In the world of sports, injuries are an unfortunate reality that athletes must face. Rapid and accurate diagnosis is crucial to ensure timely treatment and minimize downtime. Traditionally, athletes would have to undergo imaging scans off-site, resulting in delays and limited access to immediate medical care. However, with recent advancements in medical technology, ultrasound has emerged as a game-changing tool. The terms, “venue ultrasound” and “sideline ultrasound” refer to the use of ultrasonography at a sports venue, in a stadium, on the sideline of a sporting event, or in the athletic training room. Its portability and real-time imaging capabilities make it an invaluable asset for sports medicine providers. In fact, the pilot investigation using venue ultrasound at the 2020 Tokyo Olympic Games was successful in diagnosing injuries among athletes.¹

Portable and Convenient
Ultrasound technology has undergone significant advancements, making it more compact, portable, and user-friendly. Modern handheld ultrasound devices are lightweight, battery-operated, and can be easily transported to sporting events or training facilities. This portability allows medical professionals to perform immediate on-site evaluations, enabling faster diagnosis and treatment decisions. The technology continues to evolve with many pocket-sized, handheld devices by leading manufacturers. Examples include the Philips Lumify, GE Vscan, Sonosite iViz, Butterfly iQ, Viatom, and Clarius. In addition, many of the units allow for easy wireless exchange of images and remote access by off-site professionals, if further assistance is needed.

Real-Time Imaging
One of the most significant advantages of sideline or venue ultrasound is its ability to provide real-time imaging. Unlike other imaging modalities, such as X-ray (XR) or magnetic resonance imaging (MRI), which require athletes to wait for results, ultrasound allows for immediate visualization of internal structures. This real-time feedback empowers medical staff to make quick and accurate diagnoses, as well as enables expedited triage of acute athlete conditions. This is particularly useful when XR is not readily available, which is commonplace at many events, particularly non-stadium venues.

Injury Assessment and Diagnosis
Portable handheld ultrasound devices can accurately assess soft tissue injuries, detect fractures, evaluate joint stability, and identify potential nerve or vascular involvement. During the last Olympics, ultrasound showed 100% accuracy in cases that underwent confirmatory imaging.¹ In the emergency department (ED), which can be a similar setting to the sports sideline, point-of-care ultrasound (POCUS) enables appropriate medical decision-making using real-time imaging. Applications of POCUS for musculoskeletal conditions in the ED include joint effusions, long bone fractures, and muscle and tendon injuries.² Long bone fractures can be excluded and tendon injuries can be diagnosed by physicians in the ED using POCUS with high sensitivity and specificity.^3,4 Further, POCUS in the ED positively impacts medical decision-making for musculoskeletal complaints.⁵

Monitor Healing
Once an injury has occurred, ultrasound can be used to monitor the healing progress during the rehabilitation phase. Regular ultrasound assessments allow medical staff to evaluate tissue repair, assess the formation of scar tissue, and track the restoration of normal function. This real-time monitoring provides valuable insights into an athlete’s recovery trajectory, enabling adjustments to treatment plans as needed. This can be particularly helpful in athletic training room situations in determining time to return to play.⁶

Additional Applications
Sideline ultrasound has numerous applications in the care of athletes, including trauma assessments and guided injections. One notable application is the Focused Assessment with Sonography for Trauma (FAST) exam, which is a POCUS examination used to evaluate potential internal injuries, particularly within the abdomen and chest, in the context of acute trauma. While the FAST exam has more traditionally been utilized in the ED, it is becoming increasingly popular on the sideline. The exam involves using ultrasound to evaluate specific regions of the body quickly, aiding in the identification of potential organ damage or bleeding. It allows for rapid assessment and triage regarding further medical interventions or necessary actions. Meanwhile, ultrasound-guided injections and interventions have long been an essential component of sports medicine. The addition of ultrasound guidance enables medical providers to be more targeted in their treatments.

Limitations and Future Directions
While venue ultrasound has enhanced sports medicine, it is essential to acknowledge its limitations. The depth of penetration, image quality, time from injury, and operator dependence can impact the accuracy of diagnoses. Continued advancements in technology and ongoing training for sports medicine professionals are crucial to maximize the potential of sideline ultrasound.

Conclusion
The use of ultrasound on the sideline has revolutionized sports medicine, enabling rapid and accurate diagnosis of injuries. Its portability, real-time imaging capabilities, and dynamic ability to assess musculoskeletal injuries make it an invaluable tool for healthcare professionals on the sideline and in the training room. With further advancements, ultrasound’s role in sports medicine is poised to continue expanding, benefiting athletes worldwide by providing more immediate and personalized care. For further information on this topic, consider reviewing the AIUM webinar, Sideline Ultrasound (https://www.youtube.com/watch?v=aX-AibSfctc).

Robert Monaco and Lauren Rudolph.
Robert Monaco, MD, MPH, RMSK, is a physician at Atlantic Sports Health and is a team physician for USA Figure Skating. Lauren Rudolph, MD, is a physician at Boulder Biologics, adjunct faculty for ultrasound education at Rocky Vista University, and a traveling physician with the US Ski team.

References:

1. Onishi K, Engebresten L, Budgett R, Soligard T, Forster BB. The International Olympic Committee venue ultrasound program: A pilot study from Tokyo 2020 Olympic Games. Am J Phys Med Rehabil 2023; 102:449–453. 
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5. Situ-LaCasse E, Grieger RW, Crabbe S, Waterbrook AL, Friedman L, Adhikari L. Utility of point-of-care musculoskeletal ultrasound in the evaluation of emergency department musculoskeletal pathology. World J Emerg Med 2018; 9:262–266.
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