Abstract
Rachel L. Tatarski, MS, LAT, ATC
I was excited to be asked by Dr. Kevin Evans to highlight the utility and value of musculoskeletal sonography (MSK-S) as an athletic trainer (AT). I was first introduced to MSK-S during my master’s degree at East Carolina University, and upon starting a PhD at The Ohio State University (OSU), I sought out more opportunities to learn this valuable skill. I consider myself very fortunate to have had intense scanning instruction in the Laboratory for Investigatory Imaging at OSU. I have worked diligently to learn to use sonography with Dr. Kevin Volz, Dr. Evans, and Veronica Hernandez, RDMS, RMSKS. I advanced my scanning skills by attending hands-on scanning sessions at the Fourth Annual Ultrasound in Anatomy and Physiology Education conference sponsored by the Society of Ultrasound in Medical Education.
One of the most significant components of athletic training is the diagnosis of injuries, much of which relies on the use of manual evaluation (e.g., special tests) and imaging. Radiography, computed tomography, and magnetic resonance imaging dominate as the imaging modalities of choice, per the recommendations of the American College of Radiology Appropriateness Criteria. 1 However, MSK-S is rapidly gaining momentum as an alternative to these modalities. Its dynamic and portable qualities are appealing to an athletic training setting, in addition to being nonionizing, noninvasive, and cost-effective. Furthermore, it has great potential as a feedback tool for student-athletes, parents, and coaches.
Considering the high incidence of ankle sprains in the athletic population, sonography can serve as a useful model for developing a new diagnostic model that combines the use of MSK-S and our manual stress tests in a simultaneous manner. As many as 64.6% of ankle sprain diagnoses were made using the physical examination (manual stress tests) only, with 28.0% made through a combination of the physical examination and radiographs. 2 However, as much as 20% of high ankle sprains, in particular, may be missed through the clinical examination. 3 These findings suggest that the use of either the physical examination or imaging examination alone is inadequate. Since MSK-S can be performed during the clinical examination of an ankle sprain, it may prove to be a solution for two primary reasons: the ligament’s integrity (e.g., continuity) can be visualized and the joint space width can be measured and assessed dynamically under ligament strain. My doctoral research is hinged on pilot testing the ability of this diagnostic method to detect simulated high ankle sprains using a cadaveric model. Although this project is in its early stages, this imaging protocol is proving to be feasible and will be translated to a healthy population as my work progresses.
Although this diagnostic method has great potential to address the high rate of misdiagnosis of high ankle sprains, the use of sonography is not a required component of AT education, nor is it often taught. My journey to perfect my sonographic skills is unique; however, this points to an opportunity for the advancement of both athletic trainers and sonographers through interdisciplinary collaboration, as part of a dedicated training program. AT educational programs promote strong anatomy skills early on in the program and build upon them throughout. The pairing of AT and sonography students would encourage collaboration and a healthy respect for the individual professions. In addition, AT students can reinforce their own anatomy knowledge and skills by collaborating with sonography students who can likewise reinforce their own sonographic knowledge and skills with AT students.
While the use of sonography by “nontraditional” users is a topic of debate, this opportunity for professional collaboration has the potential to significantly affect injured athletes. Athletes sustain injuries acutely on the field, and many return-to-play decisions are based on the limited amount of information available at that time. These acute injuries and management decisions could have significant deleterious effects on student and professional athletes. MSK-S provided by trained ATs would allow for these athletes to be triaged to proper health care settings where a team of physicians and sonographers can provide high-level diagnosis and treatment. It is highly likely that many musculoskeletal injuries, such as acute high ankle sprains, will have a chronic trajectory. However, accurate and timely triage of these injuries may help to mitigate the potential for developing chronic symptoms after acute injury. Building a bridge such that ATs and sonographers can collaborate is in the best interest of these patients. I look forward to having an impact on the research, collaboration, and translation of sonography to the playing field.