Point-of-care ultrasonography

NewsBot · Jan 30, 2016

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Point-of-care ultrasonography in a physiatric foot clinic.
Lee SW, Kim DD, LE P, Bartels MN, Oh-Park M.
Eur J Phys Rehabil Med. 2016 Jan 28

BACKGROUND:
Few reports are available for the utility of diagnostic point-of-care (POC) ultrasonography for foot and ankle pain and diagnostic POC ultrasonography in physiatric practice has not yet been demonstrated.
AIM:
To describe POC musculoskeletal ultrasonographic (US) findings by location of pain among patients presenting to a foot pain clinic and to evaluate the concordance rate between clinical diagnoses and US findings by region of the foot.
DESIGN:
Retrospective chart review.
SETTING:
Outpatient clinic.
POPULATION:
A total of 111 patients with foot and ankle pain.
METHODS:
Retrospective chart review of clinical notes and data from POC US evaluation of patients who presented to the foot pain clinic between November 2013 and January 2015. US evaluations were performed by two physiatrist ultrasonographers.
MAIN OUTCOME MEASURES:
The concordance rate of clinical diagnosis and findings from US imaging based on the location of foot pain.
RESULTS:
One hundred eleven patients out of 205 patients who presented to the foot clinic (54.1 %) had POC US evaluation during the initial visit. The data was analyzed for patients with a single location of pain excluding 21 patients with pain more than one location. The mean age was 55.1 ? 14.3 years with 86.5 % being female. The most common location of pain was the hindfoot/ankle (n=71), followed by forefoot (n=13) and midfoot (n=6). The overall concordance rate between clinical and ultrasonographic diagnoses was 62.2 % (56/90) with a higher concordance rate in the hindfoot (67.6%) compared to the rest of the foot (50% in midfoot, 38.5% in the forefoot, p value =.042). The most common reasons for discordance (n=34) were failure to reveal abnormality on US (n=20, 58 %) followed by unexpected US findings (n=7, 20.6%).
CONCLUSION:
Concordance between clinical evaluation and POC US findings varies depending on the location of foot pain and often no US abnormalities were found in spite of clinical symptoms particularly in forefoot region. This information will enhance the selective application of POC US and improve its clinical utility in physiatric practice.
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Admin2 · Jan 30, 2016

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NewsBot · Feb 2, 2016

From latest Podiatry Today:
Neurogenic Heel Pain And The Use Of Diagnostic Ultrasound

NewsBot · Mar 25, 2017

High resolution ultrasonography in ankle joint pain: Where does it stand?
Mennatallah Hatem Shalaby et al
The Egyptian Journal of Radiology and Nuclear Medicine; 22 March 2017

Background
The ankle is frequently injured in trauma, overuse syndrome and inflammatory processes. Different imaging modalities assess the ankle, including plain radiography, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasonography (US).

Purpose
Our objective is to assess the role of high resolution US as a valuable tool in the depiction of causes of ankle joint pain.

Patients and methods
The study included 28 patients presented with ankle pain ranging in age from 17 to 60 years. They were examined by US and findings were correlated with MRI.

Results
US was capable to detect various lesions (synovitis, arthritis, plantar fasciitis, tendon and ligamentous lesions). It had a sensitivity of 95.4%, a specificity of 83.3% and an overall accuracy of 92.8%. US had a limited value in detection of avascular necrosis (AVN), bone marrow oedema and fractures.

Conclusion
US can be used as a first step diagnostic tool in cases of ankle pain. MRI should be spared to cases with negative or equivocal US findings.
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NewsBot · May 4, 2017

Clinical Utility of High-Frequency Musculoskeletal Ultrasonography in Foot and Ankle Pathology: How Ultrasound Imaging Influences Diagnosis and Management
Patricia B. Delzell, MD et al
The Journal of Foot and Ankle Surgery; 4 May 2017

The use of high-frequency (high-resolution) musculoskeletal ultrasonography is increasing and has shown promising utility in many areas of medicine. The utility of musculoskeletal ultrasonography for foot and ankle complaints has not been widely investigated, however. Although some conditions of the foot and ankle are easily diagnosed by physical examination, others can have nonspecific examination findings, making optimal treatment decisions difficult. We hypothesized that high-resolution musculoskeletal ultrasound scanning of the foot and ankle can affect the diagnosis and/or treatment for patients presenting with foot or ankle complaints. Retrospectively, the cases of 98 patients who had undergone musculoskeletal ultrasound scanning of the foot or ankle were reviewed. The pre-ultrasound clinical diagnosis and treatment were compared with the post-ultrasound diagnosis and treatment. In 64% of the patients, the diagnosis or treatment changed after the ultrasound examination. In 43% of patients, both the diagnosis and the treatment changed after ultrasound scanning. For those patients for whom the diagnosis and treatment were unchanged after the ultrasound examination, the ultrasound findings were concordant with the pre-ultrasound clinical diagnosis for 100% of the patients. These results suggest that in a large proportion of patients, high-resolution musculoskeletal ultrasonography of the foot or ankle can facilitate appropriate diagnosis and management.
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NewsBot · Dec 30, 2018

Ankle and Foot Ultrasound; Reliability of Side-to-Side Comparison of Small Anatomic Structures.
Rossi F et al
J Ultrasound Med. 2018 Dec 28.

OBJECTIVES:
In sonography of clinically relevant small structures of the ankle and foot, the healthy contralateral side can be used as a reference to identify subtle abnormalities. Intrasubject side-to-side variability must be minimal. The aim of this study was to assess the reliability of side-to-side sonographic evaluation of small structures of the ankle and foot.

METHODS:
Thirty healthy volunteers were prospectively studied. Small structures of the ankle and foot were evaluated bilaterally by 2 musculoskeletal radiologists in separate sessions. The deep peroneal nerve, superior extensor retinacula, calcaneofibular ligament, superior peroneal retinacula, tibialis posterior tendon, tibial nerve, Achilles tendon, plantaris tendon, plantar fascia, and sural nerve were considered. To assess intra- and interreader agreements, 30 (100%) examinations were repeated. A nonparametric statistic was used.

RESULTS:
Data were not normally distributed (P > .001). Intrareader agreement was k = 0.67 (95% confidence interval, 0.57-0.78) and interreader agreement was k = 0.73 (95% confidence interval, 0.68-0.77). The mean values and standard deviation for all the structures were 0.36 ± 1.85 mm. The overall coefficient of variation was 18.5%. The intraclass correlation coefficient was 0.93 (95% confidence interval, 0.92-0.94).

CONCLUSIONS:
In ankle and foot sonography, the healthy contralateral side can be used as a reference during a real-time musculoskeletal ultrasound evaluation of small structures
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NewsBot · Mar 23, 2020

Identifying and Monitoring Deficiencies in Physical Examination of the Foot and Ankle with Diagnostic Ultrasound: Experience from a Physical Medicine and Rehabilitation Residency Training Program.
Bitterman J, Oh-Park M, Lew HL, Ma RT.
Am J Phys Med Rehabil. 2020 Mar 18

Despite the high incidence of foot and ankle injuries and their biomechanical importance to more proximal joints, the foot and ankle are some of the most daunting and underemphasized musculoskeletal structures in medical training. This study used musculoskeletal ultrasound to identify a knowledge gap in Physical Medicine and Rehabilitation (PM&R) residents in foot and ankle surface anatomy palpation and to determine if senior residents had higher examination performance compared to more junior residents. PM&R residents at different levels of training were tested cross-sectionally and palpation accuracy was compared by class year. There was a trend of improvement across class years, with significant class differences in accuracy for the talonavicular joint, calcaneocuboidal joint, and posterior tibialis and peroneal tendons (p<0.05). Despite this trend, the accuracy was not consistently higher among the senior residents considering the training they received. For all 30 residents assessed, accuracy within 1cm was highest for the tibiotalar joint (93.3%), peroneal tendons (83.3%), posterior tibialis tendon (63.3%), and talonavicular joint (50%). It was lower for the calcaneocuboidal joint (26.7%), and the second (13.3%) and fourth tarsometatarsal joints (20%). Anatomical knowledge and palpation skills of the foot and ankle, particularly at the midfoot and forefoot, may be an area of improvement for PM&R resident training.
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NewsBot · Oct 24, 2021

Exploring the use of musculoskeletal ultrasound imaging by podiatrists: an international survey
Charlotte Dando, Richard Ellis, Matthew Carroll, Prue Molyneux, Gabriel Gijon-Nogueron, Heidi J. Siddle, Lindsey Cherry, Alfred Gatt & Catherine Bowen
Journal of Foot and Ankle Research volume 14, Article number: 39 (2021)

Background
Podiatrists, in musculoskeletal services, are demonstrating an expansion of their practice skills through the use of ultrasound imaging. There is an assumption that this practice is beneficial within the context of patient care and health systems. The aim of this research was to further investigate the use of musculoskeletal ultrasound (MSUS) by podiatrists within their clinical setting and gain additional insights into the impact that they perceive use of MSUS has on their approaches to management of musculoskeletal foot and ankle problems.

Method
An international study utilising a cross-sectional design and an internet-based platform was undertaken. The survey was developed and implemented through three phases: 1. survey development, 2. face validity agreement via questionnaire review, and 3. survey distribution and data collection. Twenty-two survey questions were developed and set as a two-step approach collecting quantitative data (part 1) and qualitative free text data (part 2). Data was exported from SurveyMonkey and analysed using Microsoft Excel software. Counts and frequencies were calculated for responses to all twenty closed questions. Responses to the two final open-ended questions were analysed using thematic analysis to search for patterns related to podiatrists’ perceptions of impact.

Results
Two hundred and thirty-two eligible participants consented to complete the survey. The majority (n = 159) of respondents were from the UK and Spain. Commonly MSUS has been used in practice for (i) diagnosing pathology, (ii) supporting rehabilitation, (iii) supporting interventions or (iv) research purposes. Most frequently, MSUS was used to assist in the diagnosis of injury/pathology (84%). A range of free text comments were received from the participants in response to the question relating to their thoughts on the impact of using MSUS imaging in their practice (n = 109) and on their perceptions of how the use of MSUS has influenced their approaches to management of their patients’ musculoskeletal foot and ankle problems (n = 108). Thematic analysis of the free text comments generated four themes: (i) diagnosis, (ii) delivery and access of care, (iii) patient education and engagement, and (iv) patient empowerment.

Conclusion
The perceived benefit podiatrists indicated in using MSUS as part of their practice is the perceived improvement in patient journeys through tighter, focused management plans and reduced waiting times. An additional novel finding was that MSUS provided the capacity for podiatrists to better inform patients of their diagnosis, which they believed led to improved engagement and consequent empowerment of patients in their treatment plans. We propose further investigation of patient experiences as well as testing of the model that embeds podiatrists’ use of MSUS as a key skill in musculoskeletal foot and ankle services.
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NewsBot · Feb 2, 2022

Consensus statement
Recommended musculoskeletal and sports ultrasound terminology: a Delphi-based consensus statement
Mederic M Hall et al
Source

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.
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