CME OnDemand: Novel Imaging and MIS Techniques in Foot and Ankle Care (2026)-Update in Musculoskeletal Ultrasound Research

Update in Musculoskeletal Ultrasound Research

Pdf Summary

Musculoskeletal (MSK) ultrasound research is expanding as ultrasound (US) becomes more clinically useful in sports medicine and MSK care. US is valued for high-resolution, real-time imaging, portability, and relatively low cost, making it particularly effective for focused clinical questions involving superficial structures such as tendons, ligaments, and peripheral nerves. Limitations remain for deep structures (abdomen, pelvis, lumbar nerve roots) and for assessing diffuse disease, and results can be operator dependent.<br /><br />Conventional MSK US is well established for detecting arthropathy findings including synovitis, erosions, bursitis, and tendinopathy, with strong evidence in rheumatoid arthritis for diagnosing and monitoring synovitis/tenosynovitis and for tracking response to therapies such as methotrexate and biologics. Neurosonology is increasingly used to evaluate peripheral neuropathies (eg, carpal tunnel, cubital tunnel, meralgia paresthetica, peroneal and tarsal tunnel syndromes) and can correlate well with MRI and EMG, though deep nerve evaluation and training demands are challenges. Muscle imaging can identify tears, hematomas, fatty atrophy, and fibrosis; experimental applications include assessing glycogen depletion and detecting fasciculations.<br /><br />Novel technologies aim to extend US capabilities. Fusion imaging combines real-time US with CT/MRI anatomic detail to aid procedures such as bone or soft-tissue biopsy and joint injections while potentially reducing radiation exposure; more outcome data are needed. Contrast-enhanced ultrasound (CEUS) improves assessment of low-flow microvascular perfusion and may better distinguish active from inactive synovitis and characterize soft-tissue masses or repaired tendon vascularity, but requires IV contrast and has regulatory and logistical barriers. Superb microvascular imaging (SMI) may provide similar microvascular information without contrast, though MSK evidence is not yet published.<br /><br />Quantitative US, especially elastography, measures tissue stiffness. Strain elastography is repeatable but largely qualitative; shear wave elastography is more quantitative and may detect changes not seen on grayscale imaging, though technique and positioning affect results.<br /><br />US-guided interventions are a major growth area, improving accuracy for injections and procedures. Applications include tendon fenestration/dry needling, prolotherapy, platelet-rich plasma (PRP) injections (best evidence for tendinopathy), muscle injections (mixed evidence), and perineural injections/hydrodissection for entrapment syndromes. Cervical nerve root injections under US may reduce radiation but carry potential serious risks; lumbar applications remain difficult and not well validated. Overall, the field is advancing, but many innovations require larger clinical studies to confirm efficacy.

Keywords

musculoskeletal ultrasound

sports medicine imaging

rheumatoid arthritis synovitis

tenosynovitis monitoring

peripheral neuropathy neurosonology

carpal tunnel syndrome ultrasound

ultrasound fusion imaging (CT/MRI)

contrast-enhanced ultrasound (CEUS)

ultrasound elastography shear wave

ultrasound-guided interventions PRP hydrodissection