Five Top Tips for progressing in MSK ultrasound

MSK Sonographer Kyle Foster provides five excellent top tips for progressing in MSK ultrasound
 

1. Don’t be a dabbler 
   The ultrasound machine has become an extension of you, rather than a tool in your armoury. Spatial reasoning, probe control and hand eye co-ordination are now already second nature, giving you the unique ability to practice ultrasound with continuous partial attention. Where a cleft in clinical correlation exists, remember you are best positioned to drive the machine to its full capability to optimally demonstrate the anatomy and pathology.
    
2. Liaise with the referrers
   Build channels of communication between all parties.  Strengthen that multidisciplinary team (MDT) environment outside of MDT meetings. This builds confidence between ultrasound practitioners and clinicians. It helps you establish what the pertinent information is from the scan (reducing the chance of oversaturating reports with superfluous information), provides you opportunities to elaborate on findings and establish crucial missing medical or surgical history. It also provides you with a way to audit your own performance and gain useful critical feedback.
    
3. Utilise compression
   It is worth considering the value of compression, which is used to good effect when excluding/identifying a DVT. Pertinent visual and patient biofeedback can be gained from gently compressing a tissue including establishing maximum areas of tenderness, areas of liquefaction or necrosis, identifying tears by shifting tissues, establishing tissue types through consistency/compressibility, tendinosis vs intrasubstance tears, tethering of juxtaposed structures.
    
4. Muscle contraction/relaxation
   Passive movement of a joint is well utilised to assess the integrity of a muscle or connective tissue in MSK ultrasound. Less well utilised but often very helpful, is the use of active isometric contraction which can make a tear appear more conspicuous, particularly where there is partial detachment of muscle from the adjacent fascia or intramuscular aponeurosis.
    
5. Doppler of deeper structures
   There is a plethora of information for how to optimise the Doppler signal in superficial anatomy (optimise the scale and colour gain, do not over compress, narrow colour box etc.). Where structures lie deeper, such as in larger or more dense muscle groups, aside from using the optimal Doppler mode (power Doppler and microvascular imaging), consider altering the less utilised functions such as decreasing the colour frequency, altering the colour focus, decreasing the wall filter and choosing a lower frequency probe.
   
   Mr Kyle Foster, MSK Sonographer at Mid Cheshire Hospitals NHS Trust