Musculoskeletal Procedures: Diagnostic and Therapeutic, Second Edition

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Items related to Musculoskeletal Procedures: Diagnostic and Therapeutic, Jacqueline Hodge. Publisher: CRC Press , This specific ISBN edition is currently not available. View all copies of this ISBN edition:. Synopsis In times of overburdened daily practice, we are all looking for concise, practical books; books that are easy to consult and in which we rapidly find clear answers to specific problems or suddenly arising queries. Buy New Learn more about this copy. Customers who bought this item also bought. Stock Image. Published by Landes Bioscience New Quantity Available: 1. Seller Rating:.

The Use of Photomedicine in Musculoskeletal Pain

Musculoskeletal Procedures: Diagnostic and Therapeutic J. Calcific enthesopathy was depicted in 6 cases at the level of the quadriceps tendon and in 1 case at the patellar tendon site. Clinical evaluation of the ankle and foot areas raised the suspicion of arthritis in the first metatarsophalangeal MTP joint in 1 case. The rest of the cases were evaluated as having OA 2 cases and unspecific ankle pain, tarsal tunnel syndrome, and mechanical talalgia 1 case each.


MSUS evaluation depicted in 2 cases tibiotarsal joint synovitis, and confirmed synovitis in the first MTP joint together with the presence of juxtaarticular tophus Figure 2 B. A compressive tarsal ganglion was identified as the underlying cause of the tarsal tunnel syndrome. Moreover, during the MSUS evaluation, 2 cases of tenosynovitis of the medial ankle compartment and 1 case of plantar fasciitis at the calcaneal insertion were identified. Seventeen patients, representing Nine of the patients had an initial indication for systemic therapy after clinical examination. Eight patients received a new indication for systemic therapy after the MSUS examination.

In 8 anatomic areas This implies an organizing effort involving clinical and instrumental procedures that may foster a rapid diagnosis followed by immediate therapeutic decisions. This may avoid additional hospital visits, prolonged patient pain, and persistent absence from work 16 , Clinical examination relies on several physical maneuvers testing the range of motion and the generation of pain in different anatomic structures; therefore, clinical diagnosis may be challenging when multiple structures are involved.

Within the last decade, MSUS has demonstrated accuracy and reliability in the evaluation of different musculoskeletal areas for a wide range of pathologies 4 - MSUS has become a valuable tool for improving diagnosis and care of patients with rheumatic diseases Indeed, concomitant examination of more than one anatomic area in the same patient would significantly increase the procedure exposure.

If necessary, additional anatomic areas may be examined. It is mandatory to differentiate true shoulder involvement from referred shoulder pain because an optimal treatment strategy is based on accurate diagnosis as the first step. In our study, the most important informational benefit was obtained following dynamic shoulder assessment, whereas shoulder impingement syndrome could be demonstrated in 20 of 24 areas. Apart from this, identification of inflammatory lesions led to significant local therapy changes.

The Musculoskeletal System - Merck Manual Consumer Version

The suspicion of entheseal involvement in the humeral epicondyles is easy to be raised after clinical examination, but the exact type of involvement is difficult to define unless a soft tissue imaging method is added. Traditional clinical techniques for evaluating hand arthritis rely on inspection, palpation, and dynamic examination of passive and active movements. In recent years, increasing medical data confirm that MSUS has clear superiority to clinical examination in detecting synovitis and erosions 22 - In comparison to MRI the gold standard evaluation method , MSUS has the advantage of being applicable to hands both in a multiplanar and dynamic examination in the same consultation room.

In our study, when compared to clinical examination, MSUS evaluation detected polyarticular synovitis in a larger number of patients, raising the suspicion for RA onset. This was possible because of detection of subclinical inflammatory lesions at joints and the periarticular structure level. MSUS evaluation of the hands cannot sustain a clear RA diagnosis alone, but it may help in better defining the pattern of articular and periarticular inflammatory involvement.

When considered appropriate, systemic therapy i. Clinical assessment of the hip area usually encounters difficulties because of the deep joint location. With respect to clinical examination, MSUS evaluation identifies more inflammatory and degenerative lesions at the joint as well as at the periarticular level 8 , In particular, when polymyalgia rheumatica onset or relapse is suspected, the detection of hip synovitis may contribute to radical change of the medical approach Instead, detection of asymptomatic trochanteric enthesopathy may focus attention on the possible subclinical onset of spondyloarthritides In our study, the detection of inflammatory lesions with MSUS determined the revision of the initial therapy strategies in some cases.

The ankle and foot region is well known for its complexity and difficulty of clinical examination assessment. MSUS allows frequent patient evaluation and is more sensitive in detecting tissue modifications than physical examination and radiographs 32 , In our patient group, the proportion of inflammatory findings detected by MSUS was higher in comparison to those identified by clinical examination, and the etiology of the tarsal tunnel syndrome was clarified.

The knowledge of the MSUS findings led to more guided invasive procedures aspiration as well as therapeutic injection , and this result is different from a previous study by D'Agostino et al MSUS assessment in daily practice spares time for the patient and the doctor as well as pain for the patients because it avoids referral to other imaging specialists and the second rheumatology visit.


The fact that rheumatologists may have access to more objective and detailed information via MSUS may determine a change in the classic therapeutic approach. On the other hand, in case of false clinical suspicion, therapy can be completely reset, avoiding unnecessary patient drug exposure. Our study has some limitations, since we did not longitudinally assess the impact of MSUS on the outcome and prognosis of the patients.

Future studies on the impact of MSUS on the outcome of regional pain syndromes are warranted.

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Another limitation is that we did not compare MSUS assessment with MRI examination considered as a gold standard , a target that was not possible to be reached during the first visit. Moreover, the fact that 2 of the 3 doctors involved in the clinical examination perform MSUS assessment in daily practice already being aware of the MSUS benefit may have subconsciously biased the results of the study.

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In conclusion, MSUS assessment has a relevant impact over a conventional clinical approach and may drive the therapeutic choice in many rheumatologic conditions, especially when a rapid and efficient medical service is desirable for optimizing health resources. Changes in the therapeutic approach are generated mainly by the MSUS detection of inflammatory and symptomatic as well as subclinical lesions. All authors were involved in drafting the article or revising it critically for important intellectual content, and all authors approved the final version to be published.

Micu had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Volume 65 , Issue 4.

The full text of this article hosted at iucr. If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account. If the address matches an existing account you will receive an email with instructions to retrieve your username. Musculoskeletal Ultrasound Free Access. Mihaela C. Micu Corresponding Author E-mail address: mcmicu yahoo. Sorana D.

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Tools Request permission Export citation Add to favorites Track citation. Share Give access Share full text access. Share full text access. Please review our Terms and Conditions of Use and check box below to share full-text version of article. Abstract Objective To evaluate the impact of musculoskeletal ultrasound MSUS as a complementary method to clinical assessment on rapid diagnosis and therapeutic decisions in a busy outpatient rheumatology clinic. Methods Sixty patients with different musculoskeletal symptoms were included in the study.

Conclusion Enhanced information obtained by MSUS evaluation leads to changes, with a significant impact on the initial diagnosis and treatment strategy designed after clinical examination. Statistical analysis.

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    Oxford Textbook of Musculoskeletal Medicine - Oxford Medicine

    Study conception and design. Micu, Naredo. Acquisition of data. Analysis and interpretation of data. Imaging modalities for identifying the origin of regional musculoskeletal pain.