February 2021: How POCUS Enhances Care for Musculoskeletal Injuries
Point-of-care ultrasound (POCUS) isn’t just for the emergency room. It has incredible utility and versatility in specialities as diverse as primary care, orthopedics, and sports medicine. As just one example: the diagnosis and treatment of musculoskeletal injuries.
Check out these POCUS clinical cases for two common shoulder complaints…
Case #1: Diagnosing a Rotator Cuff Tear
A 65-year-old man experiences right shoulder pain after reaching into an overhead cabinet. A physical exam performed by his PCP finds a painful arc sign, limited range of motion above 45 degrees, a negative drop arm test, and a negative Neer test. To most accurately diagnose the injury, the PCP would potentially have to order an MRI and wait for the imaging results. Instead, with musculoskeletal ultrasound, the PCP was able to confidently diagnose a partial rotator cuff tear in just two minutes.
POCUS reveals a partial tear of the supraspinatus tendon:
Musculoskeletal ultrasound is comparable to MRI in both sensitivity and specificity for partial and full-thickness rotator cuff tears. It enables rapid diagnosis at the bedside, is more cost-effective, and allows the clinician to make an excellent clinical decision about the best next steps for the patient in real-time right at the bedside. Citations: de Jesus (2009); Bureau (2016).
Case #2: Ultrasound-Guided Injection for Joint Pain
A 56-year-old ex-competitive swimmer visits her PCP for follow-up with chronic left shoulder pain. Patient has tried NSAIDS, a home exercise program, and physical therapy without achieving pain relief.
POCUS views of the superior shoulder reveal fluid collection in the subacromial bursa:
Diagnosis? Subacromial bursitis. The PCP administers an ultrasound-guided corticosteroid injection directly into the subacromial bursa:
Screenshot from GUSI’s shoulder injection lecture by Dr. Ryan Petering
Musculoskeletal ultrasound can rapidly diagnose the cause of shoulder pain at the bedside. It also enables more accurate injections to the affected location. Citations: Molini (2012); Chen, et al. (2006).
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