Diagnosing Sports Injuries with Orthopedic Ultrasound

Often, the word ‘ultrasound’ is associated with seeing a baby in a while still in the womb.  But, at Children’s Hospital Colorado, we use ultrasounds in all areas of medicine.

In our Sports Medicine Center, a musculoskeletal ultrasound machine can get a better look at abnormalities or injuries of the musculoskeletal system like bones, muscles, cartilage, tendons, ligaments, joints and connective tissue. Below, pediatric primary care sports medicine physician, Nathan Howell, MD, and Gregory Walker, MD, speaks to the benefits of ultrasound, guided injections and what to expect during a musculoskeletal ultrasound.

The benefits of orthopedic ultrasound

Musculoskeletal ultrasound machines are becoming an increasingly popular tool for orthopedic specialists, especially when it comes to diagnosing injuries in young athletes. That’s because it’s a non-invasive alternative to MRI or CT, and often provides more information at a much quicker pace.

“Although it doesn’t replace an X-ray, it’s like having X-ray vision for many conditions,” says Walker. “And that’s a huge advantage to us. It improves the accuracy of the diagnosis.”

Along with the improvements in diagnosis, musculoskeletal ultrasound allows Dr. Howell to complete an ultrasound during dynamic movements, or movements that an athlete would normally do during their sport, such as a lunge. This range of motion simply can’t be done with an MRI.

“The ability to do dynamic movements can be a huge benefit of ultrasound,” says Dr. Howell. “It offers an opportunity to evaluate an area of interest while recreating symptomatic movement patterns to understand what is happening in the body during those movements.”

Along with identifying injury and inflammation, a huge benefit is the ability for Dr. Howell to complete an ultrasound on the spot in our clinic, without sending your child to other parts of the hospital. Since it’s a portable system on wheels, it doesn’t take up much space and can be brought in and out of an exam room as needed. That’s key for future uses such as taking a similar machine to off-site sporting events where Children’s Colorado has a community partner presence. This allows our sports medicine team to provide ultrasounds, or that X-ray vision, for young athletes just moments after they experience an injury.

Ultrasound-guided injections

There are two primary ways our providers use orthopedic ultrasounds: for diagnostic purposes, such as identifying an injury, and guided injections.

When your child requires an injection, an ultrasound-guided injection allows a doctor to see a needle in real time as they place it into the body. These types of injections help ensure the medication is inserted in the correct place and the needle avoids blood vessels or other structures.

The accuracy rate of injection into a joint without ultrasound can range around 30 to 40%. However, with ultrasound navigation, the accuracy rate exceeds 90 to 100%, according to the American Medical Society for Sports Medicine.

What to Expect During a Musculoskeletal Ultrasound

A musculoskeletal ultrasound, unlike an MRI or CT scan, is quick and convenient, and allows a diagnosis at the time of injury. For the exam, your child should wear loose clothing to easily reach the affected area and may be asked to change into an exam gown or shorts.

First, the doctor applies a gel to the area to create a bond with the wand to help the sound waves connect and produce a clear image. Next, they will apply the probe and they’ll be able to see real-time images of your child’s musculoskeletal system on the screen.

During this time, your child’s doctor will explain what they see on the screen and that informs the next step, the evaluation process and further diagnosis.

Overall, it's a pretty neat process that allows our doctors to quickly confirm injury or abnormalities in young athletes in a non-invasive way.