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Introduction: Accurate diagnosis of traumatic arthrotomy of the knee (TAK) is critical for patients presenting to the emergency department (ED) to ensure timely treatment. Current diagnostic modalities including plain radiography, computed tomography (CT), and the saline load test (SLT) have advantages and disadvantages. Point-of-care-ultrasonography (POCUS) offers a possible timely, low-cost, and efficient alternative method of diagnosing TAK. In this case series we present three cases where POCUS was used to diagnose TAK in the ED.Case Series: Three patients in their early 20s presented to the ED complaining of knee trauma with wounds in proximity to the joint. Mechanisms of injury included a gunshot wound in one case and blunt trauma (motor vehicle collision and bicycle crash) in two cases. In all three cases TAK was suggested on POCUS examinations by the presence of intra-articular hyperechoic foci consistent with air artifact. All three cases had TAK confirmed by orthopedic evaluation.Discussion: Ultrasound may have utility in the evaluation of patients presenting with knee trauma where TAK is a concern. The SLT is generally considered the gold standard test for diagnosis of TAK, but it is invasive and has a wide range of diagnostic accuracy. Intra-articular air has been found to be a sensitive marker for TAK in CT studies. Thus, additional investigations into the diagnostic accuracy of POCUS for this finding should be undertaken.

Introduction/Purpose Methods Results Conclusion As the frequency and morbidity of musculoskeletal (MSK) disorders increase, the use of MSK ultrasound has become an important diagnostic and procedural tool. This has amplified the importance of quality MSK ultrasound training for medical professionals. This systematic review evaluated and compared peer‐reviewed journal articles on learning methodologies for MSK ultrasound training.Thirty‐three articles met inclusion and exclusion criteria and were evaluated.Results showed a lack of randomised studies that compared learning methodologies.There was wide variability of methodology used based on educational and institutional needs. Further randomised control trials need to be conducted to ascertain best educational practices. [ABSTRACT FROM AUTHOR]

Introduction: Musculoskeletal ultrasound (MSUS) is integral to routine clinical diagnostics for musculoskeletal and joint disorders. This study aims to establish and validate a sonography course tailored to undergraduate medical students acquiring MSUS-specific skills at a German university. Methods: A blended learning training concept, comprising 24 instruction sessions of 45 min each, was designed based on the current national guidelines of the German Society for Ultrasound in Medicine (DEGUM). This program was integrated into the clinical phase of the undergraduate students' medical education. The self-perceived improvement in competency and the effectiveness of the course design were evaluated using a a 7-point Likert scale questionnaire. Objective learning success was evaluated via a written test and a "Direct Observation of Practical Skills" practical exam. Control groups included medical students without MSUS training (control group 1) and doctors who had completed DEGUM-certified basic MSUS courses (control group 2). Both control groups completed the written test, while control group 2 also took the practical final exam. The study involved 146 participants: 56 were allocated to the study group, 44 to control group 1, and 46 to control group 2. Results: The study group rated their skills significantly higher after the course (p < 0.01). Participants expressed high satisfaction with the course design, the teaching materials, and the teachers. The study group's performance on the final written test was comparable to those of control group 2 (p = 0.06) and significantly superior to control group 1 (p < 0.001). Additionally, the study group's performance on the practical final exam was not significantly different from control group 2 (p = 0.28), with both groups achieving scores exceeding 80%. Conclusion: Both subjective and objective measures of learning suggest that an MSUS course designed for postgraduates can be effectively adapted for undergraduate medical students. Incorporating MSUS training into the clinical curriculum is recommended to enhance future medical professionals' educational experience and practical skills. [ABSTRACT FROM AUTHOR]

Background: Knee osteoarthritis (KOA) is a progressive musculoskeletal disease that leads to physical impairment and disability. Several nonoperative therapeutic options have been proposed to reduce symptoms, improve physical function, and prevent disability. One of these therapeutic options is dextrose prolotherapy (DPT). The current study aimed to investigate the efficacy of DPT in the treatment of symptomatic KOA and to evaluate its potential proliferative role as assessed by musculoskeletal ultrasound (MSUS) and magnetic resonance imaging (MRI). Results: Seventeen knees (21.25%) dropped out, leaving 63 knees in the final analysis (57 females and 6 males, aged 41–74 years) with KOA. At 24-week follow-up, the visual analogue scale and overall Western Ontario and McMaster Universities scores showed significant improvement (P < 0.001). Moreover, a highly significant increase in cartilage thickness with a decrease in effusion grade and meniscal extrusion was observed by MSUS (P < 0.001). By MRI, there was a statistically significant decrease in effusion grade (P = 0.013) and meniscal extrusion (P = 0.005) and a highly significant increase in cartilage thickness (P < 0.001). Logistic analysis showed that lower patients' body mass index (BMI) at baseline was a significant predictor for clinical improvement following DPT. Conclusion: DPT might be considered a relatively safe minimally invasive intervention for the treatment of KOA with high adherence and satisfaction. It may lead to significant clinical and structural improvement in patients with KOA. Furthermore, lower BMI is a predicting factor for better clinical response to DPT. Trial registration: The study was registered prospectively in ClinicalTrials.gov: clinical trial registration number NCT04178304 on 21 November 2019, https://register.clinicaltrials.gov/XXX. Key points: •DPT showed promising results in improving clinical symptoms in KOA patients. •Significant structural improvement in patients with KOA following DPT warrants its use. [ABSTRACT FROM AUTHOR]

To study hand and wrist musculoskeletal changes among systemic sclerosis (SSc) patients. Thirty adult SSc patients were enrolled and subjected to detailed medical history, clinical examination, laboratory investigations, and imaging studies including X-ray and musculoskeletal ultrasound (MSUS) on both hands and wrists. The mean age of the studied patients was 40 ± 9.9 years, disease duration 5.4 ± 4.1 years and 28 (93.3 %) were females. Joint space narrowing (JSN) was the commonest finding in plain X-ray being detected in 9 (30 %) patients affecting mostly metacarpophalangeal joints (MCPs). Other X-ray findings included erosions (13.3 %), osteophytes (6.7 %), calcinosis (10 %), acro-osteolysis (13.3 %), and flexion contractures (3.3 %). Tenosynovitis was the most prevalent finding in MSUS detected in 43.3 % with the sclerosing pattern being the dominant type affecting mainly extensor tendons. 23.3 % of patients had active wrist synovitis, while 13.3 % of patients had wrist effusion, 13.3 % had MCP erosions, 13.3 % had MCP JSN, and 10 % had osteophytes. Patients who had no arthritis on presentation had a higher frequency of digital ulcers and tenosynovitis. Regression analysis showed that lack of hydroxychloroquine and methotrexate intake, absence of digital ulcers, presence of morning stiffness, erythrocyte sedimentation rate (ESR) > 27 mm/h and C-reactive protein (CRP) > 9 mg/dL, JSN by X-ray and absence of tenosynovitis by US were associated with arthritis. Articular involvement in SSc is frequent and could be the main presenting symptom. Clinical examination, ESR and CRP testing, along with plain radiography, and musculoskeletal ultrasonography are important to detect arthritis early and treat accordingly. [ABSTRACT FROM AUTHOR]

Background: Axial extensor mechanism alignment is routinely assessed in patients with patellofemoral instability.Although many of these assessments are described using magnetic resonance imaging, it is plausible that ultrasound (US) imaging could be utilized to provide similar information in a more cost-effective and time-efficient manner. Purpose: To (1) describe and assess the reliability of a novel measure of extensor mechanism alignment of the patellofemoral joint using musculoskeletal US and (2) establish the construct validity of this measure through comparison of patients with and without patellar instability. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Patients with (n = 24; 14.2 ± 3.1 years; 83% female) and without (n = 26; 14.7 ± 2.8 years; 69% female) a clinical history of patellofemoral instability (PFI) participated. Extensor mechanism alignment was assessed bilaterally on US, measuring the distance between the midpoint of the patellar tendon to the lateral trochlear ridge (MPT-LTR). Interrater reliability of the measurements was assessed using the intraclass correlation coefficient (ICC), with a minimum of 1 week between measurements for test-retest reliability. Differences between limbs were assessed using paired-samples t tests, and between-group differences were compared using independent-samples t tests. Results: Patients with PFI demonstrated a significantly smaller MPT-LTR distance than healthy controls on both their involved (8.1 ± 3.6 vs 12.6 ± 2.6 mm) and uninvolved (8.9 ± 3.4 vs 12.9 ± 2.4 mm) limbs (P <.001 for both), indicating greater lateralization of the patellar tendon relative to the trochlea. There were no differences found between limbs for either patients with PFI (P =.26) or controls (P =.46). Interrater reliability was good (ICC = 0.785; 95% confidence interval [CI], 0.579-0.890), and test-retest reliability (n = 8) was excellent (ICC = 0.958; 95% CI, 0.790-0.992). Conclusion: The US-based MPT-LTR distance demonstrated good-to-excellent reliability. When compared with controls, the MPT-LTR distance was smaller in patients with PFI, indicating greater lateralization of the extensor mechanism. [ABSTRACT FROM AUTHOR]

Ultrasound imaging is a vital imaging tool in musculoskeletal medicine, with the number of publications on ultrasound-guided surgery increasing in recent years, especially in minimally invasive procedures of sports, foot and ankle, and hand surgery. However, ultrasound imaging has drawbacks, such as operator dependency and image obscurity. Artificial intelligence (AI) and deep learning (DL), a subset of AI, can address these issues. AI/DL can enhance screening practices for hip dysplasia and osteochondritis dissecans (OCD) of the humeral capitellum, improve diagnostic accuracy for carpal tunnel syndrome (CTS), and provide physicians with better prognostic prediction tools for patients with knee osteoarthritis. Building on these advancements, DL methods, including segmentation, detection, and localization of target tissues and medical instruments, also have the potential to allow physicians and surgeons to perform ultrasound-guided procedures more accurately and efficiently. This review summarizes recent advances in ultrasound-guided procedures for musculoskeletal diseases and provides a comprehensive overview of the utilization of AI/DL in ultrasound for musculoskeletal medicine, particularly focusing on ultrasound-guided surgery. [ABSTRACT FROM AUTHOR]

Background: Machine learning models can provide quick and reliable assessments in place of medical practitioners. With over 50 million adults in the United States suffering from osteoarthritis, there is a need for models capable of interpreting musculoskeletal ultrasound images. However, machine learning requires lots of data, which poses significant challenges in medical imaging. Therefore, we explore two strategies for enriching a musculoskeletal ultrasound dataset independent of these limitations: traditional augmentation and diffusion-based image synthesis. Methods: First, we generate augmented and synthetic images to enrich our dataset. Then, we compare the images qualitatively and quantitatively, and evaluate their effectiveness in training a deep learning model for detecting thickened synovium and knee joint recess distension. Results: Our results suggest that synthetic images exhibit some anatomical fidelity, diversity, and help a model learn representations consistent with human opinion. In contrast, augmented images may impede model generalizability. Finally, a model trained on synthetically enriched data outperforms models trained on un-enriched and augmented datasets. Conclusions: We demonstrate that diffusion-based image synthesis is preferable to traditional augmentation. Our study underscores the importance of leveraging dataset enrichment strategies to address data scarcity in medical imaging and paves the way for the development of more advanced diagnostic tools. [ABSTRACT FROM AUTHOR]

Background Clinical assessment of triceps brachii tendon tears is challenging, and conventional imaging methods have limitations. Timely surgical referral is important in high-grade tears to maximize patient outcomes, and musculoskeletal ultrasound (MSK US) can be used at the time of clinical examination to identify such injuries requiring advanced imaging and orthopedic referral. Hypothesis/Purpose The purpose of this case report is to describe how MSK US was used to facilitate advanced imaging and timely orthopedic referral for a patient presenting to a physical therapist with a high-grade triceps tendon avulsion. Study Design Case Report Case Description A 35-year-old male soldier presented to a direct access sports physical therapist with acute-on-chronic right elbow pain. Physical examination and MSK US were used to identify a high-grade partial triceps brachii tendon tear. The MSK US findings informed the physical therapist's decision-making process to refer the subject for timely advanced imaging studies as well as referral to an orthopedic physician. Outcomes A high-grade partial triceps tendon avulsion was confirmed on magnetic resonance imaging (MRI). The subject was then seen by an orthopedic surgeon and underwent surgical repair of the tendon within the recommended three-week timeframe for optimal outcomes. The subject completed a post-operative rehabilitation program and returned to full physical and occupational activities. Conclusion MSK US can assist in the diagnosis of challenging triceps tendon injuries, facilitating timely advanced imaging and orthopedic referrals for high-grade injuries to optimize patient outcomes. Level of Evidence 5 [ABSTRACT FROM AUTHOR]

Purpose: The shoulder pain is one of the main causes that lead the patient to medical evaluation. Today, the ultrasound (US) represents an essential tool in the orthopaedical, rheumatological and rehabilitative setting to address the musculoskeletal causes of pain. Amongst the commonest causes of shoulder complains lay the frequent subacromial chronic bursitis (SACB). In this condition, the thickening of the bursal walls and subsequent fusion of the two synovial sheets leads to the reciprocal loss of bursal walls gliding under the subacromial space and consequently pain. This condition represents a common cause of shoulder pain and may be easily addressed by musculoskeletal sonographers. The purpose of this paper will be to describe the US appearance of SACB and to evaluate the efficacy of US-guided hydrodilation in its treatment. Methods: We included patients with painful shoulder attending our outpatient clinic for shoulder complains with the diagnosis of SACB with a bursal wall > 1.5 mm. A group was treated via US-guided hydrodilation, while the control group was treated via a classical blind approach using triamcinolone acetonide. Both groups underwent the same rehabilitation program following the injections. The shoulder functionality was assessed via qDASH questionnaire at baseline, days 3, 7, 14, 30, 60, and 90. A p <0.05 was considered significant. Results: Both groups displayed a significant reduction of pain; nevertheless, in the group treated with US-hydrodilation, there was no need for re-treatment. Conclusions: The US-guided hydrodilation for SACB should be the preferred technique to detach bursal walls and improve patient symptoms, since it requires fewer invasive maneuvers. [ABSTRACT FROM AUTHOR]

Abstract Background Knee osteoarthritis (KOA) is a progressive musculoskeletal disease that leads to physical impairment and disability. Several nonoperative therapeutic options have been proposed to reduce symptoms, improve physical function, and prevent disability. One of these therapeutic options is dextrose prolotherapy (DPT). The current study aimed to investigate the efficacy of DPT in the treatment of symptomatic KOA and to evaluate its potential proliferative role as assessed by musculoskeletal ultrasound (MSUS) and magnetic resonance imaging (MRI). Results Seventeen knees (21.25%) dropped out, leaving 63 knees in the final analysis (57 females and 6 males, aged 41–74 years) with KOA. At 24-week follow-up, the visual analogue scale and overall Western Ontario and McMaster Universities scores showed significant improvement (P

Abstract Introduction Musculoskeletal ultrasound (MSUS) is integral to routine clinical diagnostics for musculoskeletal and joint disorders. This study aims to establish and validate a sonography course tailored to undergraduate medical students acquiring MSUS-specific skills at a German university. Methods A blended learning training concept, comprising 24 instruction sessions of 45 min each, was designed based on the current national guidelines of the German Society for Ultrasound in Medicine (DEGUM). This program was integrated into the clinical phase of the undergraduate students’ medical education. The self-perceived improvement in competency and the effectiveness of the course design were evaluated using a a 7-point Likert scale questionnaire. Objective learning success was evaluated via a written test and a “Direct Observation of Practical Skills” practical exam. Control groups included medical students without MSUS training (control group 1) and doctors who had completed DEGUM-certified basic MSUS courses (control group 2). Both control groups completed the written test, while control group 2 also took the practical final exam. The study involved 146 participants: 56 were allocated to the study group, 44 to control group 1, and 46 to control group 2. Results The study group rated their skills significantly higher after the course (p

Medial collateral ligament (MCL) injuries are prevalent in sports and other physical activities and constitute a significant cause of knee pain and dysfunction. Traditional diagnostic modalities such as magnetic resonance imaging (MRI) are often utilized for their detailed visualization capabilities. However, musculoskeletal ultrasound (MSK-US) has emerged as a pivotal diagnostic tool in the evaluation of MCL injuries due to its non-invasive nature, cost-effectiveness, and dynamic imaging capabilities. This article reviews the utility and advantages of MSK-US in diagnosing MCL injuries, with a specific focus on its implications for rehabilitation providers. We discuss the technical aspects of ultrasound (US) imaging, including the sonographic appearance of MCL injuries across various grades, and compare its diagnostic accuracy with other imaging modalities such as MRI. Additionally, the role of US in monitoring the healing process and guiding rehabilitation strategies is explored. This review emphasizes the practical application of MSK-US in clinical settings, offering rehabilitation providers a comprehensive understanding of how US can be integrated into patient management protocols to enhance outcomes in patients with MCL injuries. [ABSTRACT FROM AUTHOR]

Background: Machine learning models can provide quick and reliable assessments in place of medical practitioners. With over 50 million adults in the United States suffering from osteoarthritis, there is a need for models capable of interpreting musculoskeletal ultrasound images. However, machine learning requires lots of data, which poses significant challenges in medical imaging. Therefore, we explore two strategies for enriching a musculoskeletal ultrasound dataset independent of these limitations: traditional augmentation and diffusion-based image synthesis. Methods: First, we generate augmented and synthetic images to enrich our dataset. Then, we compare the images qualitatively and quantitatively, and evaluate their effectiveness in training a deep learning model for detecting thickened synovium and knee joint recess distension. Results: Our results suggest that synthetic images exhibit some anatomical fidelity, diversity, and help a model learn representations consistent with human opinion. In contrast, augmented images may impede model generalizability. Finally, a model trained on synthetically enriched data outperforms models trained on un-enriched and augmented datasets. Conclusions: We demonstrate that diffusion-based image synthesis is preferable to traditional augmentation. Our study underscores the importance of leveraging dataset enrichment strategies to address data scarcity in medical imaging and paves the way for the development of more advanced diagnostic tools.

Roumei Wang,1,&ast; Shien Fu,2,&ast; Rui Huang,3,&ast; Chengcheng Qiu,1 Yunxia Tang,1 Yaoli Liu1 1Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China; 2Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China; 3College of Public Hygiene of Guangxi Medical University, Guangxi Medical University, Nanning, Guangxi, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yaoli Liu, Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, Guangxi, 530021, People’s Republic of China, Tel +86-771-5356706, Email 100youngly@163.comObjective: This study aimed to evaluate the quadriceps femoris in patients with chronic thyrotoxic myopathy (CTM) using musculoskeletal ultrasound and to explore its practical clinical value for the diagnosis of CTM.Methods: A total of 241 subjects recruited from the First Affiliated Hospital of Guangxi Medical University were surveyed for detailed medical history and underwent grip strength tests, fixed-distance walking, and quadriceps femoris ultrasound examinations. Differences in muscle parameters between the CTM, non-CTM, and healthy groups were analyzed. An Receiver operating characteristic (ROC) curve was established to analyze the predictive value of various ultrasound measurements for CTM, and Spearman correlation analysis and binary logistic regression were applied to explore the factors associated CTM.Results: The quadriceps femoris contraction index, muscle thickness, muscle cross-sectional area, and pennation angle in the CTM group were significantly lower than those in the non-CTM and healthy groups (p< 0.01). The ROC curve prediction showed that the pennation angle had the best sensitivity and specificity for diagnosing myogenesis, with an area under the curve of 89%. Moreover, the pennation angle of the CTM group was positively correlated with step speed (r=0.245, p=0.031) and body surface area (r=0.276, p=0.014), but negatively correlated with age (r=− 0.306, p=0.007). Regression analysis showed that the quadriceps femoris contraction index, muscle thickness, pennation angle, and cross-sectional area were factors that related the CTM. After adjusting for potential confounding factors, the association between Muscle Bundle Length and CTM became significant (OR=1.99, 95% CI: 1.22, 3.35, p=0.007). Muscular echo in patients was observed to varying degrees of enhancement.Conclusion: Musculoskeletal ultrasonography in the quantitative analysis of muscle parameters and muscle echo of the quadriceps femoris can provide essential imaging evidence for predicting CTM.Keywords: chronic thyrotoxic myopathy, musculoskeletal ultrasound, muscle echo intensity, Heckmatt Scale

There are currently no studies investigating the in vivo stiffness of the most commonly used autografts for anterior cruciate ligament reconstruction (ACLR) using Shear wave elastography (SWE). We hypothesize that there are differences regarding the elastic properties between the three tendons commonly used for ACLR and that they are influenced by patient-related factors. 80 healthy subjects (25 females, 55 males, age: 25.33 ± 4.76 years, BMI: 23.76 ± 3.14 kg/m2, 40 semiprofessional athletes, athlete group [AG], age: 25.51 [19–29]; 40 healthy controls, control group [CG], age: 25.50 [20–29]) were recruited as participants. In addition to patient reported outcome scores, every participant underwent a standardized multimodal ultrasound protocol consisting of B-mode-ultrasound (B-US), Color Doppler-ultrasound (CD-US) and a SWE examination of the bilateral quadriceps tendon (QT), patellar tendon (PT) and semitendinosus tendon (ST). The highest shear wave velocity (SWV) were observed in ST (4.88 (4.35–5.52) m/s, ST vs QT, p = 0.005; ST vs PT, p < 0.001) followed by QT (4.61 (4.13–5.26) m/s, QT vs PT, p < 0.001) and PT (3.73 (3.30–4.68) m/s). Median QT, PT and ST stiffness was significantly higher in AG compared to CG. Male subjects tend to have stiffer QT and PT than female subjects. Positive correlation with SWV was obtained for age and activity level. There are significant differences regarding in vivo tendon stiffness between the most frequently used autograft tendon options for ACLR. The quantitative information obtained by SWE could be of particular interest for graft choice for ACLR. [ABSTRACT FROM AUTHOR]

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Introduction Methods Discussion Conclusion Iatrogenic and traumatic injuries to the femoral and saphenous nerves, and their branches are uncommon but can be a cause of clinically pertinent lower limb dysfunction and neuralgia. Despite this, direct sonographic imaging of these nerves is not commonly requested or performed.A review of the literature regarding the detailed relative anatomy, sonographic technique to image these nerves and their branches and their normal and abnormal appearances was conducted.These nerves are often in the direct imaging field of many ultrasound examinations including the assessment of the groin and lower limb vasculature and musculoskeletal studies. They can become entrapped at certain points throughout their path, where particular attention should be provided to these nerves.Improved knowledge regarding the sonographic imaging of the femoral and saphenous nerves and their branches can assist identification and discrimination between normal and abnormal appearances, and subsequent ultrasound‐guided nerve blockades or radiofrequency ablations for pain management where required. [ABSTRACT FROM AUTHOR]

In orthopedics, X-rays and computed tomography (CT) scans play pivotal roles in diagnosing and treating bone pathologies. Machine bulkiness and the emission of ionizing radiation remain the main problems associated with these techniques. The accessibility and low risks related to ultrasound handling make it a popular 2D imaging method. Indeed, 3D ultrasound assembles 2D slices into a 3D volume. This study aimed to implement a probe-tracking method for 6 DoF 3D ultrasound. The proposed method involves a dodecahedron with ArUco markers attached, enabling computer vision tracking of the ultrasound probe's position and orientation. The algorithm focuses on the data acquisition phase but covers the basic reconstruction required for data generation and analysis. In the best case, the analysis revealed an average error norm of 2.858 mm with a standard deviation norm of 5.534 mm compared to an infrared optical tracking system used as a reference. This study demonstrates the feasibility of performing volumetric imaging without ionizing radiation or bulky systems. This marker-based approach shows promise for enhancing orthopedic imaging, providing a more accessible imaging modality for helping clinicians to diagnose pathologies regarding complex joints, such as the shoulder, replacing standard infrared tracking systems known to suffer from marker occlusion problems. [ABSTRACT FROM AUTHOR]

Cubital tunnel syndrome (CTS), is a frequently encountered condition in clinical settings, typically arising from static or dynamic compression of the ulnar nerve. CTS is characterized by the irritation of the ulnar nerve within the cubital tunnel and is a common neuropathic condition that can significantly impact functional abilities and quality of life. This article explores the utility of diagnostic musculoskeletal ultrasound (MSK-US) in the evaluation of the cubital tunnel and the ulnar nerve. The cubital tunnel syndrome, a common entrapment neuropathy of the ulnar nerve, often presents diagnostic challenges. Traditionally, nerve conduction studies and electromyography have been the primary diagnostic tools used to diagnose CTS. Given the superficial nature of the ulnar groove and its adjacent structures, MSK-US imaging known for its non-invasive nature and high-resolution imaging capabilities, has become an increasingly valuable tool in the assessment and management of various musculoskeletal conditions. This article reviews the technical aspects of MSK-US, its advantages in visualizing the ulnar nerve and related structures, and its implications in clinical practice for rehabilitation providers. By integrating MSK-US in the evaluation of CTS, rehabilitation professionals can enhance diagnostic accuracy, tailor interventions, and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Point-of-care ultrasound (POCUS) can assist rheumatologists in monitoring disease activity, establishing diagnoses, and guiding procedural interventions. POCUS use has been increasing, but little is known about current use and barriers among rheumatologists. The purpose of this study was to characterize current POCUS use, training needs, and barriers to use among rheumatologists in practice. Methods: A prospective observational study of all Veterans Affairs (VA) medical centers was conducted using a web-based survey sent to all chiefs of staff and rheumatology chiefs about current POCUS use, training needs, barriers, and policies. Results: All chiefs of staff (n = 130) and rheumatology chiefs at VA medical centers (n = 95) were surveyed with 100% and 84% response rates, respectively. The most common diagnostic POCUS applications were evaluation of synovitis, joint effusion, tendinopathies, bursitis, and rotator cuff. The most common procedural applications were arthrocentesis and joint, bursa, and tendon injection. Most rheumatology chiefs (69%) expressed interest in training for their group. The most common barriers to POCUS use were lack of trained providers (68%), funding for training (54%), training opportunities (38%), funding for travel (38%), and ultrasound equipment (31%). Lack of POCUS infrastructure was common, and few facilities had POCUS policies (20%), image archiving (25%), or quality assurance processes (6%). Conclusion: Currently, half of rheumatology groups use diagnostic and procedural ultrasound applications. Most rheumatology groups desire training, and lack of training and equipment were the most common barriers to ultrasound use. Deliberate investment is needed in ultrasound training and infrastructure for systematic adoption of POCUS in rheumatology. Graphical Abstract available for this article. Trial Registration: NCT03296280. [ABSTRACT FROM AUTHOR]

Background: Enthesopathy is considered a crucial aspect of assessment and outcome in psoriatic arthritis (PsA). Musculoskeletal ultrasound (MSUS) is a critical tool for accurately detecting enthesitis. Recent research focuses on identifying simple biomarkers for detecting and monitoring psoriatic enthesopathy. Red cell distribution width (RDW), mean platelet volume (MPV), and neutrophil/lymphocyte ratio (NLR) are components of a complete blood count (CBC) and are reliable bio-inflammatory markers in various rheumatic diseases. Aim of work: To measure MPV, RDW, and NLR in psoriatic enthesopathy and determine their relationship to disease activity and MSUS findings. Patients and methods: This study focused on 30 people with psoriatic arthritis (PsA) as per CASPAR criteria, along with 20 control subjects. Enthesopathy was evaluated clinically using the Leeds Enthesitis Index (LEI). The modified Disease Activity Index of Psoriatic Arthritis (DAPSA28) was calculated, and RDW, MPV, NLR, CRP, and ESR were measured. Each enthesis in LEI was radiologically assessed using plain radiography and MSUS according to OMERACT definitions. Results: There was a significant relationship between clinical tenderness, the presence of enthesophytes on plain radiography, and MSUS findings at entheses sites (p < 0.001 for each). Psoriatic patients had higher levels of RDW and MPV (p < 0.001 and 0.01, respectively) than controls, with no significant differences in NLR (p = 0.189) between the two groups. RDW and MPV levels were positively correlated with the DAPSA28 score. Conclusion: Monitoring PsA disease activity can be improved by considering RDW and MPV as reliable indicators and using them to screen for psoriatic enthesopathy with MSUS indices. Key points • Clinically identifying enthesitis in patients with PsA can be challenging. Imaging MSUS indices hold promise for objective analysis, but there is no consensus on which indices to use in clinical trials and daily practice. • Patients with psoriatic enthesopathy have higher RDW and MPV levels, which are positively correlated with DAPSA28 score. • RDW and MPV can be considered in the turn of improved screening of psoriatic enthesopathy with MSUS scores. [ABSTRACT FROM AUTHOR]

Purpose: To analyse the reliability of ultrasound‐guided measurement of the cartilage thickness at the medial femoral condyle in athletically active children and adolescents before and after mechanical load in relation to age, sex and type of sport. Methods: Three successive measurements were performed in 157 participants (median/min–max age: 13.1/6.0–18.0 years, 106 males) before and after mechanical load by squats at the same site of the medial femoral condyle by defined transducer positioning. Test–retest reliability was examined using Cronbach's α $\alpha $ calculation. Differences in cartilage thickness were analysed with respect to age, sex and type of practiced sports, respectively. Results: Excellent reliability was achieved both before and after mechanical load by 30 squats with a median cartilage thickness of 1.9 mm (range: 0.5–4.8 mm) before and 1.9 mm (0.4–4.6 mm) after mechanical load. Male cartilages were thicker (p < 0.01) before (median: 2.0 mm) and after (2.0 mm) load when compared to female cartilage (before: 1.6 mm; after: 1.7 mm). Median cartilage thickness was about three times higher in karate athletes (before: 2.3 mm; after: 2.4 mm) than in sports shooters (0.7; 0.7 mm). Cartilage thickness in track and field athletes, handball players and soccer players were found to lay in‐between. Sport type related thickness changes after mechanical load were not significant. Conclusion: Medial femoral condyle cartilage thickness in childhood correlates with age, sex and practiced type of sports. Ultrasound is a reliable and simple, pain‐free approach to evaluate the cartilage thickness in children and adolescents. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Objectives: The study aimed to investigate the diagnostic values of different musculoskeletal ultrasound (MSUS) signs, serum uric acid (SUA), and their combined detection for gouty arthritis (GA). Patients and methods: In this retrospective study, 70 patients (62 males, 8 females; mean age: 46.1±14.1 years; range, 25 to 86 years) diagnosed with GA (the GA group) between August 2022 and March 2023 and 70 patients (54 females, 16 males; mean age: 49.0±14.1 years; range, 21 to 75 years) diagnosed with rheumatoid arthritis and osteoarthritis during the same period (the non-GA group) were included. The positive rate of MSUS signs and SUA in both groups was recorded to compare the differences. The correlations of MSUS signs and SUA with GA were analyzed using Spearman's rank correlation analysis. The diagnostic values of different MSUS signs, SUA, and their combined detection for GA were analyzed using a receiver operating characteristic, the area under the curve (AUC), sensitivity, specificity, and the Youden index. Results: The positive rate of the double contour (DC) sign (chi-squared [Χ²]=102.935, p<0.001), hyperechoic spots (Χ²=56.395, p<0.001), bone erosions (Χ²=10.080, p<0.001), and SUA (Χ²=41.117, p<0.001) were higher in the GA group than in the non-GA group. The positive rate of the DC sign (rs=0.829, p=0.001), hyperechoic spots (rs=0.631, p<0.001), bone erosion (rs=0.268, p=0.001), and SUA (rs=0.542, p<0.001) were positively correlated with GA. Among the single-indicator measures, the DC sign exhibited the highest diagnostic value (AUC=0.907, sensitivity=81.4%, specificity=100%, p<0.001). Among the combined-indicator measures, the DC sign combined with SUA exhibited the highest diagnostic value (AUC=0.929, sensitivity=91.4%, specificity=94.3%, p<0.001), higher than DC sign detection alone. Conclusion: The DC sign combined with SUA yielded a high diagnostic value and can thus provide a reliable basis for effectively and efficiently diagnosing GA. [ABSTRACT FROM AUTHOR]

This study compares the acute effects of a static stretching and a warmup protocol on the active and passive shear modulus of the hamstring muscles. Muscle shear modulus was assessed at rest and during isometric contractions at 20 % of maximal voluntary isometric contraction (MVIC). After stretching, the passive shear modulus pattern was not altered, while at 20 % MVIC the biceps femoris short head (BFsh) and semimembranosus showed a shear modulus increase and decrease, respectively, which resulted on BFsh-SM pair differences (pre: 3.8 ± 16.8 vs. post: 39.3 ± 25.1 kPa; p < 0.001; d = 1.66) which was accompanied by a decrease of 18.3 % on MVIC. Following the warmup protocol, passive shear modulus remained unchanged, while active shear modulus was decreased for the semitendinosus (pre: 65.3 ± 13.5 vs. post: 60.3 ± 12.3 kPa; p = 0.035; d = 0.4). However, this difference was within the standard error of measurement (10.54 kPa), and did not impact the force production, since it increased only 1.4 % after the warmup. The results of this study suggest that the passive and active shear modulus responses of the individual hamstring muscles to static stretching are muscle-specific and that passive and active hamstring shear modulus are not changed by a standard warmup intervention. [ABSTRACT FROM AUTHOR]

To assess synovitis and disease activity by musculoskeletal ultrasound (MSUS) and clinical examination in children with juvenile idiopathic arthritis (JIA). Forty-one JIA patients underwent clinical examination of the joints, juvenile arthritis disease activity score (JADAS-27) assessment, and laboratory investigations. Twenty-four joints for each patient were evaluated by MSUS, including knees, wrists, 10 proximal interphalangeal, and 10 metacarpophalangeal. The parameters evaluated were synovial effusion, hypertrophy, effusion plus hypertrophy, tenosynovitis, and subclinical synovitis based on the Outcome Measures in Rheumatology definitions. The mean age of children was 11.7 ± 3.2 years, the disease duration was 4.2 ± 2.6 years and they were polyarticular (n = 22), oligoarticular (n = 12), systemic onset (n = 6) and one had ERA. They were 29 females and 12 males. The mean JADAS27 was 7.7 ± 6.9. The total number of joints assessed clinically and by MSUS was 984. 107 (10.9 %) joints showed clinical findings, while 135 (13.7 %) showed ultrasonographic features of synovitis. On clinical examination, 17 (15.9 %) joints had limited range of motion, and 90 (84 %) joints were tender including 38 (35.5 %) swollen. On MSUS examination, 28 (20.7 %) joints showed synovial effusion, 79 (58.5 %) hypertrophy, and 28 (20.7 %) had both synovial effusion and hypertrophy. Power Doppler signals were detected in 27 joints. MSUS detected subclinical synovitis in 60 (6.1 %) joints. Synovial effusion plus hypertrophy showed moderate concordance with joint swelling (k = 0.42). The MSUS examination has a significant role in the detection of synovitis and the evaluation of disease activity in JIA patients. It is more sensitive than clinical examination. [ABSTRACT FROM AUTHOR]

Objective. The journey to a diagnosis of spondyloarthritis (SpA) can be difficult for women, who often experience delays in receiving the correct diagnosis as their symptoms are frequently misinterpreted due to other conditions like osteoarthritis, fibromyalgia, or other psychosomatic disorders. The purpose of this article is to examine the challenges in the diagnosis of SpA in women and the possible role of musculoskeletal ultrasound in early diagnosis and in avoiding misdiagnosis. Methods. We have performed a narrative review of the currently available literature on the subject. Results. The complexity of diagnosing SpA in women is compounded by the misconception that the disease predominantly affects men. To facilitate early diagnosis and prevent misdiagnosis, it is crucial not to overlook gender differences in the clinical presentation of SpA. Since women have more peripheral and enthesitic involvement, performing an ultrasound of entheses, tendons, and joints in women with musculoskeletal symptoms that could refer to SpA may help both in the early and differential diagnosis. Conclusions. There is a need to increase awareness among physicians of the existence of a different clinical presentation of SpA between men and women. The use of musculoskeletal ultrasound, which allows the detection of even subclinical inflammation and structural damage since early disease at the level of joints, tendons, and entheses can help make an early diagnosis and avoid misdiagnosis. Early diagnosis and timely treatment of SpA are crucial to reducing irreversible damage.

Abstract Background Rheumatoid arthritis (RA) is a chronic, inflammatory joint condition characterized by overproduction of pro-inflammatory cytokines. We aimed to assess TNF-α levels in both serum and synovial fluid in effusive knees in RA patients and find out if synovial fluid levels correlate with ultrasound (US)-detected local knee inflammatory and/or destructive changes in these patients. Results This study included 40 patients (20 with RA, 10 with systemic lupus erythematosus (SLE), and 10 with osteoarthritis (OA)) who had knee effusion (unilateral or bilateral) upon clinical examination. The mean age of RA patients was 48.4 years; most of them were females (80%), with a median (min–max) duration of knee effusion of 2 (1.5–3) months. Serum TNF-α was significantly higher in RA vs. non-RA and in OA cases (p = 0.052, 0.022, respectively), while in the synovial fluid, the difference was not statistically significant (3.73 ± 0.72 vs. 3.48 ± 0.58 U/ml, p = 0.252). Serum TNF-α at a cut point of > 3.24 U/ml can significantly discriminate RA from OA with 65% sensitivity and 90% specificity (AUC = 0.725, P = 0.018). There was no statistically significant correlation between synovial TNF-α and US parameters of the knee, either in RA or non-RA patients. Conclusions RA, OA, and SLE effusive joints share the presence of local articular joint inflammation, while systemic inflammation is more discriminative for RA patients regarding the level of TNF-α. The lack of correlation of TNF-α with ultrasonographic findings reflects the multifactorial complexity of these autoimmune diseases.

Xiaoyi Tang,1,2,&ast; Yijia Liu,1,2,&ast; Mengxin Zhao,3,&ast; Lei He,3 Jiahao Guo,3 Tian Wang,3 Wei Li,3 Jiaqi Zhao1 1Department of Ultrasound, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, 200434, People’s Republic of China; 2Department of Ultrasound, the Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital), Shanghai, 200003, People’s Republic of China; 3Department of Nanomedicine, Naval Medical University, Shanghai & School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, 200433, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Wei Li; Jiaqi Zhao, Email liwei@smmu.edu.cn; ultrasoundczzjq@163.comPurpose: This study aims to broaden the application of nano-contrast agents (NCAs) within the realm of the musculoskeletal system. It aims to introduce novel methods, strategies, and insights for the clinical management of ischemic muscle disorders, encompassing diagnosis, monitoring, evaluation, and therapeutic intervention.Methods: We developed a composite encapsulation technique employing O-carboxymethyl chitosan (OCMC) and liposome to encapsulate NCA-containing gold nanorods (GNRs) and perfluoropentane (PFP). This nanoscale contrast agent was thoroughly characterized for its basic physicochemical properties and performance. Its capabilities for in vivo and in vitro ultrasound imaging and photothermal imaging were authenticated, alongside a comprehensive biocompatibility assessment to ascertain its effects on microcirculatory perfusion in skeletal muscle using a murine model of hindlimb ischemia, and its potential to augment blood flow and facilitate recovery.Results: The engineered GNR@OCMC-liposome/PFP nanostructure exhibited an average size of 203.18± 1.49 nm, characterized by size uniformity, regular morphology, and a good biocompatibility profile. In vitro assessments revealed NCA’s potent photothermal response and its transformation into microbubbles (MBs) under near-infrared (NIR) irradiation, thereby enhancing ultrasonographic visibility. Animal studies demonstrated the nanostructure’s efficacy in photothermal imaging at ischemic loci in mouse hindlimbs, where NIR irradiation induced rapid temperature increases and significantly increased blood circulation.Conclusion: The dual-modal ultrasound/photothermal NCA, encapsulating GNR and PFP within a composite shell-core architecture, was synthesized successfully. It demonstrated exceptional stability, biocompatibility, and phase transition efficiency. Importantly, it facilitates the encapsulation of PFP, enabling both enhanced ultrasound imaging and photothermal imaging following NIR light exposure. This advancement provides a critical step towards the integrated diagnosis and treatment of ischemic muscle diseases, signifying a pivotal development in nanomedicine for musculoskeletal therapeutics.Keywords: ultrasonography, nanoscale contrast agent, nanotechnology, musculoskeletal ultrasound, photothermal imaging, microcirculatory perfusion

Abstract Introduction Point-of-care ultrasound (POCUS) can assist rheumatologists in monitoring disease activity, establishing diagnoses, and guiding procedural interventions. POCUS use has been increasing, but little is known about current use and barriers among rheumatologists. The purpose of this study was to characterize current POCUS use, training needs, and barriers to use among rheumatologists in practice. Methods A prospective observational study of all Veterans Affairs (VA) medical centers was conducted using a web-based survey sent to all chiefs of staff and rheumatology chiefs about current POCUS use, training needs, barriers, and policies. Results All chiefs of staff (n = 130) and rheumatology chiefs at VA medical centers (n = 95) were surveyed with 100% and 84% response rates, respectively. The most common diagnostic POCUS applications were evaluation of synovitis, joint effusion, tendinopathies, bursitis, and rotator cuff. The most common procedural applications were arthrocentesis and joint, bursa, and tendon injection. Most rheumatology chiefs (69%) expressed interest in training for their group. The most common barriers to POCUS use were lack of trained providers (68%), funding for training (54%), training opportunities (38%), funding for travel (38%), and ultrasound equipment (31%). Lack of POCUS infrastructure was common, and few facilities had POCUS policies (20%), image archiving (25%), or quality assurance processes (6%). Conclusion Currently, half of rheumatology groups use diagnostic and procedural ultrasound applications. Most rheumatology groups desire training, and lack of training and equipment were the most common barriers to ultrasound use. Deliberate investment is needed in ultrasound training and infrastructure for systematic adoption of POCUS in rheumatology. Graphical Abstract available for this article. Trial Registration NCT03296280. Graphical Abstract

Abstract Background Spondyloarthritis is a well-known chronic inflammatory disorder; despite recent advances, its genetic basis remains poorly understood. Recently, long non-coding RNA (H19) was identified to be associated with various human cancers and studied in some autoimmune diseases. Musculoskeletal ultrasound has been shown to have good sensitivity and specificity in detecting enthesitis. The Belgrade Ultrasound Enthesitis Score (BUSES) has recently been proposed as a comprehensive ultrasound enthesitis scoring system for differentiating between individuals with enthesitis associated with spondyloarthritis and those without spondyloarthritis. Aim The current work aimed to study the role of long non-coding RNA (H19) as a potential biomarker in axial spondyloarthritis and its relationship with the different disease parameters (clinical and laboratory), disease activity, and functional status as well as the relation between long non-coding RNA (H19) and articular manifestations using ultrasonographic assessment of enthesitis. Results Long non-coding RNA (H19) expression was statistically higher in axial spondyloarthritis patients than controls; there are no statistically significant correlations between long non-coding RNA (H19) relative expression and any of the listed parameters (ESR, CRP, ASDAS-CRP, BASDAI, BASFI, BASMI, BUSES, SPARCC index, mSASSS). As regards the Spearman correlation of Belgrade Ultrasound Enthesitis Score, it showed a statistically significant positive correlation with ASDAS-CRP, BASDAI, and BASMI (p value: 0.002, 0.02, and 0.046, respectively). Conclusion Both long non-coding RNA (H19) and Belgrade Ultrasound Enthesitis Score have good discriminative ability between patients with axial spondyloarthritis and normal population; this suggests a possible role in early diagnosis for patients with axial spondyloarthritis who do not fulfill ASAS classification criteria. Their role to monitor the disease activity still needs further studies to be established. Musculoskeletal ultrasound is much more accurate in the assessment of enthesis than clinical examination. Further studies are needed to study the correlation between ultrasonographic entheseal scores and activity markers either clinically or laboratory.

Purpose of reviewTo discuss the use of ultrasound for diagnosis and management of common pediatric musculoskeletal conditions through a case-based approach.Recent findingsUltrasound is an essential diagnostic modality in the early detection of developmental dysplasia of the hips and can be used as early as 6 weeks of age when the ossific nucleus has not developed yet. Ultrasound is helpful in diagnosing traumatic injuries such as fractures and intramuscular hematomas, can visualize fracture healing at early stages, and can also be used to guide aspiration of hematomas that can help with decreasing pain and faster recovery. Ultrasound is superior to radiographs in evaluating joint effusions and soft tissue infections or masses and is better tolerated by children compared to other imaging modalities such as magnetic resonance imaging (MRI). Ultrasound is an easily accessible, affordable, non-invasive, and radiation-free imaging modality that is well tolerated by children and their families. It can aid in the diagnosis and management of a wide variety of musculoskeletal conditions including developmental, traumatic, and infectious etiologies, as well as in the evaluation of superficial soft tissue masses.

Background: Rheumatoid arthritis (RA) is a chronic, inflammatory joint condition characterized by overproduction of pro-inflammatory cytokines. We aimed to assess TNF-α levels in both serum and synovial fluid in effusive knees in RA patients and find out if synovial fluid levels correlate with ultrasound (US)-detected local knee inflammatory and/or destructive changes in these patients. Results: This study included 40 patients (20 with RA, 10 with systemic lupus erythematosus (SLE), and 10 with osteoarthritis (OA)) who had knee effusion (unilateral or bilateral) upon clinical examination. The mean age of RA patients was 48.4 years; most of them were females (80%), with a median (min–max) duration of knee effusion of 2 (1.5–3) months. Serum TNF-α was significantly higher in RA vs. non-RA and in OA cases (p = 0.052, 0.022, respectively), while in the synovial fluid, the difference was not statistically significant (3.73 ± 0.72 vs. 3.48 ± 0.58 U/ml, p = 0.252). Serum TNF-α at a cut point of > 3.24 U/ml can significantly discriminate RA from OA with 65% sensitivity and 90% specificity (AUC = 0.725, P = 0.018). There was no statistically significant correlation between synovial TNF-α and US parameters of the knee, either in RA or non-RA patients. Conclusions: RA, OA, and SLE effusive joints share the presence of local articular joint inflammation, while systemic inflammation is more discriminative for RA patients regarding the level of TNF-α. The lack of correlation of TNF-α with ultrasonographic findings reflects the multifactorial complexity of these autoimmune diseases. [ABSTRACT FROM AUTHOR]

Background: The pericruciate fat pad (PCFP) in the knee joint is still insufficiently studied despite its potential role in knee pathologies. This is the first reported study which aimed to clarify the characteristics of the PCFP in healthy individuals and contrast them with cases of post-traumatic injuries. Methods: Conducted as a retrospective cross-sectional study (n = 110 knees each) following STROBE guidelines, it employed grayscale ultrasound with echogenicity measurement, compression elastography with elasticity measurement, and Color Doppler for blood flow assessment. Results: PCFP showed a homogenic and hyperechoic echostructure. The echogenicity of the PCFP was higher than that of the posterior cruciate ligament (PCL) (p < 0.001, z-score = 8.97) and of the medial head of gastrocnemius (MHG) (p = 0.007, z-score = 2.72) in healthy knees, but lower than subcutaneous fat (SCF) (p < 0.001, z-score = −6.52). Post-injury/surgery, PCFP echogenicity surpassed other structures (p < 0.001; z-score for PCL 12.2; for MHG 11.65 and for SCF 12.36) and notably exceeded the control group (p < 0.001, z-score = 8.78). PCFP elasticity was lower than MHG and SCF in both groups, with significantly reduced elasticity in post-traumatic knees (ratio SCF/PCFP 15.52 ± 17.87 in case group vs. 2.26 ± 2.4 in control group; p < 0.001; z-score = 9.65). Blood flow was detected in 71% of healthy PCFPs with three main patterns. Conclusions: The main findings, indicating increased echogenicity and reduced elasticity of PCFP post-trauma, potentially related to fat pad fibrosis, suggest potential applications of echogenicity and elasticity measurements in detecting and monitoring diverse knee pathologies. The description of vascularity variations supplying the PCFP adds additional value to the study by emphasizing the clinically important role of PCFP as a bridge for the middle genicular artery on its way to the inside of the knee joint. [ABSTRACT FROM AUTHOR]

Achilles tendon rupture is a common sports‐related injury which can carry significant morbidity to patients. Ultrasound remains the workhorse of imaging as it can confirm and localise the extent of Achilles tendon injury. The sonographic anatomy, both normal and ruptured sonographic appearances, as well as sonographic technique must be appreciated to accurately image and report findings, critical to patient management. Particular attention should be applied to the measurement of the diastasis between acutely ruptured tendon ends as this information can assist with informing the decision of conservative vs. operative management. Further work is necessary to standardise the measurement technique including correlating the degree of plantarflexion of the foot with the sonographic tendon gap measures. [ABSTRACT FROM AUTHOR]

Objective To evaluate the prevalence of clinical and US (grey-scale and Doppler) abnormalities in joints, periarticular structures and nails of children affected by skin psoriasis (PsO). Methods We conducted a cross-sectional study including consecutive children affected by PsO. A systematic clinical and US evaluation of joints, entheses, tendons and nails were performed by independent examiners blinded to each other's assessment. Results A total of 57 children [26 girls (46%)] with a mean age of 9 years (s. d. 4) were divided into two groups, asymptomatic (Asy, 42 children) and symptomatic (Sy, 15 children), according to musculoskeletal pain. Differences were observed between the two groups in relation to age [9 years (s. d. 3) vs 11 years (s. d. 4), P  < 0.05], PsO duration [2.4 years (s. d. 2.4) vs 5.4 years (s. d. 3.9), P  < 0.001], systemic treatment [23 (54.8%) vs 2 [13.3%], P  < 0.01], tender joint count [0 vs 12 children (80%), P  < 0.001], swollen joint count [0 vs 3 children (20%), P  < 0.01] and entheseal pain [0 vs 10 (66.7%), P  < 0.001] in Asy and Sy children, respectively. US evaluation showed statistically significant differences between the Asy and Sy groups for the presence of US abnormalities [16/42 (38%) vs 12/15 (80%)], synovitis [1/42 (2%) vs 4/15 (25%)] and enthesitis [4/42 (9.5%) vs 5/15 (33%)]. Three children in the Sy group were classified with juvenile PsA (JPsA). Conclusions US abnormalities were higher in the Sy group, with synovitis and enthesitis as the most prevalent findings. Asy patients were more frequently under systemic treatment. US and a systematic clinical evaluation are useful tools for detecting subclinical JPsA in children with PsO and musculoskeletal symptoms. [ABSTRACT FROM AUTHOR]

Introduction: The anatomy of the forefoot is complex, and the sonographic assessment to image the plantar digital nerves and exclude, diagnose or discriminate between a Morton's neuroma and intermetatarsal bursitis can be challenging. Topic description and discussion: A good appreciation of the sonographic anatomy, technique, normal and abnormal appearances is required to undertake a sonographic assessment of the forefoot and its interspaces, particularly the plantar digital nerves. This is unpacked in this paper with associated pictorial aids. Muscles, tendons, and ligaments of the interspaces and the nearby metatarsophalangeal joints and their associated soft-tissue structures are helpful sonographic landmarks to guide imaging and assessment of the common and proper plantar digital nerves and the intermetatarsal bursa. These need to be appreciated from both dorsal and plantar sonographic approaches, in both short- and long-axis imaging planes. Conclusion: Improved understanding of the anatomy and sonographic appearances of the interspace structures can enhance the sonographic assessment of the forefoot and improve diagnosis of a Morton's neuroma and/or intermetatarsal bursitis when present to guide patient management. [ABSTRACT FROM AUTHOR]

Hand impairment is a frequently reported complaint in systemic sclerosis (SSc) patients and a leading cause of disability and diminished quality of life. Managing hand pain can be particularly challenging due to the coexistence of non-inflammatory arthralgias, inflammatory arthritis, acro-osteolysis, tenosynovitis, joint contractures, tendon friction rubs, nerve entrapment, Raynaud's phenomenon (RP), digital ulcers (DU), sclerodactyly, calcinosis, and chronic pain. While physical examination and radiographs are the first line methods for evaluating hand pain, they are limited in scope and miss many underlying etiologies of hand impairment. We propose a joint ultrasound (US) hand protocol to differentiate between various articular, periarticular, ischemic, skin, and nerve pathologies and to assist in targeted treatment strategies. [ABSTRACT FROM AUTHOR]

Background: Spondyloarthritis is a well-known chronic inflammatory disorder; despite recent advances, its genetic basis remains poorly understood. Recently, long non-coding RNA (H19) was identified to be associated with various human cancers and studied in some autoimmune diseases. Musculoskeletal ultrasound has been shown to have good sensitivity and specificity in detecting enthesitis. The Belgrade Ultrasound Enthesitis Score (BUSES) has recently been proposed as a comprehensive ultrasound enthesitis scoring system for differentiating between individuals with enthesitis associated with spondyloarthritis and those without spondyloarthritis. Aim: The current work aimed to study the role of long non-coding RNA (H19) as a potential biomarker in axial spondyloarthritis and its relationship with the different disease parameters (clinical and laboratory), disease activity, and functional status as well as the relation between long non-coding RNA (H19) and articular manifestations using ultrasonographic assessment of enthesitis. Results: Long non-coding RNA (H19) expression was statistically higher in axial spondyloarthritis patients than controls; there are no statistically significant correlations between long non-coding RNA (H19) relative expression and any of the listed parameters (ESR, CRP, ASDAS-CRP, BASDAI, BASFI, BASMI, BUSES, SPARCC index, mSASSS). As regards the Spearman correlation of Belgrade Ultrasound Enthesitis Score, it showed a statistically significant positive correlation with ASDAS-CRP, BASDAI, and BASMI (p value: 0.002, 0.02, and 0.046, respectively). Conclusion: Both long non-coding RNA (H19) and Belgrade Ultrasound Enthesitis Score have good discriminative ability between patients with axial spondyloarthritis and normal population; this suggests a possible role in early diagnosis for patients with axial spondyloarthritis who do not fulfill ASAS classification criteria. Their role to monitor the disease activity still needs further studies to be established. Musculoskeletal ultrasound is much more accurate in the assessment of enthesis than clinical examination. Further studies are needed to study the correlation between ultrasonographic entheseal scores and activity markers either clinically or laboratory. [ABSTRACT FROM AUTHOR]

Aim of the study: Arthroscopy ranks among the frequently performed interventions in orthopedics. The aim of this study was to compare the palpation technique with the ultrasound technique for locating the dorsal glenohumeral joint space (JS) in shoulder joint punctures. Material and Methods: Participants inexperienced in ultrasound examinations were included. Palpatory and ultrasound finding of the joint space by the participants was performed according to current recommendations and was initially demonstrated by an instructional video. The ideal point (IP) was marked under ultrasound visualization by an experienced ultrasound examinator and shoulder–elbow surgeon. Furthermore, a corridor for a safe puncture was defined. The palpatorily determined point (pdP) was marked by the participants and evaluated by means of a coordinate system. The evaluation of the sonographically determined point (sdP) was performed similarly to that of the palpatory procedure. Results: Fifty-four participants were included in the study, and the mean length of work experience was 6.3 years. On average, participants had performed 16.5 punctures of the shoulder joint and 6.8 arthroscopies of the shoulder joint. The mean experience in performing sonographic examinations of the shoulder was 27.6 examinations. A total of 100 shoulder joints were examined (54 left, 46 right shoulders). The mean deviation from the ideal point (IP) for the palpatory approach was 17.1 mm with a maximum deviation of 59.5 mm; for the sonographic technique, the mean deviation was 10.3 mm (max. 30.2 mm). Overall, 22% of pdPs were within the defined corridor, while 42% of sdPs were within the target corridor. The average difference between palpatory and sonographic approaches was 9.0 mm in favor of the sonographic technique (max. 46.5 mm). A significantly greater deviation (p < 0.001) from the IP was observed with the palpatory approach than with the sonographic approach. Conclusion: Based on the results, the authors recommend ultrasound imaging of the shoulder joint as well as ultrasound-assisted punctures, especially for inexperienced users. Furthermore, training in ultrasound-assisted interventions should be implemented in future training curricula. [ABSTRACT FROM AUTHOR]

Musculoskeletal ultrasound (MSK-US) use for diagnostic purposes is expanding in physical therapy practice. Identifying and describing physical therapy-specific approaches to incorporating MSK-US into the evaluation process is needed. Musculoskeletal ultrasound extends the physical exam to allow clinicians to visualize anatomy and pathophysiology both statically and dynamically. Purpose: To document 1) weekly use of diagnostic MSK-US; and 2) clinical reasoning approach used in challenging patient cases by physical therapists (PTs) registered by Inteleos in musculoskeletal sonography (RMSK-certified). Longitudinal, observational, cohort study using mixed methods for data collection and analysis. All 23 currently RMSK-certified PTs using MSK-US in clinical practice across the United States were contacted, and 16 participated. Data were collected using an online survey created with the Research Electronic Data Capture System. Participants documented MSK-US clinical use and significant cases using weekly, reflective, online journals for three months. Demographic data were summarized using descriptive statistics. Case data were analyzed thematically. Participating RMSK-certified PTs performed 1110 MSK-US examinations over 110 weeks. Clinicians averaged 7 (range 1–25) MSK-US examinations weekly, representing 28% of an average caseload. Examinations contributed significant anatomical/ pathological information 100% of the time. The most common joints scanned were the knee (n = 281), shoulder (n = 254), and wrist (n = 228). Case data revealed three themes: 1) augmenting the clinical evaluation to extend or narrow a diagnosis; 2) outcomes guiding action; and 3) lessons learned from clinical findings. RMSK-certified PTs regularly used MSK-US to validate and refine their clinical diagnoses and treatment. Ultrasound imaging directly influenced patient care by informing the diagnostic process, guiding treatment, and appropriately identifying referrals. [ABSTRACT FROM AUTHOR]

Objectives Musculoskeletal ultrasound (MSUS) is increasingly used by rheumatologists in daily clinical practice. However, MSUS is only valuable in trained hands, and assessment of trainee competences is therefore essential before independent practice. Thus, this study aimed to establish validity evidence for the EULAR and the Objective Structured Assessment of Ultrasound Skills (OSAUS) tools used for assessing MSUS competences. Methods Thirty physicians with different levels of MSUS experience (novices, intermediates, and experienced) performed four MSUS examinations of different joint areas on the same rheumatoid arthritis patient. All examinations were video recorded (n  = 120), anonymized, and subsequently assessed in random order by two blinded raters using first the OSAUS assessment tool followed by the EULAR tool 1 month after. Results The inter-rater reliability between the two raters was high for both the OSAUS and EULAR tools, with a Pearson correlation coefficient (PCC) of 0.807 and 0.848, respectively. Both tools demonstrated excellent inter-case reliability, with a Cronbach's alpha of 0.970 for OSAUS and 0.964 for EULAR. Furthermore, there was a strong linear correlation between the OSAUS and the EULAR performance scores and the participants' experience levels (R2 = 0.897 and R2 = 0.868, respectively) and a significant discrimination between different MSUS experience levels (P  < 0.001 for both). Conclusions MSUS operator competences can be assessed reliably and valid using either the OSAUS or the EULAR assessment tool, thereby allowing a uniform competency-based MSUS education in the future. Although both tools demonstrated high inter-rater reliability, the EULAR tool was superior to OSAUS. Trial registration ClinicalTrials.gov , http://clinicaltrials.gov , NCT05256355 [ABSTRACT FROM AUTHOR]

Pronator syndrome is a median nerve entrapment neuropathy that can be difficult to diagnose due to its variable presentation and objective findings. Neurolymphomatosis is an uncommon disease in which malignant lymphocytes infiltrate central or peripheral nerve endoneurium and is often missed for prolonged periods prior to diagnosis. We present a rare case of pronator syndrome and anterior interosseous nerve palsy due to neurolymphomatosis that was occult on initial MRI in spite of the presence of a median nerve mass discovered intra-operatively during neurolysis. This case demonstrates the value of ultrasound for the examination of peripheral nerve pathology and illustrates its utility as an adjunct to MRI, in part due to the ability to screen a large region. [ABSTRACT FROM AUTHOR]

Purpose of Review: Knee osteoarthritis is a debilitating chronic disease affecting nearly half of the world's population at some point in their lives. Treatment of pain and loss of function associated with this disease has been limited. In this review, we seek to explore how neural interventions with ultrasound guidance may be an emerging option for non-pharmacologic pain relief in patients with knee osteoarthritis. Recent Findings: Cryoneurolysis techniques have been demonstrated to provide pain relief out to 150 days post-treatment in knee osteoarthritis in select individuals. There have also been studies of cryoneurolysis pre-operatively to total knee replacement providing reduced pain, reduced opioid use post-operatively, and shorter hospital length of stay. Cooled radiofrequency ablation (CRFA) has been demonstrated to significantly reduce pain, improve functionality, and reduce pharmacologic needs in knee osteoarthritis out to 2 years. Both interventions appear to have increased accuracy with ultrasound, and CRFA appears to be associated with improved patient outcomes. Summary: The research demonstrates the efficacy of both cryoneurolysis and cooled radiofrequency ablation in the treatment of knee osteoarthritis. Ultrasound guidance in neurolysis provides an additional tool with real-time, high-accuracy nerve localization. These therapies should be considered for certain patients to assist in pain management in the non-operative and post-operative phase of knee osteoarthritis management. Further research is needed to further define the long-term effects and the long-term utility of the techniques in knee pain. [ABSTRACT FROM AUTHOR]

Bowler's thumb is an uncommon traumatic neuropathy of the thumb ulnar digital nerve. We present a case of bowler's thumb in an individual who is an avid bowler, however, only manifesting following an unrelated injury. We describe the clinical and imaging findings, differential diagnostic considerations, and the treatment options. Knowledge of this entity and its sonographic features is important in order to identify this uncommon entity.

Ultrasound imaging is a vital imaging tool in musculoskeletal medicine, with the number of publications on ultrasound-guided surgery increasing in recent years, especially in minimally invasive procedures of sports, foot and ankle, and hand surgery. However, ultrasound imaging has drawbacks, such as operator dependency and image obscurity. Artificial intelligence (AI) and deep learning (DL), a subset of AI, can address these issues. AI/DL can enhance screening practices for hip dysplasia and osteochondritis dissecans (OCD) of the humeral capitellum, improve diagnostic accuracy for carpal tunnel syndrome (CTS), and provide physicians with better prognostic prediction tools for patients with knee osteoarthritis. Building on these advancements, DL methods, including segmentation, detection, and localization of target tissues and medical instruments, also have the potential to allow physicians and surgeons to perform ultrasound-guided procedures more accurately and efficiently. This review summarizes recent advances in ultrasound-guided procedures for musculoskeletal diseases and provides a comprehensive overview of the utilization of AI/DL in ultrasound for musculoskeletal medicine, particularly focusing on ultrasound-guided surgery.

We developed an intelligent assistance system for shoulder ultrasound imaging, incorporating deep-learning algorithms to facilitate standard plane recognition and automatic tissue segmentation of the rotator cuff and its surrounding structures. We evaluated the system's performance using a dedicated data set of rotator cuff ultrasound images to assess its feasibility in clinical practice. To fulfill the system's primary functions, we designed a standard plane recognition module based on the ResNet50 network and an automatic tissue segmentation module using the Mask R-CNN model. The modules were trained on carefully curated data sets. The standard plane recognition module automatically identifies a specific standard plane based on the ultrasound image characteristics. The automatic tissue segmentation module effectively delineates and segments anatomical structures within the identified standard plane. With the use of 59,265 shoulder joint ultrasound images, the standard plane recognition model achieved an impressive recognition accuracy of 94.9% in the test set, with an average precision rate of 96.4%, recall rate of 95.4% and F1 score of 95.9%. The automatic tissue segmentation model, tested on 1886 images, exhibited a commendable average intersection over union value of 96.2%, indicating robustness and accuracy. The model achieved mean intersection over union values exceeding 90.0% for all standard planes, indicating its effectiveness in precisely delineating the anatomical structures. Our shoulder joint musculoskeletal intelligence system swiftly and accurately identifies standard planes and performs automatic tissue segmentation. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the diagnostic value of musculoskeletal ultrasound measurements of subacromial bursa (SAB) thickness, supraspinatus tendon (SUP) thickness, acromiohumeral distance (AHD), and SUP‐to‐AHD ratio (AHD%) in patients with shoulder impingement syndrome (SIS). Methods: This was a prospective cross‐sectional observational study. Thirty patients with SIS (60 shoulders) admitted between January 2019 and January 2020 were enrolled. The SUP thickness, SAB thickness, AHD, and AHD% (calculated as AHD% = [(SUP / AHD) × 100%]) were measured in 60 shoulders using musculoskeletal ultrasound. Results: The affected shoulder displayed thicker SUP and SAB (t = 7.838), narrower AHD (t = 2.324), and larger AHD% (t = 6.875) than the unaffected shoulder (P <.05). The SUP thickness showed a linear positive correlation with AHD (r =.503) and AHD% (r =.792) in the affected shoulder (P <.05). On receiver operating characteristic analysis, AHD*AHD% showed the best diagnostic performance in both measurements (area under the curve: 0.877). Conclusion: This study revealed that SIS symptoms may be related to a larger AHD% with SUP thickening. As diagnostic criteria, the cut‐off values of AHD% (65.6%) and AHD*AHD% (0.504) have good sensitivity and specificity and can help improve the differential diagnosis of patients with SIS. [ABSTRACT FROM AUTHOR]

Ultrasound is a useful modality for guiding injections and other procedures in the extremities. Its portability and the ability to adjust the probe and needle in real time, as well as lack of radiation exposure make it preferable for many routine procedures. However, ultrasound is highly operator dependent and a firm understanding of regional anatomy is important, including neurovascular structures that are in close proximity during many of these procedures. Knowledge of the characteristic location and appearance of neurovascular structures in the extremities allows safe needle advancement and prevention of iatrogenic complications. [ABSTRACT FROM AUTHOR]