Our client is a 34 year-old male complaining of persistent hip pain that did not respond to physical therapy or injections to the hip joint. He turned to NYDNRehab for help.
Ten years earlier the patient had fractured the spinous process of his 4th lumbar vertebra which had largely been ignored, since such fractures tend to self-heal, and there are rarely symptoms at the fracture site. Doctors failed to connect the dots between the past lumbar fracture and the patient’s current hip pain.
After reviewing the patient’s history and conducting a clinical exam, we used high-resolution diagnostic ultrasound to visualize the patient’s hip and spine in motion.
Thanks to dynamic imaging, along with our expertise in musculoskeletal disorders, we were able to establish a link between the patient’s previous injury and his current hip pain symptoms.
We first injected the spinal injury site with Prolotherapy, then we began physical therapy, and injected the hip joint with Prolotherapy and platelet rich plasma (PRP). We were able to completely eliminate the patient’s hip pain, and he was able to resume normal physical activities without pain or limitations.
When it comes to musculoskeletal disorders, static images like MRI that focus on the locus of pain do not always paint a full picture. High-resolution ultrasonography empowers us to visualize the body through an integrative lens, connecting the dots between pain symptoms and their origins. In this case, we not only looked at the patient’s painful hip, but we examined the area of his vertebral fracture, and found that tensegrity had been lost, leading to spinal instability at L4.
Because the iliopsoas muscle is innervated from the lumbar spine, the patient had developed facilitation – a neurophysiological phenomenon where the neural pathway becomes more excitable than normal. This response triggered abnormal activation of the iliopsoas iliacus, causing loss of hip control and generating pain.
While MRI can provide clear images of a hip labral tear or detachment, dynamic ultrasound is able to find more subtle mechanical factors that can only be identified with the joint in motion. By looking beyond static images, we are able to find indicators such as synovial fluid extrusion through a cleft at the chondrolabral junction – a strong indicator of anterior labral detachment. In such cases, a dynamic ultrasound exam explains the patient’s symptoms better than static MRI imaging alone.
MRI cannot capture movement-related factors such as:
When conducted by a skilled clinician, ultrasound imaging can reveal:
Dynamic ultrasonography does not completely replace MRI, but it can provide subtle information that fills the functional gaps that MRI cannot bridge, making ultrasound one of the most powerful diagnostic tools for musculoskeletal disorders.
Verified Expert Profiles
Dr. Lev Kalika is a world-recognized expert in musculoskeletal medicine. with 20+ years of clinical experience in diagnostic musculoskeletal ultrasonography, rehabilitative sports medicine and conservative orthopedics. In addition to operating his clinical practice in Manhattan, he regularly publishes peer-reviewed research on ultrasound-guided therapies and procedures. He serves as a peer reviewer for Springer Nature.
Dr. Kalika is an esteemed member of multiple professional organizations, including:
Below is a prime example of how ultrasound can take the guesswork out of diagnosis.
A bad physical therapy experience is one of the primary causes of unnecessary surgery
In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.
Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.
The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.
Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup
Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)
Complete tear of rectus femoris
with large hematoma (blood)
Separation of muscle ends due to tear elicited
on dynamic sonography examination
Request Telehealth
