Ultrasound in Sports Medicine

Transcription

1 Ultrasound in Sports Medicine CASES AND USES T I F FA N Y T S AY, M D T O W S O N O R T H O PA E D I C A S S O C I AT E S T H E P R I M A R Y C A R E A P P R O A C H T O T R E AT I N G T H E I N J U R E D AT H L E T E M AY 4,

2 Financial Disclosures/Conflicts of Interest None

3 Background Growing interest in sports/musculoskeletal applications for ultrasound Advantages Non-invasive Point of care, potentially portable No radiation Better spatial resolution than MRI Good evaluation of soft tissue Targeted exam

4 Outline Ultrasound- the basics Cases Other applications Scanning demonstration

5 Ultrasound- The Basics Sound waves = energy waves Travel through a medium Ultrasound Pressure waves above frequency of human hearing Piezoelectric crystals in probe Electric current ultrasound waves Ultrasound waves electric current Generates echoes

6 Ultrasound- The Basics Areas described based on echogenicity Amount of ultrasound reflected relative to the area around it Echoes show up as white on screen Hypoechoic Hyperechoic Anechoic Isoechoic NOT density Bone and tendon are hyperechoic, but so are fat and gas! Sayed AA 2012

7 Ultrasound- The Basics Screen image is generated based on Degree of echogenicity Time for echo to return Longer time to return = deeper structure

8 Ultrasound- The Basics Superficial Deep

9 Ultrasound- The Basics Superficial Deep

10 Artifacts- Posterior Acoustic Shadowing Bickle I 2018

11 Superficial structures seen better Difficult to evaluate deep to hyperechoic tissues

12 Artifacts- Anisotropy

13 Jacobson 2013

14 Ultrasound- The Basics Advantages Non-invasive Point of care, potentially portable No radiation Better spatial resolution than MRI Good evaluation of soft tissue Targeted exam Disadvantages Extremely user dependent False positives, false negatives Much better for superficial structures Poor visualization with larger body habitus May not preclude need for further imaging

15 Cases

16 A pain in the ankle 55 y/o active male presents 3 days after right ankle injury Playing soccer, made a quick turn Felt a sharp pain in posterior ankle Weakness with toe-off in walking Physical Exam 4/5 right plantar flexion Palpable defect at Achilles tendon

17 A pain in the ankle Factors that affect surgical planning Complete or incomplete Location Myotendinous junction Midportion Insertion

18 Jacobson 2013

19 Jacobson 2013

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22 Surgery or no surgery? Prospective study of 125 patients Acute Achilles rupture (<7d) 5 mm or less gap in maximal plantar flexion Cast in plantar flexion x6 weeks Boot x2 weeks > 5 mm gap surgery Same PT No significant difference in rate of re-rupture 3.4% non-operative vs. 1.5% operative

23 A crushing blow 16 y/o F presents 3 weeks after left foot injury Horse slipped and fell on her foot Able to WB Physical Exam Normal strength and sensation TTP 4 th and 5 th TMT

24 MT Phalanx

25 4 th MT Cuboid

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27 Other Applications in Sports Medicine Procedure guidance Prior failed injection Deep structure/ body habitus PRP, prolotherapy Diagnosis of soft tissue injuries Foreign bodies Splenomegaly in mononucleosis (Hosey et al 2008) Focused echocardiography for pre-participation cardiac screening (Gleason et al 2017)

28 Scanning Demo

29 References Bickle I. (2018 March). Posterior acoustic shadowing and enhancement. Cunnington J, Marshall N, Hide G, Bracewell C, Isaacs J, Platt P, Kane D. A randomized, double-blind, controlled study of ultrasound-guided corticosteroid injection into the joint of patients with inflammatory arthritis. Arthritis Rheum 2010; 62: Finnoff JT, Hall MM, Adams E, Berkoff D, Concoff A, Dexter W, Smith J. American medical society for sports medicine position statement: interventional musculoskeletal ultrasound in sports medicine. PM R 2015; 7: Gleason C, Kerkhof D, Cilia EA, Lanyi MA, Finnoff J, Sugimoto D, Corrado GD. Early screening for cardiovascular abnormalities with preparticipation echocardiography: feasibility study. Clin J Sports Med 2017; 27: Hoffman F, Adams E, Bianchi S. Ultrasonography of fractures in sports medicine. Br J Sports Med 2015; 49: Hosey RG, Kriss V, Uhl TL, DiFiori J, Hecht S, Wen DY. Ultrasonographic evaluation of splenic enlargement in athletes with acute infectious mononucleosis. Br J Sports Med 2008; 42: Jacobson JA Fundamentals of Musculoskeletal Ultrasound. Elsevier Saunders, Philadelphia, 382 p. Kotnis R, David S, Handley R, Willett K, Ostlere S. Dynamic ultrasound as a selection tool for reducing Achilles tendon reruptures. Am J Sports Med. 2006; 34: Sayed AA. Pediatric ultrasound guided blocks. Ain Shams University, Cairo, Egypt. October Lecture.