Dramatically Increased Musculoskeletal Ultrasound Utilization From 2000 to 2009, Especially by Podiatrists in Private Offices

Sharpe, Richard E.; Nazarian, Levon N.; Parker, Laurence; Rao, Vijay M.; Levin, David C.

doi:10.1016/j.jacr.2011.09.008

Cited by 81 publications

(62 citation statements)

References 12 publications

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“…In a separate survey of 853 orthopaedists, 50% reported a perceived infection risk of one per 1000, and those who performed injections recalled 68 cases of postinjection infection [10]. The expanding use of ultrasound for injection guidance provide another variable for potential contamination [27]. This study had several limitations.…”

Section: Discussionmentioning

confidence: 91%

Does the Use of Ultrasound Affect Contamination of Musculoskeletal Injections Sites?

Sherman

Ferguson

Davis

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Therapeutic musculoskeletal injections require a clean or sterile skin preparation to minimize the risk of infections. Ultrasound guidance for this procedure requires the use of transmission gel in proximity to the injection site, and its effect on maintaining sterility is unknown. Questions/purposes We asked: (1) Does sterile ultrasound transmission gel increase skin contamination during therapeutic orthopaedic injections? (2) Does nonsterile gel application result in increased contamination? (3) Does a manufacturer-approved ultrasound probe disinfecting agent in the form of 17.2% isopropanol and 0.28% diisobutylphenoxyethoxyethyl dimethyl benzyl ammonium chloride wipes adequately decontaminate the ultrasound transducer? (4) Does 70% isopropyl alcohol effectively decontaminate skin for administration of musculoskeletal injections? Methods Twenty-six healthy volunteers in an outpatient orthopaedic clinical setting were recruited. The subjects' skin was prepared to simulate a therapeutic intraarticular shoulder injection under ultrasound guidance. Four skin swabs for culture from each subject were taken: one sample before preparation with isopropyl alcohol, one sample after skin preparation, one after simulated injection procedure with sterile ultrasound transmission gel using the transducer, and one after mock procedure with nonsterile ultrasound transmission gel. In addition, samples were taken from the nonsterile ultrasound transmission gel and the transducer for culture analysis. Aerobic and anaerobic cultures were incubated during a 5-day period for bacterial species identification. Results Sterile ultrasound gel use results in an increase in skin contamination (odds ratio [OR], 9; 95% CI, 1.4-57.1; p = 0.005). Compared with sterile gel use, application of nonsterile gel did not increase contamination proportion (OR, 1.1; 95% CI, 0.8-1.7; p = 0.56). All cultures from nonsterile gel were negative. None of the samples cultured directly from the ultrasound probe were positive for bacteria (0%). Skin preparation with 70% alcohol decreased the proportion of contamination when compared with unprepared skin (OR, 21.0; 95% CI, 3.1-142.2; p = 0.001). Conclusions Use of ultrasound probes and transmission gel results in greater contamination in simulated intraarticular injections of the shoulder. As such, sterile preparation of the entire injection field, including the

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Section: Discussionmentioning

confidence: 91%

Does the Use of Ultrasound Affect Contamination of Musculoskeletal Injections Sites?

Sherman

Ferguson

Davis

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Many of these prior studies have attempted to compare use between 2 physician groups based on Medicare billing data. 19,20 Criticism of this method has often centered on an inability to adequately assess the appropriateness of imaging use and on the failure of the method to account for the many complexities driving use, such as differences in disease severity between patient groups. Indeed, accurately evaluating the relationship between imaging self-referral and financial incentive is extremely challenging and would require consideration of a multitude of factors including patient populations, referral biases (specialist versus primary care), clinical setting (outpatient versus hospital), disease prevalence, variations in diagnostic standards (discordant "grading" of severity), differences in imaging protocols and equipment, and differences in terminology used by interpreting radiologists.…”

Section: Discussionmentioning

confidence: 99%

Physician Self-Referral and Imaging Use Appropriateness: Negative Cervical Spine MRI Frequency as an Assessment Metric

Amrhein

Paxton

Lungren

et al. 2014

AJNR Am J Neuroradiol

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“…Between 2000 and 2009, there was a 717% increase in the number of outpatient diagnostic MSK US studies, a majority of which were performed by non-radiologists 2. US can be used to diagnose disorders of bone, joints, tendons, muscles, ligaments, blood vessels and nerves as well as guide interventions such as aspirations, diagnostic or therapeutic injections, tenotomies, releases, hydrodissections and biopsies 3…”

Section: Introductionmentioning

confidence: 99%

American Medical Society for Sports Medicine (AMSSM) position statement: interventional musculoskeletal ultrasound in sports medicine

Finnoff

Hall

Adams³

et al. 2014

Br J Sports Med

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Background The use of diagnostic and interventional ultrasound has significantly increased over the past decade. A majority of the increased utilisation is by nonradiologists. In sports medicine, ultrasound is often used to guide interventions such as aspirations, diagnostic or therapeutic injections, tenotomies, releases and hydrodissections. Objective Critically review the literature related to the accuracy, efficacy and cost-effectiveness of ultrasoundguided injections (USGIs) in major, intermediate and small joints; and soft tissues. Design Systematic review of the literature. Results USGIs are more accurate than landmark-guided injections (LMGIs; strength of recommendation taxonomy (SORT) Evidence Rating=A). USGIs are more efficacious than LMGIs (SORT Evidence Rating=B). USGIs are more cost-effective than LMGIs (SORT Evidence Rating=B). Ultrasound guidance is required to perform many new procedures (SORT Evidence Rating=C). Conclusions The findings of this position statement indicate there is strong evidence that USGIs are more accurate than LMGI, moderate evidence that they are more efficacious and preliminary evidence that they are more cost-effective. Furthermore, ultrasound-guided (USG) is required to perform many new, advanced procedures and will likely enable the development of innovative USG surgical techniques in the future. BACKGROUND

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Dramatically Increased Musculoskeletal Ultrasound Utilization From 2000 to 2009, Especially by Podiatrists in Private Offices

Cited by 81 publications

References 12 publications

Does the Use of Ultrasound Affect Contamination of Musculoskeletal Injections Sites?

Does the Use of Ultrasound Affect Contamination of Musculoskeletal Injections Sites?

Physician Self-Referral and Imaging Use Appropriateness: Negative Cervical Spine MRI Frequency as an Assessment Metric

American Medical Society for Sports Medicine (AMSSM) position statement: interventional musculoskeletal ultrasound in sports medicine

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