Ultrasound boosts rheumatology clinical examination findings

By Lynda Williams, Senior medwireNews Reporter

Musculoskeletal ultrasound (MSUS) improves rheumatology diagnosis and guides treatment, say researchers who believe imaging should be performed alongside clinical examination.

The team considered MSUS necessary to investigate musculoskeletal complaints in 39 of 60 patients attending an outpatient rheumatology clinic, using the technique in 43 of 67 affected anatomical areas. MSUS was also advised in a further 19 patients for 22 areas of interest.

Findings from MSUS led to a change in the clinical diagnosis in 60% of anatomical areas examined, and provided a more detailed diagnosis in all areas examined compared with clinical examination alone, report Mihaela Micu (Clinical Rehabilitation Hospital, Cluj-Napoca, Romania) and co-authors.

Overall, systemic treatment recommendations were altered for 25% of areas (affecting 28% of patients) following MSUS discovery of inflammation, such as a new recommendation for nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or disease-modifying antirheumatic drugs.

Local treatment was also adjusted in 36% of areas on the basis of MSUS findings, most commonly in the knees or hands. These included the recommendation of local guided injection treatments in 22% of areas, on top of the original NSAID prescription, or physiotherapy. Guided diagnostic aspiration was recommended for 15% of areas.

"MSUS spares time for the patient and doctor as well as prolonged sufferance for the patient; a supplementary second visit is avoided," write the researchers in Arthritis Care and Research.

"Enhanced information obtained by MSUS evaluation leads to changes with significant impact on the initial diagnosis and treatment strategy designed after [clinical examination]."

The researchers say that MSUS improved on shoulder diagnoses of unspecified rotator cuff lesions, providing details on inflammatory and structural damage of specific tendons, bursae, or joints, or confirming impingement syndrome.

MSUS identified the underlying lesion in five patients with a diagnosis of elbow pain due to chronic epicondylitis. For patients with hand complaints, MSUS led to suspicion of rheumatoid arthritis onset or identified the cause of carpal tunnel syndrome.

MSUS identified coxo-femoral joint synovitis, confirmed suspected cases of hip degeneration, and led to new diagnoses of calcific peritrochanteritic enthesopathy, while knee imaging revealed inflammatory lesions, structural lesions, and calcific enthesopathy.

Finally, foot and ankle MSUS expanded on clinical examination diagnoses of arthritis, unspecified ankle pain, tarsal tunnel syndrome, and mechanical talagia. In particular, MSUS identified synovitis of the tibio-tarsal joint, tenosynovitis of the medial ankle compartment, plantar fasciitis, and a compressive tarsal ganglion.

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