Multifaceted uses for musculoskeletal ultrasound

This issue of the Australasian Journal of Ultrasound in Medicine highlights the use of ultrasound in musculoskeletal ultrasound. This area of medicine encompasses approximately 20% of presentations to primary care physicians.^{1, 2} Determining how to investigate and manage these problems is a major burden to society. This is a very large cost in both evaluation and treatment.³ Ultrasound is increasingly the modality used to investigate musculoskeletal complaints as it is relatively cheaper, safer and more available, increasingly at the bedside.⁴

Fenech describes the anatomy of the metacarpophalangeal joints and the use of real-time ultrasound to diagnose the injuries in Boxer's knuckle.⁵ Fenech demonstrates both the normal anatomy and the tears of the sagittal bands of the dorsal hood and associated extensor tendon instability. This is an important article for teaching the clinical use of ultrasound to allow patients to be able identified so that they may move forward to improve from what can result in long-term disability from the loss of hand function. The treatment may require surgical repair.

Following on from this, Renfree et al describe the evaluation of flexor tendon surgical repair with differing ultrasound transducers.⁶ The superficial nature of the flexor tendons of the hand allows high-frequency probes to be used for evaluation. This study highlights that improvements in transducer technology from 18 to 24 MHz do provide more information and may result in less re-operation. Another important aspect of ultrasound evaluation is how this study was performed using cadavers. Cadaveric evaluation of techniques for both procedures and education is an important aspect of how ultrasound can be used.^{7, 8}

Finally, Magoon et al.⁹ highlight the safe and accurate evaluation of diagnostic biopsy of soft-tissue lesions in the hand. Importantly, the study demonstrated that even small lesions (<1 cm) are amenable to this, allowing a safer evaluation than open biopsy.⁹ The article also highlights the high level of experience of all groups involved in the evaluation of the soft-tissue lesions from the ultrasound and radiology staff through to the pathologist involved.

These three articles highlight the scope of ultrasound use in musculoskeletal imaging. This includes the evaluation of injury, biopsy of lesions though to review of results of surgical treatments. Ultrasound has important roles in both the diagnosis and treatment of musculoskeletal conditions, and the increasing availability of the technology will only increase this in future. It is essential that we develop an evidence base, as these authors have done, to document the true benefit, if any of the technology.