A specialized clinic at The Ohio State University Wexner Medical Center reveals the power of ultrasound as a tool to evaluate and manage musculoskeletal disorders.
When patients visit the Musculoskeletal Ultrasound Clinic, they can receive a diagnosis and treatment in the same visit. The growing clinic now operates three days a week with three providers, up from just a half-day per week.
Musculoskeletal (MSK) ultrasound offers certain advantages compared to CT, MRI or X-rays, says Jisna Paul, MBBS, clinic director and the Division of Rheumatology director of clinical operations.
“It is readily accessible, provides real-time information for the timely care of patients, is relatively inexpensive, involves no ionizing radiation and has high patient tolerability.”
Training expands expertise for current, future rheumatologists
A large majority of practicing rheumatologists in the United States have little ultrasound training, according to the American College of Rheumatology.
Despite its benefits, training in MSK ultrasound isn’t required for rheumatologists. Learning opportunities are limited but growing as new, less-expensive mobile and hand-held models become available.
In Ohio State’s Division of Rheumatology and Immunology, Dr. Paul and her colleagues Catherine Strahle, DO, and Jasmine Thai, MD, work to expand the use of MSK ultrasound by training rheumatology fellows, as well as other Ohio State specialists, in the technique. MSK ultrasound is highly operator-dependent and requires proper training to get accurate, high-quality, reliable studies, Dr. Paul says.
“It takes time to get better, but it adds a lot to your toolbox when you can offer this to your patients,” Dr. Paul says.
The division offers an annual two-day MSK ultrasound intensive conference and cadaver workshop, with an outstanding teaching faculty from around the country. Participants receive basic training in:
- Proper technique for ultrasound-guided joint aspiration and injection, practiced on cadavers
- Proper ultrasound technique (probe choice and placement, machine settings, techniques for optimal images)
- Recognition on ultrasound of common musculoskeletal pathology
- Ultrasound appearance of normal anatomic musculoskeletal structures
“We aim to change participants’ knowledge base and provide them with the skills to utilize ultrasound in the care of patients,” Dr. Paul says.
The conference is well-attended by physicians, fellows and APPs seeking the 14 CME hours required for certification. The next conference is planned for April 25-26, 2025. To register, visit the MSK conference website.
Evolving use and benefits of MSK ultrasound
The pace of typical patient appointments also reduces MSK ultrasound use, Dr. Paul says.
“We may only have 15 or 20 minutes with a patient, making it difficult to complete an ultrasound scan,” Dr. Paul says.
That’s why the Division of Rheumatology and Immunology started the clinic. It provides dedicated time for rheumatologists to complete diagnostic scans and ultrasound-guided therapies.
The most common condition treated at the MSK Ultrasound Clinic is osteoarthritis. Other conditions include carpal tunnel syndrome, gout, impingements, rheumatoid arthritis and tendonitis.
Many musculoskeletal disorders, particularly inflammatory types of arthritis, can be difficult to diagnose and manage without imaging. Typically, doctors order an X-ray, CT scan or an MRI test that follows a patient’s appointment. After reviewing results, treatment is scheduled, such as an unguided injection or one using fluoroscopy.
“I can do a blind injection and tell you I injected into your joint, but without visual guidance, no one knows where it goes with certainty,” Dr. Paul says.
MSK ultrasound improves diagnostic accuracy of inflammatory arthritis and soft tissue pathology. It makes aspirations and injections more accurate, effective and safe.
For example, real-time images let doctors visualize the depth of a joint, Dr. Paul says. This helps select the right size needle required to reach the joint space. Ultrasound also guides rheumatologists to precise locations for an injection.
Drs. Paul, Strahle and Thai also use MSK ultrasound to monitor patient response to therapy by assessing inflammation.