American Medical Society for Sports Medicine (AMSSM) Position Statement: Interventional Musculoskeletal Ultrasound in Sports Medicine

Abstract

The use of diagnostic and interventional ultrasound has significantly increased over the past decade. A majority of the increased utilization is by nonradiologists. In sports medicine, ultrasound is often used to guide interventions such as aspirations, diagnostic or therapeutic injections, tenotomies, releases, and hydrodissections. This American Medical Society for Sports Medicine (AMSSM) position statement critically reviews the literature and evaluates the accuracy, efficacy, and cost-effectiveness of ultrasound-guided injections in major, intermediate, and small joints, and soft tissues, all of which are commonly performed in sports medicine. New ultrasound-guided procedures and future trends are also briefly discussed. Based upon the evidence, the official AMSSM position relevant to each subject is made.

Ultrasound-guided hip joint injections are more accurate than landmark-guided injections: a systematic review and meta-analysis

“…A recent position statement by the American Medical Society for Sports Medicine systematically reviewed the literature for US-guided and landmark-guided injections of major (including hip joints), intermediate and small joints; and soft tissues 6. They categorised studies using the scale published by the Journal of Bone and Joint Surgery 20.…”

“…Although a recent position statement reviewed the literature for the accuracy of landmark-guided and US-guided hip injections, no paper has systematically reviewed the literature and performed a meta-analysis of the available literature 6. As no current studies have directly compared landmark to US guidance, the aim of this study was to identify studies that assessed accuracy of either technique using an accepted gold-standard (fluoroscopic contrast, CT contrast, MRI arthrogram, or direct visualisation of injectate during surgery).…”

Are Blind Injections Ethical or Historical?

“…US guided) as regards the treatment outcome might be considered as contradictory, there is no discussion on the better targeting of tissues/ pathologies. 3 Apart from the discussion regarding the comparison of these two techniques (Table 1), during our interventional physiatry practice, we have noticed that US imaging has also a significant contribution at the decision-making step of an intervention. Accordingly, in this commentary, we aimed to highlight how US imaging can modify/ameliorate the musculoskeletal interventions.…”

Interventional ultrasound beyond the classical abdominal applications. Are guidelines for other applications urgent needed?

“…Interventional ultrasound has extensively widening its applications over the last years in many other fields (thyroid and other head and neck lesions like salivary glands tumors, soft tissue tumors, thorax lesions, musculoskeletal -MSK interventions, breast, obstetrics and gynecology, cardiology, anesthesiology, or intensive care medicine) [3][4][5][6][7][8][9][10]. A part of these interventions are performed by the interventional US physicians, mainly those with internal medicine specialty or by interventional radiologists (IRs) trained to perform INVUS [11].…”

“…Some of the non-abdominal applications of INVUS may be considered specialty-oriented interventions like MSK interventions in rheumatology and sports medicine, diagnostic and therapeutic procedures in obstetrics&gynecology, cardiology and specific interventions in anesthesiology&intensiv care medicine [6,7,[9][10][11]. Regarding education, the training in INVUS in those fields should be part of a more complex US formation (usually with 3 levels of expertise) and may be included in the residency/fellowship programs.…”