The first part of the guidelines and recommendations for musculoskeletal ultrasound, produced under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), provides information about the use of musculoskeletal ultrasound for assessing extraarticular structures (muscles, tendons, entheses, ligaments, bones, bursae, fasciae, nerves, skin, subcutaneous tissues, and nails) and their pathologies. Clinical applications, practical points, limitations, and artifacts are described and discussed for every structure. After an extensive literature review, the recommendations have been developed according to the Oxford Centre for Evidence-based Medicine and GRADE criteria and the consensus level was established through a Delphi process. The document is intended to guide clinical users in their daily practice.
The second part of the Guidelines and Recommendations for Musculoskeletal Ultrasound (MSUS), produced under the auspices of EFSUMB, following the same methodology as for Part 1, provides information and recommendations on the use of this imaging modality for joint pathology, pediatric applications, and musculoskeletal ultrasound-guided procedures. Clinical application, practical points, limitations, and artifacts are described and discussed for every joint or procedure. The document is intended to guide clinical users in their daily practice.
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Low back pain (LBP) occurs in various groups of the population, affects men and women equally, and is among the major reasons for rheumatological or orthopedic consultations. Its prevalence increases steadily with age and the rate of recurrence within one year could reach 44% [1]. Many imaging modalities are available to clinicians for evaluating LBP. The application of these modalities depends mainly on the working diagnosis, the urgency of the clinical problem, the availability, and the comorbidities of the patient [2]. Conventional radiography (CR) and computerized tomography (CT) are associated with radiation exposure and show primarily the bony elements of the lower back. Their widespread use in the 20th century might be among the reasons why paraspinal soft tissues have somehow been neglected as a cause for LBP [1]. Magnetic resonance imaging (MRI) shows both bony and soft tissue structures in the axial skeleton, but its use is hampered by the duration of the examination, its relatively high costs, its limited availability (mainly in the tertiary centers) and the contraindications for this diagnostic modality [2].Musculoskeletal ultrasound (US) is a safe, fast, inexpensive, and widely available imaging modality that is very well tolerated by patients [3]. It allows multiplanar and dynamic examinations of the musculoskeletal system and can show the soft tissues in great anatomical detail. US is used by a growing number of physicians and the list of its applications in rheumatology and orthopedics is growing [4].Therefore, the question of the possible diagnostic application of US in such a common condition as LBP is very relevant to the clinical practice. On one hand, this could decrease the radiation exposure associated with CR and CT, and reduce the costs paid for MRI. The effect could be even bigger in time, as LBP is frequently a chronic or recurrent disease [1]. On the other hand, by AbstractPatients with low back pain (LBP) frequently undergo various imaging studies in the pursuit of a more precise diagnosis. Ultrasound (US) has the advantage of being a widely available, multiplanar, fast and radiation-free diagnostic tool. Moreover, compared to most of the other imaging modalities, it is particularly efficient in the visualization and assessment of soft tissues. Consequently, the question about the possible diagnostic application of US in such a common pathology as LBP is very relevant to the clinical practice. For this reason, we performed a review of the literature on the diagnostic value of US in different conditions that could cause LBP. We hereby discuss available studies on the diagnostic application of US in spinal canal stenosis and disc herniation (probably of historical significance only), as well as in the pathology of soft tissue structures like the lumbar and pelvic ligaments, muscles and entheses, the thoracolumbar fascia and the sacroiliac joints (maybe of greater importance nowadays). The evidence for the diagnostic value of US is not equivocal, though promising for some of the causati...
Background Piriformis Syndrome is thought to account for about 5 to 10 percent of the cases of chronic low back and gluteal pain and could cause debilitating chronic suffering. However as at present there are no specific confirmatory tests, it remains mainly a diagnosis of exclusion. On the other hand musculoskeletal ultrasound is a rapidly developing imaging modality, particularly efficient in the evaluation of lesion in soft tissues. Objectives To study the piriformis muscles by sonography in patients with unilateral “nonspecific” chronic low back and gluteal pain, referred or not the thigh and in subjects without such complaints. The findings from the study were used to determine possible sonographic diagnostic features for the Piriformis syndrome. Methods We studied the piriformis muscles of 14 middle-aged patients (5 males, 9 females) with unilateral, regional chronic low back and gluteal pain of cause unidentified by clinical examination, conventional X-ray and routine laboratory tests. The contra lateral, non painful side of the same individuals as well as both piriformis muscles of another 12 adults (5 male, 7 female) of matching age, height and weight without such complaints served as control. Results Patients were examined in prone position. The thickness, echogenicity and structure of the muscle were evaluated by an ultrasound scan parallel to the long axis of the muscle. Then the smoothness of muscle gliding over the iliac bone was observed by dynamic scanning of the muscle while the unilateral hip was passively and repeatedly externally and internally rotated. The anterior-posterior thickness of the piriformis muscle measured by ultrasound varied widely between individuals: from 5.8 to 11.5 mm in males and from 4.4 to 9.6 mm in females probably reflecting the different level of physical conditioning. However the difference between the piriformis muscles in the same individual was neglect able: mean 0.51, maximum 1.34 mm. On the other hand there was significant asymmetry in size between painful and non-painful piriformis muscle in the same patient (in 13/14 subjects) with mean difference 3.98, maximal 10.4 mm. Regarding echogenicity and structure, painful muscles were more often hypoechogenic (10/14), than non-painful ones (4/38) and with buldging upper and lower margins (9/14), than non-painful (6/38). Dynamic scanning of the non painful muscles showed smooth movement of the muscle over the iliac bone in all subjects. On the other hand dynamic examination of 9 of the 14 painful muscles showed non smooth movements with catching and jumping of the inferior surface of the muscle over the iliac bone (signs of piriformis muscle impingement) with reduced distance between lower margin of the muscle and the iliac bone. That was only sonographic sign which correlated with the presence of positive tests for piriformis stressing in the given patient (FAIR and Pace tests were used). Conclusions Static and dynamic sonographic study of the piriformis muscle could be used to routinely evaluate patients wit...
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