. Real-time sonoelastography of the Achilles tendon: pattern description in healthy subjects and patients with surgically repaired complete ruptures. Skeletal Radiol. 2012;41:1067-1072.
101.
TaylorPC. The value of sensitive imaging modalities in rheumatoid arthritis. Arthritis Res Ther. 2003;5:210-213.
102.
TsukamotoHGranataGCoraciDPaolassoIPaduaL. Ultrasound and neurophysiological correlation in common fibular nerve conduction block at fibular head. Clin Neurophysiol. 2014;125:1491-1495.
103.
VerbeekRJSentnerCPSmitGP. Muscle ultrasound in patients with glycogen storage disease types I and III. Ultrasound Med Biol. 2016;42:133-142.
104.
VladVBergheaFMicuM. Tenosynovitis US scoring systems follow synovitis and clinical scoring systems in RA and are responsive to change after biologic therapy. Med Ultrason. 2015;17:352-360.
WesnerMDefreitasTBredyH. A pilot study evaluating the effectiveness of platelet-rich plasma therapy for treating degenerative tendinopathies: a randomized control trial with synchronous observational cohort. PLoS One. 2016;11(2):e0147842.
107.
WilsonSRGreenbaumLDGoldbergBB. Contrast-enhanced ultrasound: what is the evidence and what are the obstacles?AJR Am J Roentgenol. 2009;193:55-60.
108.
Wong-OnMTil-PerezLBaliusR. Evaluation of MRI-US fusion technology in sports-related musculoskeletal injuries. Adv Ther. 2015;32:580-594.
109.
YablonCMHammerMRMoragYBrandonCJFessellDPJacobsonJA. US of the peripheral nerves of the lower extremity: a landmark approach. Radiographics. 2016;36:464-478.
110.
YoshitakeYTakaiYKanehisaHShinoharaM. Muscle shear modulus measured with ultrasound shear-wave elastography across a wide range of contraction intensity. Muscle Nerve. 2014;50:103-113.
111.
ZaidmanCMSeeligMJBakerJCMackinnonSEPestronkA. Detection of peripheral nerve pathology: comparison of ultrasound and MRI. Neurology. 2013;80:1634-1640.
112.
ZissenMHWallaceGStevensKJFredericsonMBeaulieuCF. High hamstring tendinopathy: MRI and ultrasound imaging and therapeutic efficacy of percutaneous corticosteroid injection. AJR Am J Roentgenol. 2010;195:993-998.
