Thursday, April 21, 2016

Please read this article about postoperative musculoskeletal ultrasound. 
Comment on one important "take home" point that you learned about ultrasound after reading this article. 


http://e-ultrasonography.org/upload/usg-15006.pdf


39 comments:

  1. My take home from the article was that there are numerous uses for ultrasonography post-operatively. The statement that struck me the most is as follows, "Ultrasonography can be used for accurately diagnosing various abnormalities including tendon tear, joint effusion, and infection in a postoperative orthopedic patient." I did not know that ultrasonography was able to diagnose that abnormalities, however, after reading more about it it makes sense. Jenn

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  2. I found the section about identifying the source of limb stump pain after amputation to be particularly interesting, especially with identifying the presence of and location of neuromas. I didn't realize that ultrasonography was able to do this! I only had one patient who had had an amputation, and to my knowledge she did not have ultrasonography to address her limb pain.
    -Rebecca Montgomery

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  3. The important "take home" point that I learned from this article is that ultrasonography is a fast and reliable method for evaluation of postoperative complications that is not affected by the metal that appears on CT or MRI. Plus it also doesn't expose the patient to radiation like the other types of imaging. - Chricket Short Niehues

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  4. I found it interesting how well ultrasonography can diagnose abnormal lesions in soft tissues or bone. I didn't know much about it before reading this article! I think the big take home from the article was about how fast and reliable it is and that it can be used without harmful radiation and can be used with metal implants, while CT and MRIs can't.

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  5. Prior to reading this article, I did not think about using ultrasound during a dynamic assessment to accurately evaluate if tendonious impingement is occurring against metal hardware. The take home point I gathered from this article is that ultrasonography can be used in a variety of situations both pre and postoperatively to help diagnose a variety of different pathology. Ultrasonography is a safe, fast, and effective diagnostic tool to aid in clinical decision making.

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  6. One take away point from this article was about anterior knee pain post TKA which is a very common complaint during therapy. Patellar abnormalities, ruptures or tears; capsular thickening, or joint space narrowing are the common reasons for anterior knee pain and can be identified using ultrasonography rather than serial radiographs. I have had a few patients that I feel would've benefited from some further imaging to help them during their rehab and this would've given them and us real time information. -Teresa Kirby

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  7. I was not very familiar with ultrasonography, and did not know all that it was being used for such as evaluating a fracture site and assisting with finding the cause of stump pain following amputation. This technique sounds very beneficial for evaluating individuals post arthroplasty for infection post surgery as it is fast, has no radiation effects and has no contraindications due to those metal implants. Many patients with an arthroplasty are unable to benefit from other imaging techniques due to those contraindications, so this technique may benefit them if they are having any soft tissue or bony problems later on as well.

    - Amanda Rudd

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  8. The take home point for me is that ultrasonography can be used for diagnosing numerous different pathologies both in the bone and in soft tissues. It sounds as though one of the key features is that it is a quick and reliable method used for post-op musculoskeletal complications in which the metal does not interfere as it does in a CT or MRI. I also found it very interesting that it can be used for identification of possible causes of limb stump pain following amputation!

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  9. Ultrasonography was used to help diagnose my Achilles tendon tear a couple years ago. It seemed to work pretty well, and you could see the black void of where the tendon should have been. One thing I learned from the article is that ultrasound isn't able to see in or around joints with metal hardware.
    ~John Babb

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  10. From this article, the take home point for me is that ultrasonography has the ability to diagnose various pathologies and abnormalities in soft tissues, tendon tears, and joint effusion. It also has the ability to assess dynamic evaluation of joints, looking at muscle and tendon motion. Identifying these different pathologies in a fast and reliable method with no harm to patients, would be beneficial for clinical decision making! -Elissa Westbrook

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  11. The take home point for me is that ultrasonography is able to diagnose various musculoskeletal abnormalities involving soft tissue and joint problems. I concluded that this could be a way for the health care field to save money by avoiding more expensive imaging options.

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  12. I found it interesting how ultrasonography can be used to differentiate a neuroma or vascular complications in a residual limb after amputation. This can help quickly determine whether the pain is caused by a post-op complication or by phantom limb pain. Whatever you are investigating with ultrasonography, it is cheap and quick option diagnostic option!

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  13. After reading this article I better understand how ultrasonography can be used to diagnose conditions that could potentially occur postoperatively. Some examples are joint effusion, soft tissue infection, hematoma, bursitis, and tendon or ligament abnormalities. Ultrasound post op would also cut down medical costs of CT scans or MRIs, and are the first choice if metal hardware was used.

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  14. I found it intriguing to be able to use ultrasound to diagnose infection around metal implants. It can be frustrating to suspect infection and terminate a treatment session only to find out the patient's skin was just irritated. The ability for PTs to use diagnostic ultrasound to rule out infection could expedite the medical care process and save patients time and money.

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  15. Great article! I think it was interesting reading about ultrasonography following hardware placement when tendons in close proximity to the hardware may be damaged. It is also useful to know that ultrasonography can be used for assessment for a variety of soft tissue conditions one of which was the neuromas versus vascular complications following amputation. It definitely is a useful tool that reduces our exposure to irradiation and costly imaging.
    Stephanie Salisbury

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  16. I found it interesting that ultrasonography can be used for finding the cause of limb stump pain after an amputation. Ultrasonography can help confirm and locate a painful neuroma; it can even assess whether the symptoms originate from the neuroma by simply compressing the mass with the transducer!

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  17. The biggest take home point I got from this article is the various uses for ultrasonography. It can be used for multiple pathologies affecting numerous joints ranging from shoulders, knee, post amputations, ankles, and more. It is something that I am relatively unfamiliar with but was interested to read about the many uses listed in this article.

    Jake Snodgrass

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  19. The take home point for me was that ultrasonography is quick and reliable at detecting multiple pathologies. I think the most interesting was the fact that it could detect the cause of pain after amputation. I think it's a good tool for us to have in our toolbox and can potentially even save money as compared to getting a CT or MRI.

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  20. From this article my take home is that the ultrasonography is very quick. It is also reliable at detecting multiple pathologies affecting all sorts of joints including shoulder, knee, and ankles.
    It is also useful to know that ultrasonography can be used for assessment for a variety of soft tissue conditions one of which was the neuromas versus vascular complications following amputation. It will be a great useful tool for my tool box for the future.

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  21. Take home message for me was the versatility of ultrasonography, from amputations to infections, abscesses to rotator cuff tears, ultrasonography can be used in a variety of situations to help the clinician identify pathology and create appropriate care plans.

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  22. The take home message for me were the various uses for ultrasonography pre and post operatively for diagnosing pathology that I was unaware of before I read this article. It can provide patient's with a more cost friendly alternative (versus other imaging) and also has the benefit of being a fast and noninvasive tool to be used for further clinical decisions. -Amber Padgett

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  23. I agree with quite a few of my classmates in saying my take home point from this article was the multiple uses that ultrasonography has. I did not know prior to reading this what all you can see with it and use it for. I especially thought that its use for finding the cause of limb stump pain post amputation was very interesting.

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  24. There were many interests points made in this article about ultrasound, but what I found most interesting was its use with bone union. "The formation of continuous echogenic callus with no identification of the intramedullary nail at the fracture sites represents a union. On the other hand, the interruption of an echoic cortical outline with a posterior reverberation artifact due to an intramedullary nail represents a nonunion."

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  25. I agree with many classmates that the big take home is how quick and reliable ultrasonography can be. I am curious about how having this tool in the clinic would change outcomes. We know from pain science research about how times pathoanatomical injuries often times do not equal pain. Rotator cuff tears in elderly and disc herniations in middle age population, we know diagnostically the structures can often be considered torn or abnormal but patients do not have any pain. Just worry a lot of unnecessary surgeries could happen if had this technology in the clinic. However, in some cases where there is an actual structural change that is the cause of the pain then having this intervention would be awesome.

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  26. We briefly cover the fact that ultrasound can be used for many things including diagnosing however this article details particular interests we should be aware of and that are commonly seen in musculoskeletal injuries. The take home point I got as I read through this article is as a therapist and more clinics having this technology available it might be a good investment to learn more about the accurate use and deciphering of this technology. It seems as though it will continue to grow in use based on the cost, non-harmful effects, and less restrictions to patient population.

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  27. The take home is that ultrasonography can be used as a diagnostic tool to expand our ability to better treat our patients. The most exciting factor is how it is already being used to further our research with EMG studies of muscle activity. I am eager to see how our profession advances due to more widespread use of this technology.

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  28. The take home is that ultrasonography can be used as a diagnostic tool to expand our ability to better treat our patients. The most exciting factor is how it is already being used to further our research with EMG studies of muscle activity. I am eager to see how our profession advances due to more widespread use of this technology.

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  29. What I take from this article is why not use ultrasound more often? I assume it is more cost effective than MRI but I feel like MDs are less likely to order diagnostic ultrasound even if it is the more indicated procedure. Is this possibly due to a small population trained to read diagnostic ultrasound? I see this becoming a very common procedure hopefully in the realm of physical therapy in the future due to its' non-invasive nature and cost effectiveness. It was eye opening to see the broad number of uses it can be used for but I am interested in how reliable it is for all of these uses.

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  30. This article is helpful in describing all the various uses of ultrasound and how quick/reliable it is for diagnostics. One thing I found interesting is that it can help diagnose the cause of limb stump pain post-amputation. My take home point from this is that I used to think US could only be used for things like effusion or muscle/tendon tears, but this article taught me several other uses.

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  31. I did not realize ultrasound was being used like this postoperatively. I only thought it was more of a diagnostic tool to suggest soft tissue lesions or tears. In an outpatient ortho setting, a few of the procedures here (THA, RC Repair, Achilles Repair) will make up a good portion of the outpatient caseload. In my last clinical I had a RC repair who would have been a great candidate for this procedure to see what was restricting his progress. He was roughly 12 weeks out and had full passive ROM, however he could not actively flex or abduct greater than 90 degrees. He presented almost as if he had retorn his RC

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  32. I found this article very intriguing. I had some knowledge of what or why ultrasonography was used for, but defiantly under-estimated its capabilities. 2 things I found interesting were that this can detect infections outside the hardware and also that it can help determine amputation pain such as neuromoa. My take home is that ultrasonography is so much more than just detecting vascular abnormalities and tendon ruptures. It changes my outlook on diagnosing potentially dangerous abnormalities.

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  33. I found it very interesting to learn about the different uses for ultrasonography. It makes since that it should be used post operatively now that I have learned from the article more about how the metal implants can make a difference in MRI and CT scans. Its also important to note the irradiation of ultrasonography making it more beneficial and safer. I was also impressed at how it could locate a possible neuroma in amputations. I am surprised I have not heard of ultrasonography used more. It sounds like it is very beneficial, and maybe will become used more often than it is currently.

    Rachelle Fisher

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  34. Something that I found interesting from the article is the fact that ultrasound is being used postoperatively, both after total joint arthroplasties, and things like rotator cuff repairs. It makes sense that if ultrasound can be a means to diagnose soft tissue conditions like rotator cuff repairs, that it can be used to assess the condition of the tissue at some point in time after surgery. I feel like radiographs are obviously better indicators of the status of a joint after a replacement, but can understand the ability to use ultrasound to assess for post-operative swelling, for instance, in a total joint replacement. These have exciting future indications for the field of physical therapy, and will be something to continue to follow.

    Nick Johansen

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  35. I think this article was helpful in identifying ultrasonography as a means for diagnostic imaging for the evaluation of bony and soft tissue integrity following tendon repair or arthroplasty surgery, considering metal implants are a relative contraindication for MRI.

    Chelsey Claassen

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  36. My take home message was the usefulness of ultrasonography to image soft tissue post total joint arthroplasty to detect potential joint effusion. During a clinical (inpatient acute) I evaluated a total hip, and in the following clinical at a SNU I eval'd the same patient, who had since undergone 3 revisions for VRE infection. The first infection was not caught early due to MRI imaging showing artifacts and an abscess grew to the size of a softball. I see patient outcomes greatly improving with the ease and speed of ultrasonography.

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  37. What I found interesting is that ultrasonography can be used to identify limb stump pain following amputation surgery. For example, ultrasonography can reveal an inflammation of the stump, fluid collection, confirmation and location of a painful neuroma, vascular complications such as venous thrombosis and popliteal artery aneurysms (with color Doppler imaging). This would have been handy in my last rotation, since I worked with several patients following an amputation surgery that experienced a lot of pain and swelling

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  38. The take home from this article for me was how ultrasonography can be used for such a wide variety of pathologies and situations. It is cool how it can be used in our profession to diagnose pt problems and evaluate injuries and post-op check ups. I feel like this is a tool that can be used to provide a better more thorough treatment of our patients

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  39. A take away point from this article I found interesting was about anterior knee pain post TKA and the use of ultrasonography to assist with diagnosis. Anterior knee pain can be a common complaint postop and utilizing ultrasonography could be used in place of radiographs for a quicker and cost-effective alternative. --Bri Fisher

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