Ultrasound is an effective imaging modality for the evaluation of upper extremities in sports; therefore, chiropractic physicians should be aware of its usage. Many patients will come in with shoulder pain or instability, and ultrasound is ideal in the assessment of the rotator cuff, biceps brachii tendon and the subacromial-subdeltoid bursa.

An algorithm based on patient age is often utilized, where patients over the age of 40 years often are evaluated with ultrasound, and patients under 40 years are evaluated with MRI or MR arthrography. This method is utilized because patients under the age of 40 years will commonly have articular-sided partial thickness rotator cuff tears and accompanying labral pathology, both of which are better visualized with MRI.

Ultrasound is more accurate when the indication of imaging is targeted and the structure that is being imaged is a superficial structure. The rotator cuff is the most commonly imaged tendon group using ultrasound, where its diagnostic accuracy is equal to MRI. For example, at an ultrasound, tendinosis will appear as abnormal hypoechogenicity with possible increase in tendon thickness. The biceps brachii long head tendon is also commonly imaged using ultrasound. Although ultrasound is beneficial for upper extremity complaints, it can also be used in the lower extremity, including the pelvis, hip, knee, ankle and foot. In the hip, diagnostic ultrasound can detect an effusion, synovitis with the hip joint and sometimes labral tears.

And last, ultrasound can be used to guide procedures, such as injections and aspirations. The value of ultrasound in sports medicine in diagnosing tendon pathologies, along with other various issues, is greatly beneficial.

Learn more about the NUHS diagnostic imaging residency here.

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