Musculoskeletal Imaging in Physical Therapist Practice

Abstract

This article presents an overview of current concepts of evidence-based diagnosis using a variety of imaging modalities for a broad spectrum of musculoskeletal conditions and syndromes. There is limited but increasing evidence that physical therapists appropriately use diagnostic studies in clinical practice. Pathology revealed by diagnostic studies must be viewed in the context of the complete examination, as pathology is common in the asymptomatic population. Special Key Words: clinical decision rule, diagnosis, diagnostic imagingD iagnostic imaging is an important tool for the differential diagnosis of many musculoskeletal conditions. Physical therapists working in direct access roles are assuming greater diagnostic responsibility. The role of musculoskeletal imaging in physical therapist practice is therefore becoming increasingly important.127 Availability of diagnostic studies to physical therapists may vary greatly depending upon many factors within the practice setting. US Army physical therapists functioning as direct access providers have long held privileges for ordering imaging studies and laborator y tests considered essential to their diagnostic role. 7,12,43,47,48 Physical therapists who do not have the privilege to order imaging studies, especially with the greater direct access role conferred to physical therapists, should still be familiar with the indications and role of diagnostic radiology. In these situations, physical therapists should establish the proper professional interactions with individuals who can facilitate ordering necessary imaging studies. The Evidence Regarding the Use of Musculoskeletal Imaging Studies by Physical TherapistsThere is limited but increasing evidence that physical therapists appropriately use diagnostic studies in clinical practice. A study comparing the care administered by physical therapists with orthopaedic surgeons in the primary management of musculoskeletal problems determined that the physical therapists were most cost effective, with no

Musculoskeletal imaging authority, levels of training, attitude, competence, and utilisation among clinical physiotherapists in Nigeria: a cross-sectional survey

“…Also, the current study found some notable MI practices among the participants such as screening the patients with appropriate CDC before MI referral. The use of the CDC, including the American College of Radiology Appropriateness Criteria, are foundations for deciding on the appropriateness of ordering an MI procedure [ 30 – 32 ]. Moreover, some participants often reviewed the printed images before applying the accompanying report.…”

“…Moreover, some participants often reviewed the printed images before applying the accompanying report. Although radiologists are responsible for reporting diagnostic imaging, it is recommended that physiotherapists juxtapose the films, DIR, medical history, and physical examination for comprehensive assessment [ 30 ]. The current authors align with scholars who posit that MI should not be misconstrued as an alternative to detailed medical history and clinical examination [ 3 , 8 , 30 , 31 ]; rather, it should be used as an adjunct for broadening clinical assessment and decision-making.…”

An evaluation of the nature and level of musculoskeletal imaging training in physiotherapy educational programmes in Nigeria

“…For instance, ultrasound scanning (USS) has moved from the radiology suite to point-of-care, where physiotherapists can perform real-time diagnostic musculoskeletal sonography [7,8]. Magnetic resonance imaging (MRI) scans are useful when examining subtle musculoskeletal pathologies such as stress fractures, which may have consequences for a physiotherapy plan of care [9]. Also, information from dual-energy X-ray absorptiometry (DEXA), scintigraphy and computed tomography (CT) scans can be used for risk assessment to rule out red flags that may contraindicate the use of some physiotherapy modalities [9,10].…”

“…The physiotherapy programme accreditation standards in the USA and Nigeria now include specific criteria related to diagnostic imaging [2,15]. Therefore, training in MI procedures such as radiography (X-ray), CT scan, MRI, scintigraphy, USS, and DEXA has become relevant for entry-level physiotherapy programmes to prepare students for direct-access practice [9,15].…”

Functional exercise after total hip replacement (FEATHER) a randomised control trial

“…Recently real time ultrasound imaging has been utilized as an accurate and reliable means of measuring muscle parameters in a non invasive manner [15,16]. Ultrasound imaging is a fast and inexpensive tool that produces excellent images of the musculoskeletal system without the need for radiation [17]. …”