Our physicians at Arthritis and Rheumatology Clinical Center of Northern Virginia are certified by the American College of Rheumatology in MSK ultrasound. We use musculoskeletal ( MSK) ultrasound to help diagnose injuries to muscles, ligaments, tendons, joints and to guide procedures. Studies have indicated that many procedures performed with ultrasound guidance have better therapeutic outcomes. Examples of such procedures include joint injections and aspirations, decompression of cysts such as baker's cysts, treatment of bursitis, tendonitis, and carpal tunnel syndrome.
Drs. Momeni and Tehrani both have extensive training in ultrasound. In fact Dr. Momeni is one the pioneers in MSKUS and she has been teaching MSK ultrasound to the rheumatology fellows at the George Washington University for years.
Superiority of Diagnostic Musculoskeletal Ultrasound compared to X-rays, CT scans and MRI:
- Enhanced soft tissue resolution compared to MRI
- Convenient and can be performed in our office
- No exposure to ionizing radiation
- Helpful for patients with claustrophobia
- Performing a real-time dynamic study, allows direct visualization of the painful area and enhances ability to detect disease
- More cost-effective than CT scan and MRI
- Ability to see inflammation within the joints, by quantifying the amount of blood flow to the specific area of concern
- Ability to detect bony erosions up to one year earlier compared to plain X-rays, which can impact therapeutic decision-making
- Ability to guide injections for more efficacious outcomes
Studies have demonstrated that ultrasound is equivalent to or even better than MRI, for detecting rotor cuff pathology.
As with any modality, there are some restrictions/limitations:
- Ultrasound does not penetrate bone
- X-rays are more effective for analyzing the overall bony structure
- Performing and interpreting musculoskeletal ultrasound takes months of training and practice
Therefore not many physicians utilize musculoskeletal ultrasound as a medical modality. Dr. Momeni and Dr. Tehrani not only have extensive training, they are both certified by the American College of Rheumatology in Musculoskeletal Ultrasound.
Using Ultrasound For Needle Guidance
In recent years, we have learned from the medical literature that ultrasound guided joint injections are superior to blind injections. Blind injections are purely based on the physical exam and anatomical landmarks, but the physician does not visualize the area in real time. Conversely, ultrasound can be used to visualize the area of interest, and the physician can actually see the needle advancing into the area of interest and delivering the medication. In our state of the art clinic, we use the newest, top of the line ultrasound machines with advanced needle visualization software, which produce crisp quality images and even video clips of our procedures.
According to many studies, such as, "A randomized, double-blind, controlled study of ultrasound-guided corticosteroid injection into the joint of patients with inflammatory arthritis." which was performed by Cunnington J, et al, 2010, up to 70% of blind joint injections are performed inadequately, meaning the steroids do not travel to the appropriate place. The authors of this study found that joint injections, using ultrasound guidance, were significantly more accurate, hence resulting in improved functioning of the joint. Additional studies have also found about a 40% reduction in procedural pain, when injections are administered under ultrasound guidance, and a 200% enhanced ability to detect effusions (fluid) in joints.
Back to top