Journal of Rehabilitation Medicine 51-3 | Page 88

J Rehabil Med 2019; 51: 234–235
LETTER TO THE EDITOR
LIFE AFTER ULTRASOUND: Are We Speaking the Same (or a new) Language in Physical and
Rehabilitation Medicine?
Interest in ultrasound (US) imaging and its utility in
clinical practice among Physical and Rehabilitation
Medicine (PRM) physicians is ever-increasing (1,
2). Similar to the development of new diagnostic and
therapeutic skills, the use of US imaging provides a
“new language” for our specialty.
Anatomically, we can now directly visualize diffe-
rent compartments and tissues of the musculoskeletal
system. In contrast to classical knowledge, this provi-
des better understanding of the condition of our patients
(3). Now, the shape, thickness, length, and reciprocal
relationships among nearby structures (which differ
from person to person) are no longer the result of me-
mory, but are a simple observation of the biological
system. “Seeing is believing”, and factors that can be
visualized can also be (semi)quantified (Fig. 1A) (4, 5).
In addition, visualization can be used for explora-
tion of particular structures/pathologies in cases where
surgery cannot be performed. For instance, an aberrant
vessel inside an otherwise healthy nerve cannot be seen
during surgery unless resection is performed. However,
with US imaging this can conveniently and comparati-
vely be done without harm to the patient (6). As such,
we have started to talk about “virtual dissection”.
Secondly, real-time dynamic scanning provides a
superior approach during patient examination. Ob-
serving the normal and pathological movements of
a muscle, joint or tendon helps to integrate the com-
plex knowledge of biomechanical analysis with the
clinical complaints (Video 1 1 ). A muscle herniating
during contraction, a tendon/ligament being partially
detached while moving, or a calcification impeding the
joint motion, would definitely be explanatory enough
when coupled with the onset of painful symptoms
during assessment (Video 2 1 ) (7). At this stage, probe
compression can also be used to precisely localize
the pathology. Therefore, considering the fact that the
US probe has become the “stethoscope”’ or the “sixth
finger” of a physiatrist, we also speak about “sono-
auscultation”’ or “sono-palpation”, “sono-Tinel” and
“self-palpation” (Fig. 1B & C) (8).
Thirdly, the other useful philosophy pertaining to
the utility of US in PRM is that once one is able to
visualize a structure/pathology one can readily target
it. Thus, the use of US-guidance for interventional phy-
siatry has been increasing rapidly, and this issue also
necessitates further terminologies (9). For instance,
we are no longer discussing ordinary interventions,
such as “shoulder injection” or “carpal tunnel injec-
tion”. In light of the initial US imaging (findings), we
need to specify the details of the procedure; thus, we
have started to use more descriptive wording, such as
like “intralesional platelet-rich plasma injection for a
http://www.medicaljournals.se/jrm/content/?doi=10.2340/16501977-2527
1
Fig. 1. (A) “Seeing the pathology after
history-taking and physical examination”.
Split-screen panoramic imaging of the calf
shows a strain lesion at the myotendinous
junction (arrowheads) of the medial head
of the gastrocnemius muscle (GM); “tennis
leg”. A widespread haematoma (asterisks) is
seen between the layers of the intermuscular
fascia (thick arrows). Note that the muscle
fibres are relatively spread, i.e. with normal
pennate architecture (thin arrows). (B) “Sono-
palpation” and (C) “Sono-Tinel”. Using the
probe for palpating on/nearby the painful area
indisputably helps the physician “complete”
the physical examination and provides further
insight as regards the underlying problem.
Yet, a positive “sono-palpation”, coupled with
the presence of an abnormal ultrasonographic
finding, is invaluable for precise diagnosis. In
this comparative short-axis imaging (B), radial
nerve cross-sectional area measurements
are seen in exactly the area the patient
described a positive “sono-Tinel” (C), i.e.
pain or dysaesthesia on probe compression.
The nerve is significantly swollen at the spiral
groove level and the clinical diagnosis of
“Saturday night palsy” is promptly confirmed.
MG: medial gastrocnemius; H: humerus; RN:
radial nerve.
This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm
doi: 10.2340/16501977-2527
Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977