Msk Ultrasound

[dazzled85]

Where are we heading with MSK ultrasound? Are more physiatrists using it?
What about reimbursement?

Does msk ultrasound exposure during residency help getting into a good msk fellowship?

anybody know which programs have good msk ultrasound training?

😀

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[DOctorJay]

Mayo

 

[Gauss]

ultrasound will decline once reimbursement gets hit and will likely live on only in some academic centers and large practices that can support it.
Some like it, some don't, you have to try it and see how much you want to devote to it. it's a steep learning curve

 

[Louisville04]

ultrasound will decline once reimbursement gets hit and will likely live on only in some academic centers and large practices that can support it.
Some like it, some don't, you have to try it and see how much you want to devote to it. it's a steep learning curve

Stupid question....by steep learning curve do you mean it takes a long time to become proficient in ultrasound?

With a learning curve, I think of the amount of knowledge/proficiency in ultrasound on the Y axis and the time it takes to learn on th X axis.

 

[PMR2008]

Ultrasound has many benefits. It is very likely that reimbursements will be bundled/cut. I am very comfortable with using ultrasound for injections as we get a lot of exposure as residents at Marianjoy Rehabilitation Hospital. I know I will get better with diagnosis as I continue to read and attend courses. Even if reimbursements are reduced you will make more money doing a guided injection vs a blind injection. If you do the right injection and at the right place you will very likely have better patient satisfaction. There has been tons of good studies that have come out over the past 5 years and many more are in the pipeline.
PM&R should be and is at the forefront of MSK ultrasound with leaders like Jay Smith, Malanga, Finoff, etc. I think exposure during residency will help you get a good fellowship. It certainly helped me.
Some programs with great exposure that I know of include Mayo, Jefferson, U of M, Columbia/Cornell, Emory, NYU, Kessler etc.

Where are we heading with MSK ultrasound? Are more physiatrists using it?
What about reimbursement?

Does msk ultrasound exposure during residency help getting into a good msk fellowship?

anybody know which programs have good msk ultrasound training?

😀

 

[SSdoc33]

Even if reimbursements are reduced you will make more money doing a guided injection vs a blind injection.

not if you do 2x as many injections "blind", and not if the machine costs you 50k. im not advocating blind injecitons, but the time and money investment needs to be considered. sorta like majoring in poetry at a small liberal arts college for 50 grand a year......

 

[PMR2008]

not if you do 2x as many injections "blind", and not if the machine costs you 50k. im not advocating blind injecitons, but the time and money investment needs to be considered. sorta like majoring in poetry at a small liberal arts college for 50 grand a year......

I agree with you that it is faster to do "blind" injections. But honestly now that residents like me are getting exposed to ultrasound throughout residency things are different. I probably take 2-3 extra minutes per injection. I have better patient satisfaction. Most patients love watching the screen and they like the aspect of me using new technology. I agree that 2-3 minutes per patients adds up the end of the day but the reimbursement and satisfaction makes up for it. Yes the machines are expensive, but the prices are dropping due to competition and they pay for themselves within a year if you use them 6-7 times a week. So it comes down to your training and comfort level.
DOctorjay you have any comments?

 

[bedrock]

not if you do 2x as many injections "blind", and not if the machine costs you 50k. im not advocating blind injecitons, but the time and money investment needs to be considered. sorta like majoring in poetry at a small liberal arts college for 50 grand a year......

Very apt educational comparison.

I agree with you that it is faster to do "blind" injections. But honestly now that residents like me are getting exposed to ultrasound throughout residency things are different. I probably take 2-3 extra minutes per injection. I have better patient satisfaction. Most patients love watching the screen and they like the aspect of me using new technology. I agree that 2-3 minutes per patients adds up the end of the day but the reimbursement and satisfaction makes up for it. Yes the machines are expensive, but the prices are dropping due to competition and they pay for themselves within a year if you use them 6-7 times a week.

Sorry but a good machine isn't going to be less than $20,000 in this decade.

It's easy to become blinded to the economics of things as a resident as you're sheltered from the realities of private practice. Yes, ultrasound is nice, but if you can do 85% of your injections without it and your machine still costs $30,000, and you're footing the bill yourself after the guidance code is bundled, I promise you'll look at things differently.

I'm not saying that MSK ultrasound isn't very useful for specific injections, and it's a great tool to have around, but a lot less docs will be using ultrasound if they're footing the bill themselves, end of story.

 

[lobelsteve]

Don't forget the Dx component of us. Us should be bundled for Sab, shoulder, cts, gtb, hip, knee, cmc, ankle. Then in 5 yrs it should not be paid for the injection without us. Hips and ia shoulders can get done with fluoro as well. Sij, facet, esi, lsb all need fluoro and contrast.

Using us for gtb, rct, cts as Dx can be useful, but if studies cannot show clinically meaningful endpoints: then what's the point.

 

[bedrock]

Don't forget the Dx component of us. Us should be bundled for Sab, shoulder, cts, gtb, hip, knee, cmc, ankle. Then in 5 yrs it should not be paid for the injection without us.

Steve, sometimes I think you moonlight for CMS, or Obama.......

It really is okay (and fair) for us to be compensated for these additional skills that we've spent years mastering as specialists in medicine.

 

[lobelsteve]

Steve, sometimes I think you moonlight for CMS, or Obama.......

It really is okay (and fair) for us to be compensated for these additional skills that we've spent years mastering as specialists in medicine.

Rather than pay for an expensive modality to assist in something done for 50 years prior that appeared to work well, prove you've got something of value. If it has better outcomes, improved safety, and can reduce overall cost of care: we should bundle it in and let no one do it blindly after 5 years. Until then, it's a toy with a new paper published per day about how great it is in seeing posterior tins in cadavers. I feel that the myofascists are nut jobbing us and forcing it into every aspect of msk care. Emg, regional, joint, Dx. It's replacing the h&p. To me it's an expensive toy waiting for a good reason to be used. I'll hit a few courses in 2012 and figure out if it can help my patients. I've already got a Phillips on my dicom to use whenever I'd like.

 

[DOctorJay]

We get phenomenal training in msk ultrasound. I frequently see patients who have had blind injections performed elsewhere who show up in our clinics that get guided injections and finally get relief.

We are safer with it by avoiding neurovascular structures and save the pt some radiation. It's also typically much more comfortable since we see the needle the entire time and avoid things like os or quad tendon for knees. Intraarticular hips and shoulders are sweet with US.

Save the fluoro for spine stuff.

If everything gets bundled who will buy the equipment (c-arm, US) to get these procedures done? Hospitals? Just one more way to reign us all in.

I'm presenting a poster at AAPM next week. Hope to see some of you guys there! Going to be some good US sessions as well.

 

[DOctorJay]

Does Sonographic Needle Guidance Affect the Clinical
Outcome of Intraarticular Injections?

Objective. This randomized controlled study addressed whether sonographic needle guidance affect- ed clinical outcomes of intraarticular (IA) joint injections.
Methods. In total, 148 painful joints were randomized to IA triamcinolone acetonide injection by conventional palpation-guided anatomic injection or sonographic image-guided injection enhanced with a one-handed control syringe (the reciprocating device). A one-needle, 2-syringe technique was used, where the first syringe was used to introduce the needle, aspirate any effusion, and anesthetize and dilate the IA space with lidocaine. After IA placement and synovial space dilation were con- firmed, a syringe exchange was performed, and corticosteroid was injected with the second syringe through the indwelling IA needle. Baseline pain, procedural pain, pain at outcome (2 weeks), and changes in pain scores were measured with a 0–10 cm visual analog pain scale (VAS).
Results. Relative to conventional palpation-guided methods, sonographic guidance resulted in 43.0% reduction in procedural pain (p < 0.001), 58.5% reduction in absolute pain scores at the 2 week out- come (p < 0.001), 75% reduction in significant pain (VAS pain score &ge; 5 cm; p < 0.001), 25.6% increase in the responder rate (reduction in VAS score &ge; 50% from baseline; p < 0.01), and 62.0% reduction in the nonresponder rate (reduction in VAS score < 50% from baseline; p < 0.01). Sonography also increased detection of effusion by 200% and volume of aspirated fluid by 337%. Conclusion. Sonographic needle guidance significantly improves the performance and outcomes of outpatient IA injections in a clinically significant manner. (First Release Aug 1 2009; J Rheumatol 2009;36:1892&#8211;902; doi:10.3899/jrheum.090013)

 

[PMR2008]

Thank you for sharing the article and your feedback. Will you do MSK U/S during your fellowship? We get to use it quite often for hips and shoulders etc

 

[DOctorJay]

I will continue msk ultrasound in fellowship via elective from my residency. we also have a CX50 in our pain clinic and usually at least 2 half days a month of ultrasound pain procedures in clinic. We have access to US in our fluoro suites. I've seen it used for stellates, SI, piriformis.

 

[SSdoc33]

I've seen it used for stellates.

ive also seen ads for the laser spine institute in skymall.


good luck with that. hope that ultrasound has some way of regerating the spinal cord and gray matter.

 

[PMR 4 MSK]

The more you see and do US and the more you talk with the MSK US "Gurus" (Like everyone at Mayo it seems...) the more you realize that blind injections are not good enough anymore in many cases.

There is now plenty of evidence that for many injections US not only provides better diagnostic utility, but is less painful for patients and increases efficacy of the injections. For some injections, it likely does not matter.

It basically comes down to - do you need to see you target to hit it? For most spine work and large, deep joints, that is an unequivocal YES. For nerve blocks, it is a probably. For tendons it is a maybe.

Ultrasound pays well right now, but is likely to go down as it has seen a phenomenal increase in utilization. Even if payment goers away with bundling, it is still a useful tool. You need to make your decisions on tools you will use as much on their utility as their cost and reimbursement.

I would learn it as early as possible, because for us old dogs, it is hard to learn. However, we have more experience in handling needles, so maybe we pick up on it quicker than you young pups. 😀

Also know that using US to guide a needle is a different skill than using US to diagnose a problem. The latter takes a lot more experience.

 

[lobelsteve]

Does Sonographic Needle Guidance Affect the Clinical
Outcome of Intraarticular Injections?

Objective. This randomized controlled study addressed whether sonographic needle guidance affect- ed clinical outcomes of intraarticular (IA) joint injections.
Methods. In total, 148 painful joints were randomized to IA triamcinolone acetonide injection by conventional palpation-guided anatomic injection or sonographic image-guided injection enhanced with a one-handed control syringe (the reciprocating device). A one-needle, 2-syringe technique was used, where the first syringe was used to introduce the needle, aspirate any effusion, and anesthetize and dilate the IA space with lidocaine. After IA placement and synovial space dilation were con- firmed, a syringe exchange was performed, and corticosteroid was injected with the second syringe through the indwelling IA needle. Baseline pain, procedural pain, pain at outcome (2 weeks), and changes in pain scores were measured with a 0–10 cm visual analog pain scale (VAS).
Results. Relative to conventional palpation-guided methods, sonographic guidance resulted in 43.0% reduction in procedural pain (p < 0.001), 58.5% reduction in absolute pain scores at the 2 week out- come (p < 0.001), 75% reduction in significant pain (VAS pain score &ge; 5 cm; p < 0.001), 25.6% increase in the responder rate (reduction in VAS score &ge; 50% from baseline; p < 0.01), and 62.0% reduction in the nonresponder rate (reduction in VAS score < 50% from baseline; p < 0.01). Sonography also increased detection of effusion by 200% and volume of aspirated fluid by 337%. Conclusion. Sonographic needle guidance significantly improves the performance and outcomes of outpatient IA injections in a clinically significant manner. (First Release Aug 1 2009; J Rheumatol 2009;36:1892–902; doi:10.3899/jrheum.090013)

Only 148 subjects completed the protocol, with
2 (1 in each group) who did not complete and were excluded from the
study. Of the 148 subjects, 100 had rheumatoid arthritis and 48 had
osteoarthritis, and they were equally distributed between the 2 treatment
groups (Table 1). The joints consisted of 94.6% large joints (knee, hip,
shoulder, elbow, wrist, ankle) and 5.4% small joints (interphalangeal and
metacarpophalangeal joints) in the following proportions: 41.9% knee (n =
62), 18.9% wrist (28), 14.9% shoulder (22), 10.8% hip (16), 5.4% elbow
(8), 2.7% ankle (4), and 5.4% interphalangeal or metacarpophalangeal
joints (8), equally divided between the 2 treatment groups. Three subjects
in each group had palpable effusions.


These are not my patients and not my injections. Most of the patients had RA and too many injections were in small or medium joints. If we could eliminate the RA joint deformity folks and get the N up for the knee, shoulder, hip- then we can make more definitive statements.

 

[DOctorJay]

ive also seen ads for the laser spine institute in skymall.


good luck with that. hope that ultrasound has some way of regerating the spinal cord and gray matter.

Approach is lateral (see Narouze's text). No way you're going to hit cord if you keep needle in plane and tip in view. Ever hit carotid or thyroidal artery with fluoro? How would you know?

I understand you may not be personally comfortable with this. Read Narouze's articles.

 

[DOctorJay]

I agree with pmr4msks comment. Also agree we need more evidence as lobelsteve points out.

 

[lobelsteve]

Approach is lateral (see Narouze's text). No way you're going to hit cord if you keep needle in plane and tip in view. Ever hit carotid or thyroidal artery with fluoro? How would you know?

I understand you may not be personally comfortable with this. Read Narouze's articles.

The vert is lateral. Big V, THe neck V-jay-jay. It is variable and can be in the hole or outside the hole, it can be where we want to touch at body/tp junction. Fluoro with contrast and a stellate needle are good. I imagine US with color doppler would show big red as well. And US would have benefit of not having to hold the esophagus/trachea with a finger getting irradiated the entire procedure.

 

[Louisville04]

I will continue msk ultrasound in fellowship via elective from my residency. we also have a CX50 in our pain clinic and usually at least 2 half days a month of ultrasound pain procedures in clinic. We have access to US in our fluoro suites. I've seen it used for stellates, SI, piriformis.

When you use ultrasound, is it preplanned/scheduled or decided after your H&P?

 

[DOctorJay]

When you use ultrasound, is it preplanned/scheduled or decided after your H&P?

It depends. Let's say I see a pt in my continuity clinic and think they'd benefit from an injection. I can fire up the ultrasound and do a hip or shoulder or whatever right then and there so long as it isn't already in use and I have time.

Otherwise we refer to our msk ultrasound clinic, pain ultrasound clinic, sports med clinic, or hand clinic. This is similar to a fluoro suite but a regular exam room with the ultrasound in it and procedures are scheduled all day. Axial procedures are almost entirely under fluoro here. Rheum does USGIs as well.

This is how we get so much volume. We get at least one month of msk ultrasound clinic rotation and many of us do extra time for elective.

We also have a yearly didactic curriculum in US.

 

[oreosandsake]

peripherally related article

http://www.painmedicinenews.com//Vi...53&i=ISSUE:+February+2012&i_id=814&a_id=20136

Does Ultrasound Improve Pain Outcomes—And Does It Even Matter?

by Gabriel Miller
The use of ultrasound in regional anesthesia does not translate into better pain outcomes when compared with traditional techniques, according to a review of 23 randomized controlled trials published in the September 2011 issue of Anesthesia & Analgesia (113:596-604).
In fact, most studies comparing traditional localization techniques with ultrasound are not powered to look at pain outcomes, and instead define block success through surrogates like the number of needle passes or block performance time. Of the 16 studies that evaluated pain severity, eight reported improved analgesia with ultrasound guidance, whereas the remaining eight reported no difference. Of the eight trials reporting better pain outcomes with ultrasound guidance, only a single study demonstrated a decrease in numeric pain score greater than 1.
“Aside from the fact that [the decrease in pain was] statistically significant, I don’t think a decrease in numeric pain scores of less than 1 means anything to the patient,” said lead author Stephen Choi, MD, staff anesthesiologist at Sunnybrook Health Sciences Centre in Toronto, Ontario, Canada. The result speaks to the importance of statistically versus clinically significant results, he added, noting that previous research has shown that the minimal clinically important difference in pain is at least 1.3 units.
“When you look at the outcomes that are important to patients, very few of those were actually assessed in the studies,” Dr. Choi said.
Additionally, the range of designs and end points makes the studies difficult to compare. “The 23 trials look impressive until you look at each individual trial,” said Dr. Choi. “Because of the differing blocks, when you break it down you can’t actually compare them; no common effect was [measured]. From that perspective, there is actually very little data.” To wit, the studies included in the review had 11 unique primary end points, all of which essentially purported to characterize a better block when comparing ultrasound-guided and landmark or peripheral nerve stimulation techniques.
Despite the limitations of these studies, “when the techniques are really put to the test (meaning one provides a better quality surgical block), the data don’t suggest that ultrasound is better, just equivalent,” said John Antonakakis, MD, anesthesiologist at Portsmouth Regional Hospital in Portsmouth, N.H.
Because of this, Dr. Antonakakis said, “it’s an inefficient use of research time and resources to look at [pain outcomes] because first you have to prove that ultrasound gives you a better block. If we haven’t shown that ultrasound provides a better surgical block, why would we think that patients’ pain is going to be any different?
“There is nothing magical about ultrasound; it doesn’t have intrinsic therapeutic benefits that we know of,” Dr. Antonakakis said. “It’s simply a tool used for nerve localization and deposition of local anesthetic. The outcomes that have been studied to date—that is, how easy it is to perform the block and how quickly it sets up—are important to measure [and] are the appropriate outcomes to study with ultrasound.”
Whether or not there is a landmark trial demonstrating better outcomes, ultrasound has simplified regional anesthesia.
“Ultrasound itself has revolutionized regional anesthesia; it has allowed more people to become practitioners and thus more offer it to patients,” said Dr. Choi. He said novel applications of ultrasound in the field—such as blocks that use tissue planes to deliver anesthetic further away from the nerve—will only reinforce physicians’ dependence on ultrasound.
“Is it going matter if there is a major conclusive trial?” Dr. Antonakakis added. “Ultrasound has simplified regional anesthesia and given practitioners more confidence. Even if the literature shows that ultrasound and traditional techniques are equivalent, and it allows more practitioners to offer nerve blocks to their patients means that more patients will benefit.”

 

[jonnylingo]

When you use ultrasound, is it preplanned/scheduled or decided after your H&P?

The US I use is a Biosound Mylab Gold 25, $30K, portable, good resolution. Pays for itself with 5-6 inj/week. I average 3 inj/day.

In addition to injections, US is nice to use as an extension of the physical exam. I don't bill for diagnostic scan, but I scan briefly when diagnosis is in question. Dynamic evaluation is helpful when looking for impingement, especially with calcific tendinitis, subluxation of ulnar nerve, fluid in sheath (biceps, 1st dorsal compartment), or knee effusion, Baker's cyst, etc.

Regarding injections --
If it's hip, piriformis, GH, CMC, it's always with US.
If it's troch or TPI, usually not, though I'm liking TPIs more and more with US (I know, roll your eyes), it's satisfying seeing the needle tip right in the rhomboid or rectus abdominis.
It it's knee or sub delt, it's 50/50. If they've failed injections in the past, I tend to use US for both diagnostics and accuracy. If I'm doing viscosupplement , then always US.

It's been nice to use for calcific tendon lavage of the supraspinatus and tenotomy for lateral epicondylitis.

As far as when to use, I evaluate the patient and then decide. There are exceptions, such as referrals from ortho or occ med who ask for specific injection for diagnostic purposes in a difficult patient (diffuse shoulder pain, exam non-specific, etc.)

 

[DOctorJay]

The US I use is a Biosound My Gold 25, $30K, portable, good resolution. Pays for itself with 5-6 inj/week. I average 3 inj/day.

In addition to injections, US is nice to use as an extension of the physical exam. I don't bill for diagnostic scan, but I scan briefly when diagnosis is in question. Dynamic evaluation is helpful when looking for impingement, especially with calcific tendinitis, subluxation of ulnar nerve, fluid in sheath (biceps, 1st dorsal compartment), or knee effusion, Baker's cyst, etc.

Regarding injections --
If it's hip, piriformis, GH, CMC, it's always with US.
If it's troch or TPI, usually not, though I'm liking TPIs more and more with US (I know, roll your eyes), it's satisfying seeing the needle tip right in the rhomboid or rectus abdominis.
It it's knee or sub delt, it's 50/50. If they've failed injections in the past, I tend to use US for both diagnostics and accuracy. If I'm doing viscosupplement , then always US.

It's been nice to use for calcific tendon lavage of the supraspinatus and tenotomy for lateral epicondylitis.

As far as when to use, I evaluate the patient and then decide. There are exceptions, such as referrals from ortho or occ med who ask for specific injection for diagnostic purposes in a difficult patient (diffuse shoulder pain, exam non-specific, etc.)

This is very consistent with how we use ultrasound with the exception of the sports med clinic where the examiners (consultants and fellow) are experienced enough to do diagnostic scans.

 

[specepic]

The more you use and are comfortable with US the more you see its value. Those who decry US and find many faults with it are almost always someone who has not had the training/skills. They feel those with the training have a financial bias to stick everything in sight with US guidance, but perhaps not realizing that their claims that US is superfluous reflects their own bias.

I cross check the valuew of US all the time. After palpating and deciding where I thought the GT was, for example (using both their tenderness and bony palpation), after they have failed a non-guided by a collegue, then I get the US on there, and surprise, surprise, the GT is actually 2 inches away, then I follow my needle tip EXACTLY to the spot and deliver 100% of the med there. Shockingly , they do better.

I have no doubt that when fluoro came on the scene, the old guard said, "hey, I can do facets perfectly without that crap,and it is much quicker, show me a study"

 

[DOctorJay]

agree with specepic

also, I forgot to mention that we utilize ultrasound in our EMG clinic as well. we will use it for sticking rhomboids or diaphragm to avoid pneumo.

there is a lot of really interesting research coming out in this arena with the ability to visualize muscle fibrillating (yes fibrillating, not fasics). this has huge potential especially in peds EMG since these are usually done under anesthesia here. the other thing is that you can pick up echotexture of muscles that have fibrous or fatty replacement and can localize areas you want to stick much better.

we use ultrasound in our hand clinic to deliver botox to intrinsic muscles and it is also used for trigger finger A1 pulley releases. our consultant will also map out neurovascular structures in the palm and the hand surgeon then does percutaneous dupuytren's release. patient leaves the office with a few bandaids able to open their hand fully and return to full activity the next day.

 

[lobelsteve]

From Journal of Medical Case Reports
Phrenic Nerve Block With Ultrasound-guidance for Treatment of Hiccups
A Case Report
Kristiina Kuusniemi*; Ville Pyylampi

http://www.medscape.com/viewarticle/754783?sssdmh=dm1.760958&src=journalnl

If you ain't sounding, you ain't jecting.

I gotta get to some courses. I may do cash only US guided haircuts with a laser.

 

[DOctorJay]

Currently at AAPM. Narouze gave a nice talk. Big talking point was safety and utilizing us in combo with fluoro. You can document being intravascular flow with fluoro but you can AVOID vasculature with us. Hands on sessions were great.

 

[MedBronc23]

Oreoandsake bitter?

Agree with doctorjay and Stevelobel I do.

If you arent sounding you aren't injecting. I know for a fact that our pain department at the WFMC is integrating us with various pain procedures such as GON TON and TAP blocks. US is here to stay abd those of us who are lucky enough to be exposed are leaps and bounds ahead of our competitors graduating with minimal to no formal US exposure.

 

[MedBronc23]

Excuse my posting via iPhone

 

[DOctorJay]

Purple text = sarcasm font

 

[MedBronc23]

Oh well I missed the sarcasm

 

[oreosandsake]

Oreoandsake bitter?



Not bitter.

There are two sides to every coin.

 

[oreosandsake]

Your Academy Requests Your Input Regarding Ultrasound Usage in PM&R
As part of continuing efforts to improve practice quality and patient care, AAPM&R is conducting a survey of needs related to ultrasound-guided procedures and diagnostic ultrasound in the PM&R community. Your feedback as an Academy member is important to assess needs for ultrasound education. The questionnaire should only take about 10 minutes to complete.
We ask that you please provide your input before March 14, 2012.
Thank you in advance for your participation. If you have any questions or concerns, please do not hesitate to contact your Academy at (847) 737-6000 or by e-mailing us at [email protected].
To complete the survey, please click on the Zoomerang link below:




http://www.zoomerang.com/Survey/U2MREAHARJG4

 

[Doctodd]

Can u see deep structures in a knee or shoulder with ultrasound? Id like to see meniscal tears if possible for exact placement of PRP and stem cell injections. I have fluoro for anything else. thx for your advice. The Biosound rep said i could do the same things with a MyLab5 or smaller version of the MyLab25. Any other specific units that are recommended? Sounds like Sonosite is all marketting, and barely good enough for basic stuff due to inability to adjust for finer procedures.

 

[DOctorJay]

You might be able to see a far lateral tear but the bone is going to obstruct your view into the joint. You can however see rotator cuff tears. I think the PMR pain guys like ultrasound so much due to our strong background in msk anatomy.

We use Philips iu22 and CX50 machines.

 

[PMR2008]

You might be able to see a far lateral tear but the bone is going to obstruct your view into the joint. You can however see rotator cuff tears. I think the PMR pain guys like ultrasound so much due to our strong background in msk anatomy.

We use Philips iu22 and CX50 machines.

DOctorJay can you find out from Dr. Smith when the ultrasound guided injection book him, Cianca, Finnoff and Wisniewsk are working on will be published. Thanks.

 

[RUOkie]

Can u see deep structures in a knee or shoulder with ultrasound? Id like to see meniscal tears if possible for exact placement of PRP and stem cell injections. I have fluoro for anything else. thx for your advice. The Biosound rep said i could do the same things with a MyLab5 or smaller version of the MyLab25. Any other specific units that are recommended? Sounds like Sonosite is all marketting, and barely good enough for basic stuff due to inability to adjust for finer procedures.

I found very little difference resolution wise with the Esaote machines and the Sonosite. The difference was all portablity. GE was superior, but also much more expensive.

You can see some, but not most meniscal tears because of their location to bone. Just like seeing the RTC in the shoulder, but not the labrum.

 

[Doctodd]

I think the PMR pain guys like ultrasound so much due to our strong background in msk anatomy.

We use Philips iu22 and CX50 machines.

that's me......i went to Baylor way back before Cianca was doing any US. He was more interested in his Runner's World articles. Then again i wasnt the best resident either.

 

[DOctorJay]

DOctorJay can you find out from Dr. Smith when the ultrasound guided injection book him, Cianca, Finnoff and Wisniewsk are working on will be published. Thanks.

I think they're all away at some conference now but when I get a response I'll let you know.

 

[MedBronc23]

OreonSake...Sorry about the presumed bitter comments... That was probably out of line. I am notably pro MSK and pro Ultrasound in PM&R.

Does anyone know the results of the Ultrasound survey from the AAPMR that was posted a few months ago on this forum?

Also, in case anyone cares, at the AIUM course last month in Rochester, MN > 75% of the attending physicians were physiatrists seeking exposure and eventual accreditation in diagnostic and interventional MSK US. Given this, I think it is here to stay.

Also, the academy and AAP are integrating more and more exposure to MSK US at each successive meeting. At AAP last year, they were doing a demo on US, for which my most fond memory was showing one of the fellows demonstrating how to properly place the transducer to see the glenohumeral joint...needless to say there is more exposure...and I did not stay long.

Getting taught by Dr. Smith and our staff has jaded me somewhat....AIUM is great btw....many residents attended to get MSK US hands on exposure

 

[Louisville04]

OreonSake...Sorry about the presumed bitter comments... That was probably out of line. I am notably pro MSK and pro Ultrasound in PM&R.

Does anyone know the results of the Ultrasound survey from the AAPMR that was posted a few months ago on this forum?

Also, in case anyone cares, at the AIUM course last month in Rochester, MN > 75% of the attending physicians were physiatrists seeking exposure and eventual accreditation in diagnostic and interventional MSK US. Given this, I think it is here to stay.

Also, the academy and AAP are integrating more and more exposure to MSK US at each successive meeting. At AAP last year, they were doing a demo on US, for which my most fond memory was showing one of the fellows demonstrating how to properly place the transducer to see the glenohumeral joint...needless to say there is more exposure...and I did not stay long.

Getting taught by Dr. Smith and our staff has jaded me somewhat....AIUM is great btw....many residents attended to get MSK US hands on exposure

Why do you need accreditation unless you are doing it in a hospital using their equipment.

 

[MedBronc23]

You do not need accreditation yet. But many of the docs at AIUM who do US (diagnostic and interventional) that were not trained in a primary imaging speciality (Radiology) are anticipating that payers will want some proof of competency in the future to provide payment for ultrasound imaging and guided injections.

I do think given the additional profit/charge and room for abuse (any guy can buy a machine and say he is doing an US guided injection, when he could be looking at nothing and doing the same blind technique) that their will be accreditation required in the future.