Episode Transcript
Dr. Miller: Ultrasound guided procedures in orthopedics. We're going to talk about that next on The Scope Radio.
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Dr. Miller: I'm here with Dr. Daniel Cushman and he's a nonoperative sports medicine physician using ultrasound guided techniques to deliver therapy to patients. Daniel, can you tell me a little bit about how ultrasound made its way into sports medicine? I mean, I think most people are aware that ultrasound is used to look at little babies in utero and to diagnose other things, but this is kind of new in sports medicine, kind of interesting and cool.
Dr. Cushman: Definitely.
Dr. Miller: Tell me a little bit about that.
Dr. Cushman: The most common joke I hear when I'm ultrasounding a patient is they say, "Is that a boy?" And I think that's what everybody knows ultrasound from is it's from babies.
Dr. Miller: You haven't found any head?
Dr. Cushman: No, fortunately not yet.
Dr. Miller: Okay, they haven't asked you just check out the probe over the area where the baby might be.
Dr. Cushman: I had a pregnant woman do that and it's kind of fun actually. But originally, the thought was you do an x-ray, you get radiation. You do a CT scan, you get radiation. But a lot of the time with ultrasound, we get the same amount of information without having to do radiation.
The other advantage that we found nowadays is that you can actually have somebody move while you're doing it. So if you're doing an x-ray, the person is standing still. If you're doing an ultrasound, you could have them move their shoulder and actually see if something is pinching up on something else or something like that. So that's kind of where it came from and it's really developed a lot over the last ten years especially.
Dr. Miller: So expand on that a little bit. The great news is that when you use ultrasound, when does the patient doesn't receive radiation nor does anyone else using the probe, what is ultrasound? Is it a sound wave?
Dr. Cushman: Yeah, good question. That's it exactly, it's a sound wave. I think about it like putting a speaker on your hand. If you think about doing that you can kind of feel those vibrations and those vibrations are what you get with an ultrasound but they're so small you don't feel them. So the machine can send out sound waves and then pick them back up. Based off of that, it can tell how tissues are looking like underneath the skin.
Dr. Miller: How long ago did the ultrasound make an appearance in the use of musculoskeletal?
Dr. Cushman: Yeah, I think it was originally in the '50s is when ultrasound was originally made and that was one of the original thoughts is that you could use it for something like this, but it never really caught on until probably the last 20 years or so is when it's really caught on.
Dr. Miller: How many doctors now are able to do this?
Dr. Cushman: So it's getting more and more common. There are two areas that it's used probably the most commonly. The rheumatologist use it a lot looking at joints and then additionally, the orthopedics specialist like myself tend to use it a lot for these sorts of things.
Dr. Miller: Now for this little podcast, I wanted to talk a bit about how you use ultrasound to deliver medication or therapy into areas that you're interested in treating.
Dr. Cushman: We do that very commonly and there are a couple of advantages we find. Number one is kind of the way we're taught in medical school is to take a needle and put it into the area based off of landmarks on the body.
Dr. Miller: That's what I used to do in injecting the shoulders, and I don't do that anymore because people like you have an ultrasound probe and do it probably a lot better than I ever did.
Dr. Cushman: Yeah, and there's been a lot of studies on this and in some places, it honestly doesn't matter. You can do for example, the knee, somewhere around 93% accurate if you just do it by landmarks. If you do it with the ultrasound, it's closer to 100%. So most of the time, you really don't need to. But in some places like the hip where only about 40% accurate, if we just put a needle down to the hip, while it's 100% accurate with an ultrasound machine.
Dr. Miller: How about shoulders?
Dr. Cushman: Shoulders, so if we're talking about the shoulder joint, it's probably in somewhere in the range of 80% accuracy without it. So a lot of the times, we'll have doctors who have done the injection and they're just not 100% sure it was in the right spot and the person didn't get better. So they will do an injection with ultrasound to make sure it's in the right spot and see if that's really helping.
Dr. Miller: How about spine? I know that some people with back pain ultimately get injections to try to get by the need for surgery. Do you use ultrasound in delivering injections into the spine?
Dr. Cushman: So for the spine, that's still what I would call in the experimental phase. So there are some people who do it, but for the most part, we still rely on x-rays to do those.
Dr. Miller: So for folks who might need some type of injection and I guess typically, you're injecting medications to reduce pain or inflammation, what would be the reason for them to seek out someone with your skills?
Dr. Cushman: I find that a lot of the times, it's more of the doctors they work with are the ones who kind of send them over to us to help out with that. But a lot of the times, I find that just from my own patients, when I see them I use these a lot of the times to help diagnose the problem. So a good example would be if somebody's shoulder hurt. Sometimes that pain is coming from their neck, not from their shoulder. So when we do an injection and it doesn't help, we know we were in the right spot so it really could be coming from somewhere else.
Dr. Miller: So it helps with diagnoses as well?
Dr. Cushman: Yeah, exactly.
Dr. Miller: So the bottom line is, if you're interested in having one of your joint pains evaluated, you could have this done under ultrasound guidance. If there's therapy that's needed, it could be injected via an ultrasound guided
Dr. Cushman: Definitely.
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