The Utilization of Diagnostic Musculoskeletal Ultrasound in the Evaluation of Gluteus Medius Tendon Pathology: A Perspective for Rehabilitation Providers.

Gluteus medius tendon pathology, encompassing tendinopathy and tears, is a significant source of lateral hip pain and functional impairment. Traditional diagnostic approaches have relied on clinical examination and magnetic resonance imaging (MRI). However, the advent of diagnostic musculoskeletal ultrasound (MSKUS) has transformed the evaluation process. Musculoskeletal ultrasound has emerged as a highly valuable diagnostic tool in the evaluation of gluteus medius tendon pathology, offering a non-invasive, cost-effective, and dynamic assessment method. This modality provides real-time visualization of soft tissue, enabling the detailed examination of tendon structure, vascularity, and associated musculature. For rehabilitation providers, understanding the application, strengths, and limitations of diagnostic MSKUS can enhance clinical decision-making, facilitate targeted therapeutic interventions, and potentially expedite the recovery process. This article reviews the application of MSKUS in diagnosing gluteus medius tendon pathology and its implications for rehabilitation practice. This should help to equip rehabilitation professionals with knowledge to better integrate this diagnostic tool into their clinical repertoire.

Utilizing Diagnostic Musculoskeletal Ultrasound in the Evaluation of Cubital Tunnel Syndrome and Ulnar Nerve Pathology.

Cubital Tunnel Syndrome (CTS), is a frequently encountered condition in clinical settings, typically arising from static or dynamic compression of the ulnar nerve. CTS is characterized by the irritation of the ulnar nerve within the cubital tunnel and is a common neuropathic condition that can significantly impact functional abilities and quality of life. This article explores the utility of diagnostic musculoskeletal ultrasound (MSK-US) in the evaluation of the cubital tunnel and the ulnar nerve. The cubital tunnel syndrome, a common entrapment neuropathy of the ulnar nerve, often presents diagnostic challenges. Traditionally, nerve conduction studies and electromyography have been the primary diagnostic tools used to diagnose CTS. Given the superficial nature of the ulnar groove and its adjacent structures, MSK-US imaging known for its non-invasive nature and high-resolution imaging capabilities, has become an increasingly valuable tool in the assessment and management of various musculoskeletal conditions. This article reviews the technical aspects of MSK-US, its advantages in visualizing the ulnar nerve and related structures, and its implications in clinical practice for rehabilitation providers. By integrating MSK-US in the evaluation of CTS, rehabilitation professionals can enhance diagnostic accuracy, tailor interventions, and improve patient outcomes.

MSK Ultrasound: A Powerful Tool for Evaluating and Diagnosing Pectoralis Major Injuries in Healthcare Practice.

Accurately diagnosing pectoralis major injuries, particularly in athletes, often presents a challenge for healthcare practitioners. Although pectoralis muscle injuries are relatively uncommon, the diagnosis of a tear may be overlooked without careful screening by a thorough physical examination of both the injured and uninjured sides. While magnetic resonance imaging (MRI) has traditionally held the gold standard, musculoskeletal ultrasound (MSKUS) has emerged as a viable alternative. This article delves into the power of MSKUS in evaluating and diagnosing pectoralis major injuries, highlighting its dynamic capabilities, real-time visualization, and cost-effectiveness in comparison to MRI. By equipping healthcare professionals with a thorough understanding of MSKUS's potential, this article aims to empower them to confidently diagnose and manage pectoralis major injuries, ultimately improving patient outcomes and facilitating a faster return to function.

Enhancing the Diagnosis of Lateral Ankle Sprains: The Role of MSK Diagnostic Ultrasound in Evaluating ATFL and CFL.

Lateral ankle sprains, predominantly involving the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL), constitute a significant portion of sports-related injuries, with a notable rate of recurrence and progression to chronic instability. Precise diagnosis and effective treatment of the ATFL and CFL injuries are crucial in preventing long-term complications. Musculoskeletal (MSK) diagnostic ultrasound has emerged as a pivotal tool in the rehabilitation sector, particularly in assessing lateral ankle ligament injuries. This article will highlight its benefits over traditional diagnostic methods and the emerging role of MSK diagnostic ultrasound as a superior tool for accurate, cost-effective, and comprehensive assessment of these injuries. We discuss the technology's ability to provide objective, real-time imagery, facilitating accurate diagnosis, treatment planning, and injury monitoring emphasizing the need for a standardized approach to ultrasound evaluation to improve diagnostic accuracy and patient outcomes.

MSK Diagnostic Ultrasound for the Assessment of the Acromioclavicular Joint.

The acromioclavicular joint (ACJ), a key element in shoulder movement and stability, is prone to various injuries such as sprains, dislocations, and osteoarthritis, typically resulting from physical trauma or wear and tear. Accurate and timely diagnosis is paramount for effective treatment and rehabilitation. Musculoskeletal (MSK) ultrasound has emerged as a pivotal diagnostic tool due to its ability to visualize soft tissues and provide real-time imaging. This non-invasive tool is also invaluable for monitoring healing progress and the evolution of osteoarthritic changes. This article reviews the application of MSK ultrasound in the evaluation of ACJ injuries, highlighting its advantages, specific applications, and recent technological advancements that enhance its diagnostic capabilities.

Utilizing MSK Ultrasound for Comprehensive Assessment of the Femoral Trochlea: A Game Changer in Sports Medicine.

Musculoskeletal (MSK) ultrasound has emerged as a valuable tool for sports physical therapists in the assessment and treatment of various knee pathologies. Its ability to provide high-resolution images of soft tissue and superficial bone surfaces makes it especially useful for sports physical therapists and orthopedic clinicians. Specifically, MSK-ultrasound is increasingly recognized as a potent tool for the assessment of the femoral trochlea. Its non-invasive nature and dynamic imaging capabilities make it particularly suited for visualizing the femoral trochlea, a critical component in knee function and biomechanics. The use of MSK ultrasound in the evaluating the femoral trochlea provides sports medicine professionals with a dynamic, non-invasive, and cost-effective means to diagnose, and monitor knee-related injuries. This article delves into the utility of MSK ultrasound in the anatomical and functional assessment of the femoral trochlea, elucidating its benefits, limitations, and clinical implications for athletes.

The Application of Musculoskeletal Ultrasound in the Diagnosis of Supraspinatus Injuries.

Musculoskeletal (MSK) diagnostic ultrasound has become an invaluable tool in the assessment of musculoskeletal pathologies, including rotator cuff injuries, notably the supraspinatus tendon. MSK ultrasound, characterized by high-resolution and real-time imaging capabilities, presents a cost-effective, safe, and patient-friendly alternative. This modality allows precise visualization of the supraspinatus tendon's structure and function, aiding in the identification of pathological alterations, such as thickening, thinning, or disruption, critical in diagnosing conditions like tendonitis, partial tears, and ruptures. In this manuscript, we detail the diagnostic utility of MSK ultrasound in assessing supraspinatus injuries, discussing the indications, techniques, and findings relevant to the supraspinatus tendon. Moreover, we examine the advantages and limitations of this imaging modality and provide a step-by-step guide for accurate supraspinatus tendon evaluation. The evidence suggests that MSK ultrasound is a dependable and cost-effective imaging technique for diagnosing supraspinatus injuries when executed by skilled operators.

Musculoskeletal Ultrasound: An Essential Tool in Diagnosing Patellar Tendon Injuries.

Musculoskeletal (MSK) ultrasound has emerged as a vital tool in diagnosing patellar tendon injuries. Traditional imaging techniques, such as X-rays and Magnetic Resonance Imaging, have certain limitations in assessing soft tissue structures or may not be easily accessible. MSK ultrasound, with its high-resolution, real-time imaging capabilities, offers a cost-effective, safe, and patient-friendly alternative. It allows for accurate visualization of the patellar tendon's structure and function, thereby facilitating the identification of pathological changes such as thickening, thinning, or disruption which aids in diagnosing conditions such as tendonitis, partial tears, and ruptures. Furthermore, MSK ultrasound serves as an invaluable tool for guiding interventions like injections, as it provides real-time imaging. This article explores the role and benefits of MSK ultrasound in diagnosing patellar tendon injuries, highlighting its cost-effectiveness, accessibility, real-time assessment capabilities, and reduced patient burden compared to other imaging modalities. Despite its numerous benefits, the need for ongoing research to enhance its utility is highlighted. As technology advances, MSK ultrasound is set to revolutionize the early detection and management of patellar tendon injuries.

Using MSK Ultrasound in the Evaluation of Subscapularis Injuries.

The shoulder is an area that can be prone to a variety of injuries, including subscapularis tendon tears. The subscapularis muscle is one of the four muscles that make up the rotator cuff in the shoulder and plays an essential role in stabilizing the shoulder joint while at the same time facilitating internal rotation of the humerus. Injuries to the subscapularis can occur due to trauma, overuse, or degeneration, leading to pain, weakness, and limited mobility. When injury occurs, subscapularis tendon tears are often difficult to diagnose and evaluate due to their location deep within the shoulder joint. While traditional imaging techniques like radiographs, and magnetic resonance imaging may give us insight into the structures present, they do not always provide detailed enough information for clinicians. Ultrasound has become increasingly popular in musculoskeletal (MSK) rehabilitation as it allows for direct visualization of soft tissue abnormalities like tendinopathies or subtle rotator cuff tear patterns. In this Ultrasound Bites article, we will discuss how MSK ultrasound can be used in the evaluation of subscapularis tendon pathology with a specific focus on its utility in the physical therapy clinic.

The Use of MSK Ultrasound in the Evaluation of Elbow Ulnar Collateral Ligament Injuries.

As physical therapists, understanding the anatomy and biomechanics of the musculoskeletal system is essential for accurate diagnosis and effective treatment outcomes. Musculoskeletal ultrasound (MSK-US) is one tool that has revolutionized the way physical therapists evaluate musculoskeletal pathology. Specific to the elbow, assessing the ulnar collateral ligament (UCL) proves especially beneficial for providing both diagnosis and treatment planning. By directly visualizing static and dynamic loads to the ligament, physical therapists can gain valuable information about underlying pathology and guide the therapeutic decision-making process. In this sound byte, we will look at how incorporating MSK-US imaging into your patient assessments can provide you with more comprehensive data to make informed clinical decisions when treating UCL injuries in the elbow.

MSK Ultrasound - An IJSPT Perspective.

MSK ultrasound is a valuable imaging technique which has become increasingly popular in recent years. This efficient technique proves beneficial in a variety of ways. MSK ultrasound effectively streamlines the process by enabling practitioners to securely and accurately image and assess structures all in one simple step. By allowing healthcare providers to access critical information quickly and conveniently, MSK ultrasound can help identify conditions early when interventions are most effective. Moreover, it may be able to shorten diagnostic times and reduce costs through more cost-effective use of resources such as imaging and laboratory testing. Furthermore, MSK ultrasound can provide additional insights into musculoskeletal anatomy and help improve patient care and outcomes. In addition, utilizing this method reduces exposure to radiation and provides enhanced patient comfort with its quick scan duration. MSK ultrasound has a high potential to provide quick and accurate diagnosis of MSK disturbances when used correctly. As clinicians become more comfortable and familiar with this technology, we will continue to see its use expand for various MSK assessments. In this commentary we'll explore how ultrasound can be used in physical therapy, specifically for musculoskeletal assessment. We'll also look at some of the potential benefits and limitations of using ultrasound in PT practice.

The Use of MSK Ultrasound with Quadriceps Muscle Injury.

Quadriceps muscle injury is a common occurrence, especially among athletes. While a careful history and a thorough physical examination are important steps in the assessment of quadriceps muscle pathology, it is still difficult to differentiate the type and severity of the pathology. Because of this difficulty, musculoskeletal ultrasound (MSK-US) is an invaluable tool in the diagnosis of quadriceps muscle or tendon injury. Utilizing this noninvasive imaging technique, medical professionals can easily diagnose and monitor muscle and tendon disorders to quickly determine the correct treatment plan for each individual case. The ability to view these structures in real-time allows identification of any present pathologies. MSK-US has become a useful component in diagnosing quadriceps muscle and tendon injuries due to its ability to clearly display the affected structures without exposing the patient to radiation or utilizing ionized contrast media. MSK-US provides valuable insight into fluid dynamics around joints and can even detect myotendinous tears that might otherwise be overlooked with the clinical examination or symptoms usually reported by patients. MSK-US can provide precise visualization of edema and can easily distinguish between benign and potentially pathological findings which make it an integral part of any holistic evaluation of quadriceps muscle and tendon injury. Additionally, it can be used to track the progress of physical therapy treatments and monitor tissue healing. This information is invaluable in ensuring an optimal outcome for any quadriceps muscle and tendon injury. Therefore, when used in combination with clinical tests, MSK-US can drastically increase the accuracy of the clinical examination. By utilizing this technology, healthcare practitioners have reliable access to more comprehensive diagnostics for musculoskeletal injuries and diseases than ever before. Clinicians are then able to tailor rehabilitation plans more effectively and ensure their patients receive proper treatment. As a result, recovery times may be shortened, and patients are able to return to their normal activities more quickly.

Quadriceps Strength and Knee Function After Anterior Cruciate Ligament Reconstruction with Quadriceps Tendon Bone Autograft: A Preliminary Report.

Introduction: The purpose of this study was to evaluate quadriceps strength and knee function after anterior cruciate ligament (ACL) reconstruction using a quadriceps tendon bone (QTB) autograft. Methods: Preliminary data were extracted from an ongoing prospective cohort study in which the operative extremity was compared to non-operative extremity. Patients from 14 to 40 years of age who had an ACL reconstruction with QTB autograft volunteered to have knee assessment including quadriceps isokinetic strength measures and functional knee testing at 6 and 12 months post-operatively. Paired t-tests were conducted to compare post-operative strength and function scores on participants who had minimum one-year post-surgical follow-up. Results: Patients had a significant recovery of quadriceps strength as determined by isokinetic testing and single leg hop test. For 31 participants, quadriceps strength of the operative leg measured at 60 deg/sec was 63% of the non-operative leg at six months, increasing to 79% at one year (p < 0.001); when measured at 180 deg/sec, these values were 68% at six months, increasing to 82% at one year (p < 0.001). For 30 participants, single leg hop functional scores of the operative leg were 80% of the non-operative leg at six months, increasing to 91% at one year (p < 0.001). Conclusions: After QTB autograft for ACL reconstruction, there were significant gains in quadriceps strength and knee function from six months to one year post-operative. These findings indicated the QTB is an acceptable ACL reconstruction option.

Exploring the integration of diagnostic musculoskeletal ultrasound imaging into clinical practice by physical therapists.

BACKGROUND: Musculoskeletal ultrasound (MSK-US) use for diagnostic purposes is expanding in physical therapy practice. Identifying and describing physical therapy-specific approaches to incorporating MSK-US into the evaluation process is needed. Musculoskeletal ultrasound extends the physical exam to allow clinicians to visualize anatomy and pathophysiology both statically and dynamically. Purpose: To document 1) weekly use of diagnostic MSK-US; and 2) clinical reasoning approach used in challenging patient cases by physical therapists (PTs) registered by Inteleos in musculoskeletal sonography (RMSK-certified). METHODS: Longitudinal, observational, cohort study using mixed methods for data collection and analysis. All 23 currently RMSK-certified PTs using MSK-US in clinical practice across the United States were contacted, and 16 participated. Data were collected using an online survey created with the Research Electronic Data Capture System. Participants documented MSK-US clinical use and significant cases using weekly, reflective, online journals for three months. Demographic data were summarized using descriptive statistics. Case data were analyzed thematically. RESULTS: Participating RMSK-certified PTs performed 1110 MSK-US examinations over 110 weeks. Clinicians averaged 7 (range 1-25) MSK-US examinations weekly, representing 28% of an average caseload. Examinations contributed significant anatomical/ pathological information 100% of the time. The most common joints scanned were the knee (n = 281), shoulder (n = 254), and wrist (n = 228). Case data revealed three themes: 1) augmenting the clinical evaluation to extend or narrow a diagnosis; 2) outcomes guiding action; and 3) lessons learned from clinical findings. CONCLUSION: RMSK-certified PTs regularly used MSK-US to validate and refine their clinical diagnoses and treatment. Ultrasound imaging directly influenced patient care by informing the diagnostic process, guiding treatment, and appropriately identifying referrals.

Supraspinatus Fatty Infiltration Correlation with Handgrip Strength, Shoulder Strength, and Validated Patient-Reported Outcome Measures in Patients with Rotator Cuff Tears.

Introduction: The purpose of this study was to investigate the relationships between supraspinatus atrophy on magnetic resonance imaging (MRI) and other objective parameters in patients with rotator cuff tears. It was hypothesized that high-grade supraspinatus fatty infiltration would be correlated negatively with handgrip strength, shoulder strength, and patient-reported outcome measures (PROMs). Methods: Patients with MRI-proven rotator cuff tears treated by a single sports medicine fellowship-trained orthopaedist at a single institution underwent comprehensive preoperative evaluation including bilateral handgrip and shoulder strength measurements with dynamometers and multiple online questionnaires from the Surgical Outcomes SystemTM (Arthrex, Naples, FL). Available shoulder MRIs were reviewed to grade supraspinatus fatty infiltration severity according to the 5-tier Goutallier system and an alternate 3-tier classification scheme. Difference analysis and Spearman (rho) rank order correlation were applied to the collected data to define the relationships between supraspinatus fatty infiltration and key variables including handgrip strength, shoulder strength, and scores derived from the shoulder PROMs. Results: Ninety of the 121 patients enrolled in the study had shoulder MRIs available for review. There was no correlation found between supraspinatus fatty infiltration and handgrip strength, shoulder abduction strength, or any of the seven common shoulder PROM scores evaluated. There was statistically significant, albeit weak, correlation between MRI-derived fatty infiltration and shoulder external rotation strength. Conclusions: Contrary to the hypothesis, high-grade supraspinatus fatty infiltration is largely unrelated to and should not be considered predictive of handgrip strength, shoulder strength, or common shoulder PROM scores.

Hamstring Strain Injury in Athletes.

Hamstring strain injury (HSI) may result in considerable impairment, activity limitation, and participation restriction, including time lost from competitive sports. This CPG includes sports-related overloading and overstretching injuries to myofascial or musculotendinous structures in any combination of the 3 hamstring muscles (the semitendinosus, semimembranosus, and biceps femoris). J Orthop Sports Phys Ther 2022;52(3):CPG1-CPG44. doi:10.2519/jospt.2022.0301.

A Comparison of Resting Scapular Posture and the Davies Closed Kinetic Chain Upper Extremity Stability Test.

BACKGROUND: In orthopaedic practice, it is well established that weak scapular stabilizers and an unstable scapula is related to shoulder dysfunction. Faulty scapular position has been linked to decreased scapular stability and is thought to be a result of weak or unbalanced timing in the recruitment of scapulothoracic dynamic stabilizing muscles. Kibler has described a four-type classification of scapulothoracic dysfunction. Functional performance testing is used to objectively measure activities that simulate various desired activities. The reliability of assessing the four static scapular positions may be important in diagnosing shoulder dysfunction. An understanding of the scapular position and its relationship to functional performance testing is needed. PURPOSE: The purpose of this study was to determine if a static scapular test, the Kibler scapula classification, in healthy participants affects the ability to perform a closed chain functional test that involves the use of the scapula and the upper extremity, the Davies Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST). A secondary analysis was performed to evaluate the reliability of a student physical therapist and an experienced physical therapist to identify scapular type by observation. STUDY DESIGN: Multicenter, single session descriptive cohort. METHODS: Sixty-one healthy participants (33 males, 28 females; mean age 24.19±2.61) completed testing across two locations in one testing session. Blood pressure and heart rate as well as height and weight were measured for each participant. Participants were classified by visual observation of Kibler scapular classification. The average number of CKUEST touches, a normalized score, and a power score were calculated for each participant. Three trials were performed and participants were required to take a 45-second rest break between each CKCUEST trial. RESULTS: One way analysis of variance (ANOVA) showed statistically significant differences in Type I and Type IV Kibler scapula classification for the CKCUEST power score, however when an ANCOVA controlled for body mass index, there was no statistically significant difference. A strong correlation r=.94 was observed between student and experienced physical therapist in evaluating all four types of Kibler scapular classification. CONCLUSIONS: Visually observed Kibler scapular position does not affect the ability to perform the Davies CKCUEST in healthy young adults. The ability to identify Kibler scapular position was reliable between student and experienced physical therapists. Additional studies are required to identify the usefulness of the Kibler scapular position classification. LEVEL OF EVIDENCE: 2b: Individual Cohort Study.

Survey of Physical Therapists' Attitudes, Knowledge, and Behaviors Regarding Diagnostic Imaging.

OBJECTIVE: The purpose of this study was to describe physical therapists' attitudes, knowledge, and behaviors regarding the use of diagnostic imaging. METHODS: Physical therapists in the United States were recruited from July 2018 through May 2019 to complete a web-based, cross-sectional survey. Participants were asked about demographics, their perceived knowledge base and skills for recommending or ordering different imaging modalities, and their behaviors regarding diagnostic imaging. Descriptive statistics were used to characterize the participants' demographics and responses to all questions. Chi-square tests were performed to compare responses by characteristics of survey participants and Wilcoxon signed-rank tests to compare levels of agreement. RESULTS: The mean age was 43 years, and of the 739 respondents, 58% (n = 417) were female. Ninety-two percent of respondents (n = 595) reported having recommended diagnostic imaging to another provider at least once. Only 11.6% (n = 75) reported having ever directly ordered diagnostic imaging. Participants' attitudes about their knowledge base and skills for recommending or ordering plain radiographs were stronger compared with any other imaging modalities followed by magnetic resonance imaging (MRI) over other imaging techniques. Participants' attitudes on recommending plain radiographs or MRI differed by professional education level, board-certification status, fellowship completion, and years since graduation. CONCLUSION: It is common for physical therapists to recommend imaging, but few have directly ordered imaging. Most survey participants believed that they have an adequate knowledge base and skills for recommending and ordering plain radiographs and MRI. IMPACT: These results can serve as a benchmark for future comparison as policies and educations evolve. Understanding physical therapists' attitudes, knowledge, and use of diagnostic imaging is important to inform research, policy, and education.

Grip and shoulder strength correlation with validated outcome instruments in patients with rotator cuff tears.

HYPOTHESIS/BACKGROUND: The ability to better define preoperatively the extent of rotator cuff (RC) dysfunction is desired. The study's purpose was to prospectively examine the relationships between absolute and percentage loss (affected compared to unaffected) of grip and shoulder strength, and RC dysfunction. METHODS: Forty-seven consecutive patients with proven RC tears participated in this study. Prior to surgery, bilateral strengths of grip, shoulder abduction, and shoulder external rotation (ER) were measured with a handheld dynamometer, and subjective outcome measures were gathered. RC tear size was determined via arthroscopy. Patient-reported outcomes were gathered on the day of the examination or via e-mail following initial evaluation. Descriptive statistics, difference analysis, and correlation coefficients (reported as either direct or negative) were used to analyze data. Grip, abduction and ER strengths, and percentage loss of grip, abduction, and ER strengths (percentage loss affected vs. unaffected), and tear size were analyzed in relation to all of the scores on selected subjective outcome measurement tools. The P value was set at .05. RESULTS: Fair direct correlations were found between grip strength and the Veterans RAND 12-Item Health Survey (VR-12) mental health scores, ER strength and Simple Shoulder Test (SST), abduction strength, and both the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) function score and SST score. Abduction and ER strengths were also found to possess a fair direct correlation. Fair negative correlations were found between the ASES function score and each of the following: percentage loss of abduction strength, percentage loss of ER strength, and tear size in centimeters. Another fair negative correlation was found between the Single Assessment Numerical Evaluation (SANE) score and tear size in centimeters. DISCUSSION: Our findings suggest that as shoulder strength decreases, ipsilateral shoulder RC dysfunction increases. Grip strength was not related to shoulder RC dysfunction. CONCLUSION: Grip strength was not found to correlate with RC tears. Those with decreased abduction and ER strengths and low ASES scores should be considered more likely to have an RC tear.