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Diagnostic Musculoskeletal Ultrasound

One of the most frustrating parts of having an injury is not knowing exactly what your diagnosis is.


Is something torn?
Is it just a strain?
Should I rest it?


Dynamic Ultrasound Imaging can tell you in seconds. Dr. Rodman and Dr. Knapp represent a small percentage of Chiropractors that are trained in musculoskeletal ultrasound. The reason they took a year to study this technique is to give our patients the most accurate diagnosis possible. Instead of guessing what your injury is we can put an exact name on it. 


Some of the benefits of diagnostic ultrasound include:


1.) Reduces you wasting your time and money with an incorrect diagnosis and treatment.


2.) Gives you an accurate diagnosis so we can organize the most appropriate treatment plan


3.) Allows us to measure your progress


4.) If found to be an injury that is too catastrophic for us to treat we will recommend the most appropriate provider for your condition.

Here are some other benefits of musculoskeletal ultrasound as written by Dr. Sebastian Gonzales.


1: There are no contraindications to Musculoskeletal Ultrasound

In certain situations, you are not allowed to use X-ray or MRI. Some of the negatives surrounding X-ray are radiation exposure, how much radiation is allowed per year, pregnancy, and more. While x-rays are useful for some conditions, two more useful tools for evaluation of soft tissue, such as muscle and tendon, are MRI and Musculoskeletal Ultrasound.


MRI is great because there is no radiation transferred to the patient and it allows the doctor to see much more detail in the soft tissues, muscle, tendon, and cartilage. It’s even great for finding fractures missed on X-ray examination.

MRI machines are made of large magnets, which can present some issues. Patients with pacemakers, metal, and other implants cannot undergo MRI examination, but from a clinical standpoint, it is hard to ignore how much value there is in the detail that can be found on MRI. It is a very valuable piece of imaging.


Musculoskeletal Ultrasound is safe and can be done on anyone. There is no radiation, no magnets and it is commonly done on pregnant women, which demonstrates just how safe it can be.


2. Musculoskeletal Ultrasound is a Dynamic or movement-related image done in real time

This is where the magic of Musculoskeletal Ultrasound comes in. I have read numerous cases where an athlete can only feel pain with movement, which can only be visualized on a test such as Musculoskeletal Ultrasound.

MRI is what we call a “static image.” In fact, if you are in the MRI tube and move too much, the image will become useless due to motion artifact.Some injuries can be categorized as “instabilities” and visualized extremely well on Ultrasound when the patient’s tissue or joint is stressed.


In an MRI, a slight dislocated joint might be visualized as edema and swelling around the joint, but on an Musculoskeletal Ultrasound you actually SEE the joint move out of place. It’s amazing to see and very confirmatory of this type of diagnosis.


3. Patient feedback allows us to pinpoint a pain source at the time of the image

Often on an MRI, a Vitamin capsule is used to mark the level of pain, but on Musculoskeletal Ultrasound, it is not uncommon for the technician to press on the skin “at painful spot” and visualize a depression in the image at the same point, which confirms the pain generator in real time. In fact, non-symptomatic abnormalities are found all the time on imaging, but in a report, it is important to be able to highlight the pain generator so it can be treated accordingly.


4. Metal and surgical implants are not contraindications and can be visualized on imaging

Metal implants are a contraindication to the use of MRI in any patient…plain and simple. The use of Musculoskeletal Ultrasound would be extremely beneficial to patients still experiencing pain after surgery. I have heard of a few actual cases where surgically implanted hardware was rubbing against a muscle or tendon creating extreme pain and constant irritation to the structure. Only with Musculoskeletal Ultrasound can you see this type of complication.


5. We can compare bilateral structures on the same testing day

Comparing possible pathology on both sides is helpful in determining if the pathology is in fact, the pain generator. For example, on occasion, thickening of a tendon can be seen on both sides of the body regardless if symptomatic or not.

On MRI, we are only able to view one side per imaging study, which can lead the doctor to an incorrect diagnosis or cause increased cost for the patient for follow up imaging.


6. Long structures (like nerves and muscle) can be viewed in their entirety all in one test

In my opinion, this is one of the best advantages of Musculoskeletal Ultrasound compared to MRI.

MRI can only show a section of limb or the body. Musculoskeletal Ultrasound is a dynamic study that allows us to follow a structure all the way from its origin to its attachment. Nerve symptoms, like numbness in the fingers, can be the result of compression or swelling around the nerve anywhere along its course down the limb. The majority of its course can be evaluated with this image. The same goes for a muscle, such as the hamstring.

It is common to feel tightness and pain along the course of the hamstring after a tear. An ultrasound can pin point the exact location and severity of the injury.

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