Treatment Methods:

Musculoskeletal Ultrasound

Anyone who has ever had an X-ray or MRI knows that the images from those procedures are still shots, taken while the patient is immobile. But the human body is a living moving organism, and pain often manifests during physical activity.

What if there was a way to see inside the body to observe the muscles and joints in motion, while simultaneously getting feedback from the patient?

Real-time ultrasound imaging (RUSI) offers just such technology. It is a valuable diagnostic tool for visually observing musculoskeletal structures, including muscles, tendons, ligaments, joints and bursae as they interact in real-time, in ways the patient would normally use them.

Advent of Real-Time Ultrasonography

Real-time ultrasound imaging (RUSI) started to appear in the early 1980s, and by the1990s, 3D and 4D images were clear enough for the public to interpret, and were enhanced by color. Early iterations of the technology required large scan heads and heavy cables, making the equipment cumbersome and immobile. Today, some ultrasound equipment is so compact that it can be carried to patients on a battlefield or used by astronauts in space.

Adventage of Real Time Ultrasound Imaging

Since the 1980s, the use of RUSI for diagnosis and treatment of musculoskeletal injuries has continued to grow, as real-time ultrasound has numerous advantages over other imaging technologies like X-ray, MRI and CT scan:

  • Non-invasive
  • No radiation exposure
  • Easy to use and control
  • Compact
  • Portable
  • Low cost
  • Safe
  • Shows real-time images in motion
  • Provides instant quantitative feedback

How does msk ultrasound Work?

During a RUSI session, a water-based gel is applied to the area being examined. A small transducer, or probe, is placed directly on the skin and transmits high-frequency sound waves through the gel into the body’s tissues. Sound waves are then reflected off the tissues. Because different tissues have different densities, the sound waves reflect back at various rates, making it possible to distinguish one type of tissue from another.

The transducer collects the sounds that bounce back, and a computer then creates images that are displayed on a screen. Because ultrasound images are captured in real-time, they can show the structure and movement of the body’s muscles, joints, internal organs, and even blood flowing through blood vessels.

Using RUSI, your therapist is able to observe the movements of your muscles as they occur and determine whether they are functioning correctly. The therapist can observe different layers of muscles contracting and relaxing, can look at the timing and size of muscle contractions, and can even see fatty tissue within your muscles.

RUSI is used in conjunction with an integrated total body assessment to diagnose muscle dysfunction. Feedback from RUSI can then be used to retrain muscles to perform optimal contractions. Images of a normal functional contraction can be compared to a patient’s dysfunctional muscle contraction so they are better able to understand the deficiency and how to correct it.

Who can benefit from real-time ultrasonography?

The vast applications of RUSI are growing daily, both for diagnosis and treatment. Patients with acute injuries, overuse syndromes, gait and performance deficiencies, and chronic diseases can all benefit from RUSI.

Physical therapists can use RUSI to provide quick diagnosis and perform muscle re-education through visual feedback in a variety of patients, including:

  • Athletes
  • Runners
  • Dancers
  • Fitness enthusiasts
  • Patients with pelvic instability
  • Sufferers of low back pain
  • Patients with heel pain
  • Patients with shoulder pain and stiffness
  • Older adults with balance and joint issues
  • Women recovering from C-section
  • Post-partum females with diastasis recti
  • Patients with rheumatoid arthritis

Virtually anyone who suffers from muscle and joint pain, dysfunction or instability can benefit from RUSI.

RUSI and Physical Therapy Treatment

RUSI allows your therapist to examine the function of specific muscles. It is often used to view the core muscles of the trunk that function to stabilize and protect your spine. RUSI is frequently used for pelvic floor rehabilitation to alleviate low back pain and correct its underlying causes. Retraining of deep trunk muscles improves their function, reducing low back pain and disability, and reducing the risk of recurrence.

Muscles can be difficult to reactivate after injury or surgery, especially those muscles that are deep, weak and small. RUSI allows the therapist to clearly display muscles on a screen, to show a patient how the muscles are working. RUSI feedback allows the patient to learn to control these muscles again in the most functional way.

Dynamic Ultrasound imaging enables physical therapist to quantify and qualify the patient’s motion potential. It thus facilitates treatment planning for the impaired motion. It can provide objective measurement of structures on clinical examination, to confirm or question the results of the usual clinical tests. Monitoring the progression of sonographic signs helps assess the effectiveness of physical therapy , ensuring a treatment plan optimally adjusted to the patient. Dynamic ultrasound imaging, associated to clinical tests, improves the choice of therapeutic strategy following initial work-up and helps guarantee the appropriateness of the treatment.

Musculoskeletal Ultrasound in NYC

At NYDNRehab, we routinely incorporate RUSI into our diagnosis and treatment of a host of deficiencies and impairments. Used in conjunction with other cutting edge technologies like CAREN, our expert physical therapy team is able to accurately diagnose and effectively treat a broad range of conditions without surgery or other invasive procedures.

Our goal at NYDNRehab is to get to the source of your pain or disability and provide corrective strategies to restore optimal function. While many healthcare providers focus on treating your symptoms, we are dedicated to eliminating them by eliminating their underlying causes.

Treatment Methods: Musculoskeletal Ultrasound

It would be nice if athletic injuries were simple, clean and easy to diagnose. However, most athletic injuries occur during play, involving large force loads at high velocities, often resulting in complex injuries to multiple structures.

Traditionally, X-Ray and MRI have been used to assess and diagnose sports injuries. However, those methods have some limitations, and it can take hours or even days for the images to be read and interpreted. Meanwhile, athletes and coaches are left guessing about the extent and severity of an injury, and treatment is delayed.

Advantages of Ultrasound Imaging

Musculoskeletal Ultrasound (MSUS) delivers high frequency sound waves to the injured area, which bounce back as images that can be viewed on a computer monitor. Unlike X-ray or MRI, MSUS equipment is lightweight and portable, enabling accurate diagnosis to be done within minutes after the injury occurs. Moreover, the images can be viewed in real time by both clinician and patient.

Advantages of MSUS over X-Ray and MRI include:

  • Ultrasound can be used on anyone. Because X-ray emits radiation, the amount of exposure per year is limited, and it cannot be used on pregnant females, and in certain other cases. MRI does not emit radiation, and it provides more detail of soft tissues, muscles, tendons, and cartilage. However, because it uses large magnets, it cannot be used on patients with metal implants or pacemakers, during pregnancy, and in other less common cases.
  • A high-end MSUS transducer can provide more details that X-ray or MRI, in real time.
  • MRI and X-ray produce a static image, and the patient must remain very still. During MSUS, dynamic real-time images enable the patient to reproduce movements that cause pain, giving greater insight into the nature and location of injury. Movement can reveal joint abnormalities that cannot be detected with a static image.
  • Because tendons are hyperechoic relative to muscle, ultrasound waves provide high resolution images of tendon tissue, making MSUS the method of choice for distinguishing between partial- and full-thickness tendon tears. It is also useful for depicting tendon subluxation and calcific tendonitis, and for evaluating tendons of the feet and ankles.
  • Ultrasound provides a useful tool for performing accurate real-time guided injections or aspirations.
  • The patient is able to provide valuable feedback during MSUS in response to palpation and movement. When a painful area is detected, associated abnormalities can often be seen on the monitor, confirming diagnosis.
  • MSUS can detect changes in blood flow that can help the clinician pinpoint the injured area.
  • With MSUS, the clinician can quickly and easily view images of both sides of the body during the same session, to compare the patient’s injured structures to bilateral “normal” structures.
  • X-ray and MRI images only depict segments of long structures like muscles and nerves. MSUS allows for a dynamic view of the entire length of a structure. The transducer can follow the entire pathway of a nerve to identify the specific point at which it is compressed. It can follow a long muscle like a hamstring from origin to insertion to pinpoint the precise location and nature of an injury.

Both MRI and MSUS provide superior imaging over X-ray, and they are similar in sensitivity and specificity. However, in addition to the advantages listed above, the cost of MSUS is a small fraction of MRI, and the equipment requires very little space compared to MRI.

Ultrasound Imaging for Diagnosis and Treatment of Athletic Injuries

For athletes, early and accurate diagnosis and treatment means sooner return to play. Not only does MSUS allow for diagnosis within minutes of injury, but it provides an important tool for assessing the progress of rehabilitation, and for determining whether an athletic injury has healed sufficiently for the athlete to safely return to play.

Some common athletic injuries and pathologies for which MSUS provides superior imaging include:

  • Injuries to the rotator cuff
  • Ankle and Achilles tendon injuries
  • Carpal tunnel syndrome
  • Foot pain and plantar fasciitis
  • Knee pain and injuries, including ACL and meniscal tears, IT band syndrome, Baker’s cyst and patellar tendonitis
  • Ligament sprains and cartilage disorders

MSUS at NYCSPT

Dr. Lev Kalika, founder of NYCSPT, has personally studied with some of the world’s most prestigious experts in diagnostic ultrasonography, including Carlo Martinolli MD,PhD , Alexander Kinzersky MD PhD , Thomas Clark DC, RMSK, Anna Vovchenko MD, and Rostislav Bubnov MD, PhD. Over the past seven years, Dr. Kaika has attended MUSOC, EFSUMB, AIUM and Gulfcoast Ultrasound Institute. He is an active member of the American Institute of Ultrasound in Medicine (AIUM), and is currently developing his own unique approach to Dynamic Functional Ultrasonography. Dr. Kalika is also in process of organizing a post graduate education school for physiotherapists, sports medicine physicians and chiropractors.

Dr. Kalika’s services are frequently sought out by elite athletes for rehabilitation and performance enhancement.

RUSI for Core Stability and Pelvic Floor Dysfunction

When it comes to imaging of the musculature of the pelvis and pelvic floor, RUSI provides superior technology, setting a new standard for imaging of core activity. RUSI is the imaging method of choice for viewing and measuring the multifidus, transversus abdominis, pelvic floor and diaphragm, structures that are difficult to view with the patient in a static supine posture.

During movement, the deep core muscles play a crucial role in mediating load transfer between the lower and upper body. When the core muscles are weakened, the pelvis becomes less stable, increasing the risk of injuries, low back pain and herniated discs.

Real time ultrasonography has been shown in multiple clinical trials to provide reliable images of the deep core muscles at rest and while in motion. Other imaging methods are only able to view the body’s structures in a static state. RUSI’s real-time dynamic imaging enables both patient and practitioner to collaborate in the diagnostic process, with the body in motion.

 

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