What is Ultrasound?

Ultrasound imaging uses safe sound waves to produce pictures of different parts of the body. It is frequently used in obstetrics to assess babies, as well as abdominal and pelvic imaging. There have been dramatic improvements in musculoskeletal ultrasound technology allowing radiologists to perform guided interventions safely and painlessly under local anaesthesia.

How should I prepare for an ultrasound examination?

This procedure requires little to no special preparation.

  • Loose comfortable clothing should be worn
  • You may be asked to wear a gown and the portion of your body being imaged will be uncovered.
  • It would be best to arrange for a driver to take you home until the local anaesthetic has worn off.

What is Ultrasound used for in musculoskeletal imaging?

Ultrasound is used to produce pictures and make a diagnosis — this is termed diagnostic ultrasound. Ultrasound can also be used to facilitate a therapeutic procedure allowing for example visualization in real time of a needle tip so that it can be precisely positioned during the procedure.

As well when medication is introduced through the needle the radiologist can see exactly where the medication is distributed to ensure that the local anaesthetic (numbing medications) or steroids (anti-inflammatory medication) have been directed to the right target. An ultrasound examination performed for assistance of a therapeutic procedure is termed an interventional ultrasound.  To learn more about ultrasound for therapeutic use, click here. 

What are the limitations of musculoskeletal ultrasound?

Ultrasound does not see through bone and so structures such as articular cartilage, the labrum of hip or shoulder or the menisci or cruciate ligaments of the knee can be only partly visualized and are better assessed with MRI.

What is diagnostic ultrasound used for in musculoskeletal imaging?

  • Ultrasound is used to produce pictures of muscles, tendons, ligaments and joints throughout the body.
  • Ultrasound allows for the dynamic evaluation of different tendons, ligaments, joints and bursae throughout the body.
  • Ultrasound is able to evaluate with greater internal detail than any other imaging modality some superficial structures — such as tendons and nerves.

The musculoskeletal radiologist performing the ultrasound examination will be able to correlate the real-time imaging results with the site and characteristics of your pain.

Ultrasound is safe and uses sound waves without ionizing radiation.

All diagnostic and interventional procedures are performed on a state of the art ultrasound machine with extremely high definition and excellent image processing capability. The CMI Ultrasound machine and rooms have been assessed and passed by the Diagnostic Accreditation Program (DAP) of the College of Physicians and Surgeons of BC, ensuring the highest standards of sterility and professionalism.

Disposable surgical drapes, sterile covers, gloves and needles are used for each intervention.

Who performs the diagnostic or interventional ultrasound procedures at CMI?

Radiologists are physicians specifically trained to perform and interpret radiology exams and ultrasound exams in particular. The radiologists at CMI performing these procedures are all staff radiologists at St. Paul’s Hospital in Vancouver who subspecialize in musculoskeletal radiology. The radiologist will perform and discuss the results of your exam at the time of your procedure and a more detailed written report will be produced and available to you and your referring physician(s) within 2-3 business days.

If the radiologist finds a treatable cause for your pain/ symptoms during the examination, you may request to proceed with an intervention to treat the problem.

What common diagnostic musculoskeletal ultrasound examinations are performed at CMI?

All Ganglions and joint effusion assessments, inflammatory synovitis (rheumatoid and other arthritis), post operative assessments, dynamic assessment for impingement.

Shoulder:

  • Rotator cuff tendons and muscle bellies
  • Acromioclavicular joint (ACJ),
  • Glenohumeral joint
  • Long Head of biceps tendon  (LHB)
  • Subacromial subdeltoid bursa.
  • Deltoid muscle
  • Inflammatory synovitis (rheumatoid and other arthritis)
  • Post operative assessments
  • Dynamic assessment for impingement

Perishoulder:

  • Sternoclavicular joint
  • Scapulothoracic region

Elbow:

  • Common flexor and extensor origin (CFO & CEO)
  • Elbow joint
  • Perineural (usually ulnar nerve in cubital tunnel), radial nerve, median nerve

Forearm muscles and nerves.

Wrist:

  • Distal radioulnar joint (DRUJ)
  • Wrist, radiocarpal joint, midcarpal joint, carpometacarpal (CMCJ)
  • MCPJ, PIPJ DIPJ
  • Flexor and extensor tendons, tenosynovitis, (ECU, EPL), trigger finger, Stenner lesion
  • De Quervains tenosynovitis
  • Proximal and distal crossover syndrome
  • Perineural  ulnar nerve, radial nerve, median nerve

Hand:

  • Carpometacarpal (CMCJ)
  • MCPJ, PIPJ DIPJ
  • Flexor and extensor tendons, tenosynovitis, (ECU etc)
  • De Quervains tenosynovitis

Hip:

  • Iliopsoas
  • Hip joint
  • Tendon injections
  • Groin injections adductor injections rectus abdominus
  • Dynamic assessment of iliopsas and trochanteric snapping
  • Femoral and inguinal hernias
  • Athletic pubalgia \ sportsman’s hernia
  • Sciatic and femroal nerves
  • Lateral cutaneous nerve of thigh (meralgia parasthetica)
  • Sacrotuberous ligament

Thigh:

  • Muscle and nerves

Knee 

  • Suprapatella pouch knee joint
  • Prepatella, & infrapatella bursa
  • Patella and quadriceps tendon procedures
  • Collateral ligaments
  • Popliteal fossa bursa and cysts (Bakers cysts)
  • Common peroneal nerve
  • Posterior tibial

Ankle:

  • Ankle & subtalar joint
  • Ankle tendons including: achilles, peroneal, anterior and posterior tibial and flexor and extensor tendons, ankle ligaments (ATFL, Calcaneofibular, syndesmotic
  • Retrocalcaneal bursa
  • Plantar fascitis
  • Sural nerve, posterior tibila nerve
  • Spring ligament

Foot: 

  • All joints (talonavicular (TNJ), navicular cuneiform, tarsometatarsal (TMTJ), Metatarsal phalangeal joint (MTPJ), PIPJ and DIPJs
  • Mortons neuroma
  • Plantar fascitis
  • Foot tendons
  • Spring ligament

Peripheral nerves:

  • Perineural masses, ganglions

Spine:

  • Diagnostic imaging of the brachial plexus and neck.
  • Assesment of masses (lipomas or sarcomas), dynamic assessment of clicking & subluxation.