Musculoskeletal ultrasound (MSK US) has emerged as a powerful tool that is advancing pediatric sports medicine. Its noninvasive nature, real-time imaging capabilities, and portability make it invaluable for injury assessment and treatment planning. Let’s delve into some key points:
- Utility in Sports Medicine: The American Medical Society for Sports Medicine (AMSSM) developed a recommended MSK US curriculum for sports medicine fellows in 2010 to help guide programs towards adequate training during their fellowship to meet the requirements of competency outlined by the American Institute of Ultrasound in Medicine (AIUM) Training Guidelines for the Performance of MSK US Examination. This was later revised in 2015 and it was where the term “sports ultrasound” was first introduced to reflect the use of ultrasound by sports medicine physicians for both musculoskeletal and non-musculoskeletal indications. Since then, sports US has become nearly ubiquitous in sports medicine clinics, training rooms, and at sporting events across the country. Finally, in 2017, ultrasound training was formally added to the Accreditation Council for Graduate Medical Education (ACGME) core program requirements for sports medicine fellowships, including pediatric-based programs.
- Pediatric Considerations: Skeptics may argue that ultrasound isn’t necessary for evaluating musculoskeletal (MSK) complaints in children, assuming they don’t experience the same amount of pathology as adults. However, as a pediatric sports medicine physician with a decade of ultrasound experience, I can attest that children do encounter similar MSK issues. Children exhibit both common MSK conditions (like tendinosis, ligament tears, muscle injuries, effusions, and fractures) and unique ones related to their growing skeletons (like osteochondral defects, Salter Harris injuries, apophysitis, and avulsion fractures). MSK US can play a role in evaluating all of these conditions at the point of care.
- Beyond Pediatric Sports Medicine: MSK Ultrasound is a valuable tool that extends beyond pediatric sports medicine as well. It is widely used in rheumatology clinics, where it helps diagnose conditions like synovitis, arthritis, and enthesitis. Emergency physicians can quickly identify joint effusions and dislocations, full-thickness tendon tears, and fractures, influencing acute management decisions. General pediatricians can benefit from MSK ultrasound, too, and this is not just ordering ultrasounds to rule out hip dysplasia in infants. Simple questions—like distinguishing between solid versus cystic soft tissue masses and assessing joint effusions—can guide primary care clinicians. When families seek answers about their child’s condition and treatment options, especially “How can we get them back to sports safely?” time is of the essence and point-of-care ultrasound (POCUS) becomes even more important!
- Interventional Possibilities: While the volume of procedures may not match clinics focused on older athletes, there are still opportunities for the pediatrician. US guidance opens the door to injections of not only joints and their recesses but also within tendon sheaths, bursa, and perineural spaces. Therapeutic injections have their obvious role in successful treatment of pathologic conditions, but diagnostic injections can also play a crucial role, especially for patients with chronic pain. Precise targeting using ultrasound ensures accurate delivery of anesthetic injectates that can help inform the clinician of the etiology of pain, which often goes undiagnosed for years in the more challenging patient scenarios.
- Safety and Efficiency: Sonologists with diagnostic expertise can now confidently guide needles to precise locations, minimizing risks. Unlike radiography, which involves radiation exposure, ultrasound is radiation-free. This safety aspect is crucial, especially when discussing imaging options with pediatric patients and their families. For example, repeating radiographs or imaging contralateral sides for comparisons may be unnecessary if the pediatric clinician has POCUS in their toolbox.
In summary, MSK ultrasound is a versatile tool that empowers clinicians across pediatric specialties to make informed decisions and provide better patient care. I challenge you to take advantage of all the great MSK US resources available through the AIUM and ask yourself how you could start incorporating this tool into your practice.
Drew Duerson, MD, RMSK, is a Sports Medicine physician in the Division of Sports Medicine at Nationwide Children’s Hospital. He is also a clinical associate professor of Pediatrics at the Ohio State University. Drew is a board-certified Pediatrician with a certificate of added qualification in Sports Medicine. He also holds a POCUS Musculoskeletal certification from the Alliance for Physician Certification and Advancement.
Drew.Duerson@nationwidechildrens.org
@pedsmskusdoc
Interested in reading more about MSK ultrasound? Check out these on-demand webinars from the American Institute of Ultrasound in Medicine (AIUM):
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