Ultrasound Opens New Vistas in Rheumatology
Parents-to-be are no strangers to ultrasound, which enables miraculous views of their unborn children. But ultrasound has many other applications in the world of medicine.
UAB rheumatologist Laura B. Hughes, MD, MSPH, and UAB musculoskeletal radiologists, Matthew Larrison, MD, Philip Lander, MD and Carl Narducci, MD, use ultrasound to diagnose and treat patients suffering from such debilitating diseases as arthritis, rheumatoid arthritis, and gout.
“We find musculoskeletal ultrasound—referring to its application in imaging joints and soft tissues—to be a very useful tool in rheumatology,” says Dr. Hughes, who practices at The Kirklin Clinic and is a member of UAB’s Division of Clinical Immunology and Rheumatology. “It enables us to detect subtle changes in bones, tissues, and tendons that X-rays often can't detect as readily.”
One of the advantages of musculoskeletal ultrasound versus other imaging modalities such as CT or MRI is cost – it’s less expensive to perform. It also provides real-time feedback to patients and their doctors. The appeal of ultrasound doesn't end there, however. Unlike X-rays, MRI and CT scans, ultrasound enables patients to be repositioned during the procedure so doctors can hone in on specific areas that are causing pain. Moreover, the sound waves are non-invasive and pain-free. Another plus-factor: it does not involve ionizing radiation.
Some patients find the tightly confining “tube” of imaging devices such as MRIs too claustrophobic, but musculoskeletal ultrasound is performed in a standard clinic exam room and takes only a few minutes, depending on how many areas of the body are being imaged. The procedure itself is simple. After a gel is placed on the affected area, the physician gently moves a handheld instrument over the areas. Patients can see the images on a screen during the procedure.
The physician then interprets the images and provides that information to the referring physician so that appropriate therapy can be prescribed to lessen pain, inflammation, and help direct therapy.
For musculoskeletal problems, ultrasound offers the advantage of detecting subtle changes that are causing pain but might not be apparent through other imaging techniques—giving the doctor a head start on both diagnosis and initiation of medications.
Musculoskeletal ultrasound can also be used to guide needle injection of therapeutic medications into a specific joint or bursa in order to reduce pain and inflammation, as well as for needle aspiration of fluid from swollen joints. “We find this is particularly useful in obese patients or those with severe joint deformity where we have difficulty to knowing exactly where to place the needle without the use of ultrasound to guide us, “says Dr. Hughes. “Ultrasound is a very powerful adjunct in these situations.”
UAB Rheumatology consistently ranks among the top such programs in the nation, according to U.S.News & World Report.