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Why isn’t diagnostic ultrasound used in orthopedics? They inspect fetus hearts and other organs everyday, why not shoulders? Seems much cheaper and faster.

by tiahura 4mo ago

sxg 4mo ago
They do. Ultrasound in orthopedics is a relatively newer field, and there aren't quite as many sonography techs and radiologists experienced in reading these studies, which is likely why you don't see it offered more widely. Edit: I should mention that ultrasound is basically unusable for evaluating bones. Sound waves can't penetrate bone, and so you end up just seeing a huge black void. That's a huge orthopedics use case that ultrasound just can't benefit. However, ultrasound is fantastic for evaluating muscles, ligaments, tendons, and other superficial soft tissues.
- VoidWhisperer 4mo ago
  Serious question: If the bones specifically show up as black on ultrasound but the surrounding (muscle, etc) don't, wouldn't that be an option that could be used to try to determine a broken/fractured bone without the radiation from an xray? Or are the gaps in those cases usually too small to pick up?
bflesch 4mo ago
It's a manual, non-standardized process without a standardized output. Image quality depends both on user skills (how deeply they press the sensor on the skin) and the machine they have. Unlike CT/MRI the examination results cannot be easily shared and compared between patients for studies.
scrollop 4mo ago
We order ultrasounds all the time for shoulders (for like soft tissue issues; for trauma, you'd start with an xray). For other joints, such as the knee, MRIs are a better choice (unless htere has been substantial trauma, in which case xray initially or further), though more expensive, unless you're excluding a Baker's cyst, in which case an ultrasound is fine. Since MRIs are more expensive, private doctor's might order them instead of an ultrasounds. (I'm a doctor)
- tiahura 4mo ago
  Where are you? Pi and work comp attorney in medium US midwest metro. I've never seen one in 20y. Not from HCA ERs, medicaid er visits to univ affiliated er, nor prestige practices.
prdonahue 4mo ago
They're used quite a bit for nerve entrapment—both in diagnosing and treating.
trentor 4mo ago
Ultrasound was overlooked by US medicine as a first line imaging tool for a long time because it takes real skill and experience to do it right. But it's making a comeback. We've had Chinese, Indian, Australian, and American doctors visit us for one to two month stints to build up their skills. Given the skill involved, it's probably a liability concern they don't want the exposure over there.

Why isn’t diagnostic ultrasound used in orthopedics? They inspect fetus hearts and other organs everyday, why not shoulders? Seems much cheaper and faster.

by tiahura 4mo ago

Why isn’t diagnostic ultrasound used in orthopedics? They inspect fetus hearts and other organs everyday, why not shoulders? Seems much cheaper and faster.

sxg 4mo ago

They do. Ultrasound in orthopedics is a relatively newer field, and there aren't quite as many sonography techs and radiologists experienced in reading these studies, which is likely why you don't see it offered more widely. Edit: I should mention that ultrasound is basically unusable for evaluating bones. Sound waves can't penetrate bone, and so you end up just seeing a huge black void. That's a huge orthopedics use case that ultrasound just can't benefit. However, ultrasound is fantastic for evaluating muscles, ligaments, tendons, and other superficial soft tissues.

VoidWhisperer 4mo ago
Serious question: If the bones specifically show up as black on ultrasound but the surrounding (muscle, etc) don't, wouldn't that be an option that could be used to try to determine a broken/fractured bone without the radiation from an xray? Or are the gaps in those cases usually too small to pick up?

bflesch 4mo ago

It's a manual, non-standardized process without a standardized output. Image quality depends both on user skills (how deeply they press the sensor on the skin) and the machine they have. Unlike CT/MRI the examination results cannot be easily shared and compared between patients for studies.

scrollop 4mo ago

We order ultrasounds all the time for shoulders (for like soft tissue issues; for trauma, you'd start with an xray). For other joints, such as the knee, MRIs are a better choice (unless htere has been substantial trauma, in which case xray initially or further), though more expensive, unless you're excluding a Baker's cyst, in which case an ultrasound is fine. Since MRIs are more expensive, private doctor's might order them instead of an ultrasounds. (I'm a doctor)

tiahura 4mo ago
Where are you? Pi and work comp attorney in medium US midwest metro. I've never seen one in 20y. Not from HCA ERs, medicaid er visits to univ affiliated er, nor prestige practices.

prdonahue 4mo ago

They're used quite a bit for nerve entrapment—both in diagnosing and treating.

trentor 4mo ago

Ultrasound was overlooked by US medicine as a first line imaging tool for a long time because it takes real skill and experience to do it right. But it's making a comeback. We've had Chinese, Indian, Australian, and American doctors visit us for one to two month stints to build up their skills. Given the skill involved, it's probably a liability concern they don't want the exposure over there.