RESUMO
OBJECTIVES: To 1) determine the types and frequency of complications within 3 months following ultrasound-guided surgical procedures, and 2) identify any patient demographics, co-morbidities, or procedural characteristics that were associated with an increased risk of complications. METHODS: A retrospective chart review was performed at six Sports Medicine clinics across the United States. The Clavien-Dindo classification was used to categorize procedural complications on a 5-point scale from 1, representing any deviation in post-procedure care without requiring pharmacological or invasive treatment to 5, representing death. Generalized Estimating Equations for binomial outcomes with a logit link were used to estimate the overall and procedure-specific 3-month complication rates. RESULTS: Among 1902 patients, 8.1% (n = 154) had diabetes and 6.3% (n = 119) were current smokers. The analysis included 2,369 procedures, which were performed in either the upper extremity (44.1%, n = 1045) or lower extremity (55.2%, n = 1308) regions. The most common procedure was ultrasound-guided tenotomy (69.9%, n = 1655). Additional procedures included, trigger finger release (13.1%, n = 310), tendon scraping (8.0%, n = 189), carpal tunnel release (5.4%, n = 128), soft tissue release (2.1%, n = 50), and compartment fasciotomy (1.6%, n = 37). Overall, there was a complication rate of 1.2% (n = 29 complications; 95% CI: 0.8-1.7%). Individual procedures had complication rates that ranged from 0 to 2.7%. There were 13 Grade I complications in 13 patients, 12 Grade II complications in 10 patients, 4 Grade III complications in 4 patients, and 0 Grade IV or V complications. No associations between complication risk and any patient demographics (age, sex, BMI), co-morbidities (diabetes, smoker), or procedure characteristics (type, region) were identified. CONCLUSION: This retrospective review provides an evidence-based estimate supporting the low level of risk associated with ultrasound-guided surgical procedures for patients from a variety of geographical settings who are seeking care at private and academic-affiliated clinics.
RESUMO
OBJECTIVES: The current lack of agreement regarding standardized terminology in musculoskeletal and sports ultrasound presents challenges in education, clinical practice, and research. This consensus was developed to provide a reference to improve clarity and consistency in communication. METHODS: A multidisciplinary expert panel was convened consisting of 18 members representing multiple specialty societies identified as key stakeholders in musculoskeletal and sports ultrasound. A Delphi process was used to reach consensus which was defined as group level agreement >80%. RESULTS: Content was organized into seven general topics including: 1) General Definitions, 2) Equipment and Transducer Manipulation, 3) Anatomic and Descriptive Terminology, 4) Pathology, 5) Procedural Terminology, 6) Image Labeling, and 7) Documentation. Terms and definitions which reached consensus agreement are presented herein. CONCLUSIONS: The historic use of multiple similar terms in the absence of precise definitions has led to confusion when conveying information between colleagues, patients, and third-party payers. This multidisciplinary expert consensus addresses multiple areas of variability in diagnostic ultrasound imaging and ultrasound-guided procedures related to musculoskeletal and sports medicine.
Assuntos
Sistema Musculoesquelético , Esportes , Consenso , Técnica Delphi , Humanos , Sistema Musculoesquelético/diagnóstico por imagem , Ultrassonografia/métodosRESUMO
Sports ultrasound is commonly used by sports medicine physicians to enhance diagnostic and procedural accuracy. This expert consensus statement serves as an update to the 2015 American Medical Society for Sports Medicine recommended sports ultrasound curriculum for sports medicine fellowships. Although written in the context of the American sports medicine fellowship training model, we present a stepwise progression in both diagnostic and interventional sports ultrasound that may be applicable to the broader sports medicine community. The curriculum is divided into 12 units with each unit including didactic instructional sessions, practical hands-on instruction, independent scanning practice sessions and mentored clinical experience. To assist with prioritisation of learning, we have organised relevant pathology and procedures as essential, desirable and optional The expanded content can serve as an outline for continuing education postfellowship or for any physician to further advance their sports ultrasound knowledge and skill. We also provide updated scanning protocols, sample milestones and a sample objective structured clinical examination to aid fellowships with implementation of the curriculum and ongoing assessment of fellow progress.
Assuntos
Bolsas de Estudo , Medicina Esportiva , Competência Clínica , Currículo , Humanos , Sociedades Médicas , Medicina Esportiva/educação , Estados UnidosRESUMO
The current lack of agreement regarding standardised terminology in musculoskeletal and sports ultrasound presents challenges in education, clinical practice and research. This consensus was developed to provide a reference to improve clarity and consistency in communication. A multidisciplinary expert panel was convened consisting of 18 members representing multiple specialty societies identified as key stakeholders in musculoskeletal and sports ultrasound. A Delphi process was used to reach consensus, which was defined as group level agreement of >80%. Content was organised into seven general topics including: (1) general definitions, (2) equipment and transducer manipulation, (3) anatomical and descriptive terminology, (4) pathology, (5) procedural terminology, (6) image labelling and (7) documentation. Terms and definitions which reached consensus agreement are presented herein. The historic use of multiple similar terms in the absence of precise definitions has led to confusion when conveying information between colleagues, patients and third-party payers. This multidisciplinary expert consensus addresses multiple areas of variability in diagnostic ultrasound imaging and ultrasound-guided procedures related to musculoskeletal and sports medicine.
Assuntos
Sistema Musculoesquelético , Esportes , Consenso , Técnica Delphi , Humanos , Sistema Musculoesquelético/diagnóstico por imagem , Ultrassonografia/métodosRESUMO
ABSTRACT: Sports ultrasound is commonly used by sports medicine physicians to enhance diagnostic and procedural accuracy. This expert consensus statement serves as an update to the 2015 American Medical Society for Sports Medicine recommended sports ultrasound curriculum for sports medicine fellowships. Although written in the context of the American sports medicine fellowship training model, we present a stepwise progression in both diagnostic and interventional sports ultrasound that may be applicable to the broader sports medicine community. The curriculum is divided into 12 units with each unit including didactic instructional sessions, practical hands-on instruction, independent scanning practice sessions, and mentored clinical experience. To assist with prioritization of learning, we have organized relevant pathology and procedures as essential, desirable, and optional. The expanded content can serve as an outline for continuing education postfellowship or for any physician to further advance their sports ultrasound knowledge and skill. We also provide updated scanning protocols, sample milestones, and a sample objective structured clinical examination (OSCE) to aid fellowships with implementation of the curriculum and ongoing assessment of fellow progress.
Assuntos
Currículo , Bolsas de Estudo , Medicina Esportiva , Competência Clínica , Humanos , Sociedades Médicas , Medicina Esportiva/educação , Estados UnidosRESUMO
The utility of ultrasound in sports medicine is improving the sports medicine physician's ability to rapidly diagnose and treat a multitude of sports related pathologies. In this article, we clearly outline the current status of the evidence in support of using sports ultrasound in the setting of acute ocular injury, evaluation of elevated intracranial pressures, deep venous thrombosis, and soft tissue complaints.
Assuntos
Traumatismos em Atletas/diagnóstico por imagem , Traumatismos Oculares/diagnóstico por imagem , Corpos Estranhos/diagnóstico por imagem , Hipertensão Intracraniana/diagnóstico por imagem , Ultrassonografia/métodos , Trombose Venosa/diagnóstico por imagem , Humanos , Medicina Esportiva/métodosRESUMO
The utility of ultrasound in sports medicine is improving the sports medicine physician's ability to rapidly diagnose and treat a multitude of sports related pathologies. In this article, we clearly outline the current status of the evidence in support of using sports ultrasound in the setting of acute abdominal and thoracic trauma, acute lung illness, limited cardiac evaluation of a collapsed athlete, volume status assessment, and fracture evaluation.
Assuntos
Traumatismos em Atletas/diagnóstico por imagem , Medicina Esportiva , Ultrassonografia , Traumatismos Abdominais/diagnóstico por imagem , Doença Aguda , Fraturas Ósseas/diagnóstico por imagem , Cardiopatias/diagnóstico por imagem , Humanos , Pneumopatias/diagnóstico por imagem , Sistemas Automatizados de Assistência Junto ao Leito , Traumatismos Torácicos/diagnóstico por imagemRESUMO
Due to the novelty of percutaneous ultrasonic tenotomy, the risks and benefits of this minimally invasive procedure for insertional Achilles tendinopathy pain have only been examined in case studies and retrospective chart reviews for other diagnoses. This retrospective chart review over a 3.5-year period identified 34 patients with insertional Achilles tendinopathy who had percutaneous ultrasonic tenotomy (mean age ± SD, 52.2 ± 11.6 years; mean body mass index, 32.9 ± 7.5 kg/m2 ; 62% female). This procedure reduced the rate of moderate/severe pain from 68% at baseline to 15% at the long-term follow-up and had a satisfaction rate of 70%. There was 1 minor complication out of 40 procedures in 34 patients.
Assuntos
Tendão do Calcâneo/diagnóstico por imagem , Tendão do Calcâneo/cirurgia , Satisfação do Paciente/estatística & dados numéricos , Tendinopatia/cirurgia , Tenotomia/métodos , Ultrassonografia de Intervenção/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tendinopatia/diagnóstico por imagem , Resultado do TratamentoRESUMO
BACKGROUND: Tendinopathy is a common cause of elbow pain in the active population. Ultrasound-guided tenotomy (USGT) is a minimally invasive treatment option for cases recalcitrant to conservative management. Several case studies have shown promising preliminary results of USGT for common extensor tendinopathy and common flexor tendinopathy, but none have included USGT for triceps tendinopathy. This larger retrospective study evaluates the effectiveness and safety of USGT for all elbow tendinopathy sites at short- and long-term follow-up. METHODS: Retrospective chart review identified 131 patients (144 procedures; mean age ± standard deviation [SD], 48.1 ± 9.8 years; mean body mass index ± SD, 32.2 ± 7.7; 59% male) with elbow tendinopathy (104 common extensor tendinopathy, 19 common flexor tendinopathy, 8 triceps tendinopathy) treated with USGT over a 6-year period by a single physician. Pain and quality-of-life measures were collected at baseline. Pain, quality-of-life, satisfaction with outcome, and complications were collected at short-term (2-, 6-, and 12-week) and long-term (median 2.7 years, interquartile range = 2.0-4.0 years) follow-up. RESULTS: Overall, USGT for elbow tendinopathy decreased pain from moderate/severe at baseline to mild/occasional at short- and long-term follow-up (P < .01). Quality-of-life assessments showed significant improvement in physical function at short- and long-term follow-up (P < .01). The majority (70%) of patients were satisfied with the procedure. There was a 0% complication rate. CONCLUSION: Benefits of USGT include pain relief, improved physical function, and high patient satisfaction. USGT is a safe, minimally invasive treatment for refractory elbow tendinopathy.
Assuntos
Artralgia/etiologia , Articulação do Cotovelo/cirurgia , Tendinopatia do Cotovelo/cirurgia , Tenotomia/métodos , Adulto , Articulação do Cotovelo/fisiopatologia , Tendinopatia do Cotovelo/complicações , Tendinopatia do Cotovelo/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Medição da Dor , Satisfação do Paciente , Qualidade de Vida , Estudos Retrospectivos , Cirurgia Assistida por Computador , Tenotomia/efeitos adversos , UltrassonografiaRESUMO
Return to play after thigh muscle strain injury is difficult to predict and recurrent injury rates are high. There is currently no agreement on the optimal return to play protocol following muscle injury and utility of imaging is debated. Ultrasound has become an increasingly utilized imaging modality and offers several potential advantages for monitoring the return to play process following muscle injury. An ultrasound scanning protocol is presented which provides real-time guidance on muscle healing and may assist with identification of those athletes at risk of reinjury who otherwise appear clinically fit for return to play.
Assuntos
Traumatismos em Atletas/diagnóstico por imagem , Músculo Esquelético/lesões , Volta ao Esporte/normas , Coxa da Perna/lesões , Ultrassonografia , Atletas , Humanos , Músculo Esquelético/diagnóstico por imagemRESUMO
Although nonoperative treatment options for chronic exertional compartment syndrome (CECS) are often used in clinical practice, supporting evidence is limited. The objective of this study was to systematically review the literature for nonsurgical treatment options for CECS of the lower leg. The literature search identified seven articles describing in total four different treatment options: massage, gait changes, chemodenervation, and ultrasound-guided (USG) fascial fenestration. Pertinent studies were in the form of case series and one case report, which limited the robustness of the data. Nevertheless, all four treatment options have little to no reported adverse effect profiles and can be considered in clinical practice. In addition, gait changes and USG fascial fenestration were found to have continued effect at 1 and 1.5 years, respectively.
Assuntos
Síndromes Compartimentais/terapia , Transtornos Traumáticos Cumulativos/terapia , Terapia por Exercício/métodos , Massagem/métodos , Simpatectomia Química/métodos , Terapia por Ultrassom/métodos , Adolescente , Adulto , Síndromes Compartimentais/diagnóstico , Tratamento Conservador/métodos , Transtornos Traumáticos Cumulativos/diagnóstico , Descompressão Cirúrgica , Medicina Baseada em Evidências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVES: The primary purpose of this investigation was to determine the prevalence and spectrum of asymptomatic sonographically determined structural changes in the plantar fascia and plantar heel pad among experienced runners without a history of heel pain. METHODS: Thirty-nine asymptomatic runners without a history of plantar heel pain were recruited. The following sonographic measures were recorded: power Doppler sonography in the plantar heel pad and plantar fascia, echo texture of the plantar heel pad, uncompressed heel pad thickness, compressed heel pad thickness, heel pad compressibility index, plantar fascia thickness, and plantar fascia echo texture. RESULTS: Doppler flow was shown in the plantar heel pads of 88% (68 of 77) of heels and 92% (36 of 39) of runners. Heel pad echo texture abnormalities were found in 86% (66 of 77) of heels and 97% (38 of 39) of runners. Mean values for right and left uncompressed heel pad thickness were 13.8 and 13.7 mm, respectively. The mean heel pad compressibility indices were 0.51 for the right heel and 0.53 for the left heel. Eight percent (6 of 77) of fat pads in 10% (4 of 39) of runners had abnormal compressibility indices. Doppler flow was present in the plantar fascia in 31% (24 of 77) of heels and 44% (17 of 39) of runners. The mean plantar fascia thicknesses were 3.78 mm for the right and 3.87 mm for the left. Forty-eight percent (37 of 77) of heels had an abnormal plantar fascia echo texture. CONCLUSIONS: At least 1 potentially abnormal sonographic finding was present in each heel of all asymptomatic runners in this study. Consequently, sonographic abnormalities in the plantar heel should be interpreted within the clinical context when evaluating runners.
Assuntos
Fasciíte Plantar/diagnóstico por imagem , Fasciíte Plantar/epidemiologia , Calcanhar/diagnóstico por imagem , Dor/epidemiologia , Corrida/lesões , Corrida/estatística & dados numéricos , Adulto , Distribuição por Idade , Idoso , Comorbidade , Feminino , Humanos , Incidência , Iowa/epidemiologia , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico , Resistência Física , Prevalência , Medição de Risco , Distribuição por Sexo , Ultrassonografia Doppler , Adulto JovemRESUMO
BACKGROUND: The use of diagnostic and interventional ultrasound has significantly increased over the past decade. A majority of the increased utilisation is by non-radiologists. In sports medicine, ultrasound is often used to guide interventions such as aspirations, diagnostic or therapeutic injections, tenotomies, releases and hydrodissections. OBJECTIVE: Critically review the literature related to the accuracy, efficacy and cost-effectiveness of ultrasound-guided injections (USGIs) in major, intermediate and small joints; and soft tissues. DESIGN: Systematic review of the literature. RESULTS: USGIs are more accurate than landmark-guided injections (LMGIs; strength of recommendation taxonomy (SORT) Evidence Rating=A). USGIs are more efficacious than LMGIs (SORT Evidence Rating=B). USGIs are more cost-effective than LMGIs (SORT Evidence Rating=B). Ultrasound guidance is required to perform many new procedures (SORT Evidence Rating=C). CONCLUSIONS: The findings of this position statement indicate there is strong evidence that USGIs are more accurate than LMGI, moderate evidence that they are more efficacious and preliminary evidence that they are more cost-effective. Furthermore, ultrasound-guided (USG) is required to perform many new, advanced procedures and will likely enable the development of innovative USG surgical techniques in the future.
Assuntos
Sistema Musculoesquelético/diagnóstico por imagem , Medicina Esportiva/normas , Ultrassonografia de Intervenção/normas , Tecido Conjuntivo/diagnóstico por imagem , Consenso , Análise Custo-Benefício , Previsões , Humanos , Injeções/economia , Injeções/normas , Injeções Intra-Articulares/economia , Injeções Intra-Articulares/normas , Articulações/diagnóstico por imagem , Lesões dos Tecidos Moles/diagnóstico por imagem , Medicina Esportiva/economia , Medicina Esportiva/tendências , Ultrassonografia de Intervenção/economiaRESUMO
The American Medical Society for Sports Medicine (AMSSM) developed a musculoskeletal ultrasound curriculum for sports medicine fellowships in 2010. As the use of diagnostic and interventional ultrasound in sports medicine has evolved, it became clear that the curriculum needed to be updated. Furthermore, the name 'musculoskeletal ultrasound' was changed to 'sports ultrasound' (SPORTS US) to reflect the broad range of diagnostic and interventional applications of ultrasound in sports medicine. This document was created to outline the core competencies of SPORTS US and to provide sports medicine fellowship directors and others interested in SPORTS US education with a guide to create a SPORTS US curriculum. By completing this SPORTS US curriculum, sports medicine fellows and physicians can attain proficiency in the core competencies of SPORTS US required for the practice of sports medicine.
Assuntos
Educação de Pós-Graduação em Medicina/métodos , Doenças Musculoesqueléticas/diagnóstico por imagem , Sistema Musculoesquelético/diagnóstico por imagem , Medicina Esportiva/educação , Ultrassom/educação , Competência Clínica/normas , Currículo , Bolsas de Estudo , Mentores , Ensino/métodos , Ultrassonografia/normasRESUMO
Tenosynovial (extra-articular) chondromatosis (TC) is a condition characterized by the cartilaginous proliferation of synovial cells derived from the synovial lining of bursa and tendon sheaths. These lesions are often multinodular and most commonly present with complaints of swelling or pain. Treatment of TC primarily entails surgical excision. There are no known reports of TC in collegiate athletes. We present a case of TC in a Division I tennis player.
Assuntos
Articulação do Tornozelo/patologia , Condromatose Sinovial/diagnóstico , Tendões/patologia , Tênis , Articulação do Tornozelo/cirurgia , Atletas , Condromatose Sinovial/cirurgia , Feminino , Humanos , Tendões/cirurgia , Adulto JovemRESUMO
The use of diagnostic and interventional ultrasound has significantly increased over the past decade. A majority of the increased utilization is by nonradiologists. In sports medicine, ultrasound is often used to guide interventions such as aspirations, diagnostic or therapeutic injections, tenotomies, releases, and hydrodissections. This American Medical Society for Sports Medicine (AMSSM) position statement critically reviews the literature and evaluates the accuracy, efficacy, and cost-effectiveness of ultrasound-guided injections in major, intermediate, and small joints, and soft tissues, all of which are commonly performed in sports medicine. New ultrasound-guided procedures and future trends are also briefly discussed. Based on the evidence, the official AMSSM position relevant to each subject is made.
Assuntos
Traumatismos em Atletas/diagnóstico por imagem , Sistema Musculoesquelético/diagnóstico por imagem , Medicina Esportiva/normas , Ultrassonografia de Intervenção/normas , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/terapia , Humanos , Injeções Intra-Articulares/normas , Sociedades Médicas , Tenotomia/normas , Estados UnidosRESUMO
The following sports ultrasound (SPORTS US) curriculum is a revision of the curriculum developed by the American Medical Society for Sports Medicine (AMSSM) in 2010. Several changes have been made to the curriculum with the primary aim of providing a pathway by which a sports medicine fellow can obtain sufficient SPORTS US training to become proficient in the core competencies of SPORTS US. The core competencies of SPORTS US are outlined in the learning objectives section of this document. The term "SPORTS US" was purposefully chosen rather than "musculoskeletal ultrasound" (MSK US) because it was recognized by the panel that the evolving field of SPORTS US encompasses non-MSK applications of ultrasound such as the FAST examination (focused assessment with sonography for trauma). Although the SPORTS US core competencies in this curriculum are all MSK in nature, they represent the minimum SPORTS US knowledge a sports medicine fellow should acquire during fellowship. However, additional training in more advanced MSK and non-MSK applications of ultrasound can be provided at the fellowship director's discretion. Completion of this SPORTS US curriculum fulfills the American Institute of Ultrasound in Medicine's (AIUM) requirements to perform an MSK US examination and the prerequisites for the American Registry for Diagnostic Medical Sonography's (ARDMS) MSK sonography certification examination.
Assuntos
Traumatismos em Atletas/diagnóstico por imagem , Currículo/normas , Bolsas de Estudo/normas , Sistema Musculoesquelético/diagnóstico por imagem , Medicina Esportiva/educação , Ultrassonografia , Humanos , Sociedades Médicas , Ultrassonografia de Intervenção , Estados UnidosAssuntos
Beisebol/lesões , Articulação do Ombro/diagnóstico por imagem , Dor de Ombro/diagnóstico , Ultrassonografia , Corticosteroides/administração & dosagem , Artroscopia , Atletas , Humanos , Masculino , Articulação do Ombro/fisiopatologia , Dor de Ombro/reabilitação , Dor de Ombro/terapia , Adulto JovemRESUMO
SYNOPSIS: Clinical practice guidelines for Achilles tendinopathy do not recommend imaging to inform diagnosis. However, there is considerable variation in how imaging is used, particularly in research and sports. Early imaging risks that people who see the images presume that what they "see" as pathology is the primary cause of pain; patients might end up receiving invasive treatments on the basis of the image when rehabilitation may suffice. On the other hand, imaging can help rule out Achilles tendinopathy and identify differential diagnoses. As more rehabilitation clinicians are direct access practitioners and take on expanded roles as primary health practitioners, ultrasound imaging might serve as a valuable point-of-care tool for diagnosis, identifying conditions that warrant referral and managing conditions like Achilles tendinopathy. We argue that the value of ultrasound imaging to diagnose tendinopathy outweighs the potential limitations. J Orthop Sports Phys Ther 2024;54(1):1-4. Epub 16 November 2023. doi:10.2519/jospt.2023.12255.
Assuntos
Tendão do Calcâneo , Doenças Musculoesqueléticas , Tendinopatia , Humanos , Tendão do Calcâneo/diagnóstico por imagem , Tendinopatia/terapia , Cintilografia , UltrassonografiaRESUMO
There is much debate in the sports medicine community regarding the need for image guidance during peripheral joint and soft tissue injections. With the increasing availability of office-based ultrasound, many injections that were performed previously with a palpation-guided technique are being performed now under direct sonographic guidance. However some question the need for such guidance, particularly given the increased cost. This manuscript will review the reported accuracy and efficacy for various injections commonly performed in a sports medicine practice.