Ultrasound Offers Advantages in Musculoskeletal Disorders Diagnosis and Treatment

Ultrasound imaging is the use of high-frequency sound waves to obtain images for diagnosis or treatment. Ultrasonography is safe and does not use ionizing radiation like x-rays to obtain images. In musculoskeletal ultrasound (MSK US) we use high frequency transducers that produce images with higher resolution than MRI. In addition, we can obtain real time motion studies to see how ligaments, tendons, muscles, and joints function under normal conditions or abnormally when injured, degenerated, or unstable. We can also image nerves and detect abnormalities of position, size, adhesions, and tears in many areas. Ultrasound does not use radiation and is therefore safe during pregnancy.


Ultrasound can be an effective tool for diagnosing problems in patients with difficult-to-evaluate conditions. For example, to determine whether a tendon tear is the source of a patient’s ankle pain, the practitioner can use ultrasound to precisely inject anesthetic into the tendon sheath and assess the patient’s response. This diagnostic injection can help differentiate incidental from symptomatic structural abnormalities.

Ultrasound can also help diagnose the source of painful movement-related snaps and pops. By evaluating patients dynamically while they demonstrate their symptoms, practitioners can identify unstable tendons, snapping calcifications within tendons, and other sources of motion-induced pain.

Common applications of diagnostic musculoskeletal ultrasound include:

  • Identification of tendon or ligament tears, inflamed bursa, compressed nerves, cysts, and joint fluid.
  • Evaluation of painful pops and snaps.
  • Diagnostic injections into joints and tendon sheaths or around nerves.


In many cases, the use of ultrasound also allows the skilled practitioner to precisely and safely deliver therapies to the affected tissue. During ultrasound-guided injections or aspirations, practitioners can directly visualize the needle passing to the target. Direct visualization ensures accurate injectate placement and offers a greater margin of safety. Smaller needles may also be used, improving patient comfort and potentially reducing risk.

Applications for ultrasound-guided injections include:

  • Needle placement into joints for aspiration or injection, particularly in patients with challenging anatomy, those on blood thinners, or those in whom a nonguided injection has failed.
  • Injection into tendon sheaths or bursae.
  • Aspiration and injection of ganglion cysts.
  • Diagnostic or therapeutic nerve blocks, including carpal tunnel syndrome.
  • Percutaneous treatment of calcific tendonitis.