Musculoskeletal Ultrasound

Truth in medicine is an unattainable goal, and the art as described in books is far beneath the knowledge of an experienced and thoughtful physician. Rhazes1 Persian physician 865-925 A.D.

Experience in medicine is achieved with relentless practice. Practice and attaining excellence may be facilitated by accumulating knowledge through learning from experts in their respective fields. Experience dominates the field of musculoskeletal ultrasound to which this issue of Seminars in Musculoskeletal Radiology is dedicated.

Musculoskeletal ultrasound is widely utilized outside the United States. It is being increasingly embraced by US academic radiology circles and slowly gaining popularity across all radiology practices. An abundance of literature on this subject in radiology, sports medicine, orthopedic, and rheumatology journals has put both radiologists and clinicians at ease with this modality. My colleagues and I repeatedly find musculoskeletal ultrasound a priceless adjunct to our diagnostic armamentarium. It is my honor to welcome a distinguished team of national and international experts to contribute articles to this issue.

Wrist and hand ultrasound is no longer a novelty with rheumatologists. At times it also provides an invaluable guidance to hand surgeons for preoperative planning. Drs. Tagliafico, Rubino, Autuori (Genoa, Italy), Bianchi (Chen-Bougeries, Switzerland), and Martinoli (Genoa, Italy) provide an extensive review of various pathologies affecting the hand and wrist.

The majority of elbow joint tendons and ligaments are superficial, thus readily accessible for evaluation with ultrasound. Drs. Tran (San Jose, California) and Chow (Los Angeles, California) provide an excellent insight into different elbow disorders amenable to ultrasound examination.

Shoulder ultrasound in particular has proven to be an excellent choice for diagnosis of rotator cuff pathologies. Dr. Kolla (Brooklyn, New York) and I attempt to familiarize the reader with shoulder specific examination techniques, while providing examples of common pathologies.

Ultrasound has a long tradition in diagnostic work-up of hip pathologies in pediatric population. While tackling various hip pathologies in children, Drs. Bancroft, Merinbaum, Zaleski, Peterson, Kransdorf, and Berquist (Jacksonville, Florida) continue with an exhaustive review of adult hip disorders in their article.

Knee MRI has been the mainstay of musculoskeletal imaging. In early subtle stages of various pathologies about the knee joint, ultrasound can help the radiologist hone down to the area of interest. This is demonstrated in the comprehensive article provided by Drs. Lee (Burbank, California) and Chow (Los Angles, California).

The next article deals with the ankle and foot. Drs. Khoury, Guillin (Montreal, Canada), Dhanju (North York, Canada), and Cardinal (Montreal, Canada) take a broad approach to ultrasound of foot and ankle, providing a masterful review on this subject. This article contains ample imaging examples, while discussing the myriad of pathology in this region.

Traditionally muscle injuries have been studied with MRI in the United States. However, ultrasound has been successfully utilized around the world for diagnosis of muscle injuries, especially in athletes. Drs. Koh and McNally (Oxford, Great Britain) provide an in-depth analysis of this subject with incredible images that speak for themselves.

Ultrasound has often been used as the initial examination in the evaluation of soft tissue masses or collections. The pathologies encountered are numerous and ultrasound can offer invaluable additional diagnostic information. Drs. Smith (Baltimore, Maryland), Salanitri, and Lisle (Brisbane, Australia) explore the role of ultrasound in evaluating various “lumps and bumps” of the body. This article stands out as a result of its impressive array of impeccable images.

In the last article, we share our enthusiasm for using ultrasound in guidance of a multitude of musculoskeletal interventions. Drs. Joines, Seeger, DiFiori, and I (Los Angeles, California) discuss the value of ultrasound for guidance of various musculoskeletal interventions.

I would like to thank Dr. David Karasick and Dr. Mark Schweitzer for their generous invitation to guest edit this issue of Seminars in Musculoskeletal Radiology, and all my esteemed colleagues for their remarkable contributions.

1 Walsh JJ. Medieval medicine. New York, NY: Fordham University Press; 1911:115-116.