Caring Medical - Where the world comes for ProlotherapyMusculoskeletal Ultrasound

Our centers in Florida and Illinois are utilizing musculoskeletal ultrasound to allow us to effectively visualize and diagnose various musculoskeletal conditions and efficiently treat one joint or multiple joints with Prolotherapy immediately thereafter in cases that warrant this type of technology.

ross hauser ultrasoundConcomitantly diagnosing and treating injured and degenerated joints is an added bonus in particular aspects of patient care. The use of ultrasound at Caring Medical will not replace palpation of the painful joint and the clinical examination, but will be used as a tool to compliment the expertise at hand. Ultrasound guidance can be used before treatment to assess and diagnose, during treatment to inject directly into the injured joint structures, and after treatments-once repair has occurred- to document the successful healing outcomes.

We are using the SonoSite ultrasound system, a lightweight, portable point-of-care ultrasound machine, originally created in 1980 for the Department of Defense, as a durable and efficient battlefield unit. The use of ultrasound imaging began in the 1950’s, and was first applied in musculoskeletal medicine in 1972.1 Ultrasound imaging of musculoskeletal structures has continued to advance. The portable high-resolution ultrasound machines, compared to the rather large and cumbersome conventional machines, have allowed for wide access for use in various types of clinics, beyond the traditional context of hospitals and radiology centers. The progress of ultrasound technology includes increased image quality in these laptop-sized machines, as well as lowered pricing for affordability for the average practitioner.With these advances, the ultrasound machine can be brought directly to the patient!

What is Ultrasound?

Ultrasonography is an imaging modality that uses high frequency sound waves, which normally cannot be heard by human beings, to visualize internal structures of the body. “Ultrasound travels as sound waves, and images are generated when pulses of ultrasound from the transducer produce echoes at tissue or organ boundaries. Between pulse transmissions, the transducer serves as a detector of echoes, which are processed to form an anatomic image.”2 The waves are recorded and made into images, allowing us to visualize structures such as tendons, muscles, ligaments, and more. “Interpretation of the ultrasound images depends on the echogenicity: the brightness of the image, depending on the degree of reflection in the ultrasound waves. The images are also described in terms of the plane on which the sonogram is viewed, which is usually longitudinal or transverse in relation to the structure scanned.”2

ultrasound.shoulder tear-1The benefits of using Ultrasound in treating chronic pain

Ultrasound is attractive to patients because of its safety! It is non-invasive, painless, convenient, cost-effective, and free of radiation! Other benefits include:

Potential to show documented improvement in soft tissue injuries and track patient objective outcomes from Prolotherapy treatments utilizing before and after images.

Documents musculoskeletal pathology. Studies suggest that ultrasound is the primary imaging technique for soft tissue injuries.2

Sensitivity in diagnosing rotator cuff injuries.

“Rotator cuff disease is common and is one of the most common reasons for using ultrasound. Many studies report excellent sensitivity and specificity of ultrasound in diagnosing rotator cuff tears.”2

Ultrasound diagnosis and treatment aid in Tendon degeneration and tears.

Tendon degeneration on ultrasound is seen as irregularities of fibrillar appearance, such as thickening and fragmentation, focal hypoechoic areas, and calcifications.

“Dynamic imaging deserves special emphasis because it is useful in differentiating full-thickness from partial-thickness tendon tears, muscle tears, and tendon and nerve subluxations or dislocations.”3

Accurately visualize and diagnose tendon tears of the upper and lower extremities.

For example, studies reported an accuracy of 94% when ultrasound was used to diagnose tendon tears of the ankle.3

Reveals altered anatomy after surgery. In many post-surgical cases, a patient’s anatomy may be altered slightly. Ultrasound is effective for evaluation of soft tissue near metal hardware, which may include metal screws, plates, etc.

ultrasound.ankle tearIn certain instances, anatomy is relocated, such as in the case of the ulnar nerve in the elbow, which may be relocated as part of the surgery. Ultrasound can help visualize the altered anatomy so as to avoid transposed nerves or metal structures. “Ultrasound applications are not limited to, but include evaluation of peripheral nerves, evaluation for soft-tissue foreign bodies, evaluation of soft-tissue abnormalities adjacent to hardware.”3

Monitor needle positioning during the injection procedure.  For example, injections into joints such as the hip, as well as soft tissue injections into the tendons, ligaments and other joint structures.

CostSelective substitution of musculoskeletal ultrasound for MRI can result in significant cost saving to the health care system.”3

Ultrasound can be performed during motion. Unlike an MRI, ultrasound can be performed on a patient while joints are in motion. In cases of shoulder impingement, for example, a patient may only have pain with certain motions and none at rest. Ultrasound can help visualize what happens with the tissue during motion. “The main advantages are its ability to perform dynamic examinations and to conduct side-to-side comparisons on the spot, allowing clinicians to correlate their patients’ symptoms directly with anatomic visualization.”3“Studies have shown ultrasound to be accurate in the diagnosis of conditions that require joint movement or positioning to display the abnormality, such as peroneal tendon subluxation in the ankle (100% positive predictive value). Such diagnoses are not possible or are difficult with routine MRI.”3

Assists in performing hydro-dissection of nerves. Rarely, a patient presents with a chronic pain condition that relates solely to nerves. However, in such cases, ultrasound allows practitioners to hydro-dissect affected nerves (this involves administering small amounts of fluid around a nerve to help free it up from surrounding tissue) to help ease chronic pain.“Ultrasound evaluation for peripheral nerve abnormalities, such as nerve entrapment disorders and nerve dislocation, is now common at many institutions as part of musculoskeletal imaging.” 3

Are there any disadvantages to using Ultrasound?

The main disadvantages are operator dependence. The same holds true for MRI, X-ray and any other diagnostic tool. Ultrasound must be used as an adjunct to treatment. Palpation, physical exam, patient history and practitioner experience are paramount.

 Ultrasound guided joint injections

ultrasound danielle ankle1Ultrasound allows us to visualize musculoskeletal tissue. We can visualize the injured tissue right in the office without having to wait for an MRI. During treatment, we can inject the injured structures and maintain continued needle visualization of the targeted areas.

Ultrasound guided treatment is not used on every patient. Caring Medical has been a practicing Prolotherapy clinic for over 50 years without the use of image guidance for injections. Dr. George Hackett used and taught the palpation guided technique included in his textbook in 1956 until the latest publication in 1991.4

The Prolotherapists at Caring Medical, along with many other physicians have been using this same treatment method. During this time, thousands and thousands of patients have had their pain levels improve dramatically without the addition of ultrasound. At Caring Medical, our success rate in using the palpation guided technique is about 88-92%.

The many benefits of ultrasound are noted above; however, we try to keep our Prolotherapy -related costs as low as possible. Any added cost can be a financial burden to patients, especially those who require many treatments or those who have multiple joints treated. In addition, patients not receiving insurance coverage for their treatments will have this added expense.

The decision to use ultrasound guidance is based on the needs of the individual patient and is not a rule for all.

As one of the largest Prolotherapy clinics in the world, we see a lot of the more complicated cases. People come to us in pain! They have frequently seen numerous physicians, received numerous procedures, tried multiple medications and have been subjected to one or multiple surgeries. Upon arrival to Caring Medical, these patients are oftentimes in worse condition then when they started their quest for pain relief. If their anatomy has been changed due to surgery, with ultrasound we can safely localize the altered anatomy, implants, screws and rods, and then treat the injured or degenerated joint(s).

ultrasound. shoulder.dsUltrasound allows visualization of pathology during motion. This means that we can watch the ligaments and tendons around the joint through ultrasound as you move. Take a ball player for example. They may only feel discomfort when they throw the ball or with overhead movements, but have no pain at rest. With ultrasound, the patient can perform the motion that elicits the pain, while we visualize the joint and joint structures. This allows us to see directly and immediately, any changes that occur in the anatomy during the motion that exhibits pain. We can then treat the visualized musculoskeletal condition with Prolotherapy.

As you know, the Prolotherapists at Caring Medical do not rely on MRIs or other imaging. However, in certain cases imaging may be deemed necessary. Some patients may not be able to get an MRI due to metal implants in their body. If someone has a metal implant from a previous surgery, we can still perform ultrasound to help visualize the pathology without risk of dislodging the implant. Also, in complicated cases, imaging may be advantageous. Having the availability of ultrasound is a valuable option.

How does ultrasound compare to MRI?

knee.ultrasoundUltrasound has significant advantages over MRI, specifically in regards to dynamic imaging, or imaging while the joint is in motion. For example, we can evaluate external rotation in the shoulder to diagnose a tendon dislocation or arm elevation to diagnose an impingement or adhesive capsulitis. The elbow can be flexed to diagnose snapping triceps syndrome. Visualization of movement in the hip can diagnose snapping hip syndrome. Ultrasound imaging of the ankle can aid in diagnosing a tendon subluxation or tear.

References:

1.Kane D, Balint PV, Sturrock R, Grassi W. Musculoskeletal ultrasound—a state of the art review in rheumatology. Part 1: Current controversies and issues in the development of musculoskeletal ultrasound in rheumatology. Rheumatology. 2004; 43 (7): 823-828.

2.Lew HL, Chen CPC, Wang T-G, Chew KTL. Introduction to musculoskeletal diagnostic ultrasound: examination of the upper limb. Am J Phys Med Rehabil. 2007;86:310–321.

3.Jacobson JA. Musculoskeletal Ultrasound:Focused Impact on MRI.AJR 2009; 193:619–627.

4.Linetsky F, Torres F. An assessment on the ultrasound guided dextrose prolotherapy for persistent coccygeal pain: A case series and review of literature. Altern Integ Med. 2014; 3 (2): 155. doi:10.4172/2327-5162.1000155

How Can We Help You?
Contact Information:
First Name*:
Last Name*:
E-mail*:
Address:
City:
State/Providence:
Zip:
Country:
Phone:
How did you hear about us?
Are you looking for more information on our specialties?
I am interested in ProlotherapyI am interested in Stem Cell TherapyI am interested in Platelet Rich PlasmaI am looking for a potential alternative to surgeryI am interested in Digital Motion X-ray in Florida
Tell us more about your case:
Current diagnoses by another healthcare provider:
My primary medical concern I would like to inquire about*:
My current level of athletics and/or daily activities
(ie: marathon training, manual labor, etc..):
I am interested in an appointment at this location:
Oak Park, IllinoisFort Myers, Florida
as soon as possiblewithin a couple weekswithin 1-2 monthsnot sure
Please leave this field empty.

SEARCH
for your symptoms

Prolotherapy, an alternative to surgery

Were you recommended SURGERY?
Get a 2nd opinion now!

WHY TO AVOID:
★ ★ ★ ★ ★We pride ourselves on 5-Star Patient Service!Come see why patients travel from all
over the world to visit our clinics.
Current Patients
Become a New Patient

Chicagoland Office
715 Lake St., Suite 600
Oak Park, IL 60301
(708) 393-8266 Phone
(855) 779-1950 Fax
Southwest Florida Office
9738 Commerce Center Ct.
Fort Myers, FL 33908
(239) 303-4069 Phone
(855) 779-1950 Fax Fort Myers, FL Office
© 2017 | All Rights Reserved | Disclaimer
National Prolotherapy Centers specializing in Comprehensive Prolotherapy,
Stem Cell Therapy, and Platelet Rich Plasma.

Meet our Prolotherapy Doctors and check out our Prolotherapy research.