CME OnDemand: Novel Imaging and MIS Techniques in Foot and Ankle Care (2026)-Ultrasonography as a Diagnostic, Therapeutic, and Research Tool in Orthopaedic Surgery

Ultrasonography as a Diagnostic, Therapeutic, and Research Tool in Orthopaedic Surgery

Pdf Summary

This review outlines how musculoskeletal ultrasonography (US) can serve as a diagnostic, therapeutic, and research tool in orthopaedic surgery. US is portable, relatively inexpensive, produces real-time cross‑sectional images, and avoids ionizing radiation, helping drive rapid growth in outpatient use. However, it remains underused in orthopaedics compared with MRI, CT, and radiography, partly due to operator dependence and technical limitations.<br /><br />The article summarizes core ultrasound principles relevant to clinical interpretation: image formation via reflected sound waves, the frequency–penetration tradeoff (high frequency improves resolution but limits depth), attenuation, and echogenicity (hyperechoic, hypoechoic, anechoic appearances). It emphasizes common artifacts such as anisotropy—particularly important in tendons and ligaments—where probe angle can make normal tissue appear pathologic, underscoring the need for training and anatomic knowledge.<br /><br />As a diagnostic modality, US performs well for many superficial soft-tissue structures. Evidence shows sensitivities and specificities comparable to MRI for various tendon, ligament, and rotator cuff pathologies, though accuracy depends heavily on operator expertise and may be weaker for certain lesions (e.g., partial biceps tears). US can also evaluate knee conditions (collateral ligaments, ACL signs, meniscus tears), identify cysts and bursitis, and assist in infection workups by detecting and guiding aspiration of joint effusions—while noting that appearance alone cannot definitively diagnose septic arthritis.<br /><br />US is also useful for fracture detection (including some occult fractures) and for monitoring fracture healing, sometimes demonstrating callus earlier than radiographs. In therapeutics, US guidance improves injection accuracy versus landmark techniques and approaches fluoroscopy accuracy without radiation, potentially reducing complications from misplaced corticosteroid injections. Finally, research applications include tracking disease progression, postoperative tendon integrity, and emerging techniques like elastography to assess tendon stiffness and degeneration.

Keywords

musculoskeletal ultrasonography

orthopaedic surgery

diagnostic ultrasound

ultrasound-guided injections

tendon and ligament pathology

rotator cuff evaluation

ultrasound artifacts anisotropy

joint effusion aspiration

fracture detection and healing monitoring

elastography tendon stiffness