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Jackson SS, Le HM, Kerkhof DL, Corrado GD. Point-of-Care Ultrasound, the New Musculoskeletal Physical Examination. Curr Sports Med Rep 2021; 20:109-112. [PMID: 33560035 DOI: 10.1249/jsr.0000000000000810] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ABSTRACT The availability of handheld ultrasound offers physicians an opportunity to better define anatomy and pathophysiology, thus enhancing the diagnostic capabilities of a standard physical examination. The medical community increasingly embraces the potential for point-of-care ultrasound across medical specialties. The primary aim of this review was to identify and compile information on the current clinical utility of point-of-care ultrasound for musculoskeletal examination. This information will enable health care providers to understand the current utility and potential of musculoskeletal point-of-care ultrasound, thus facilitating its appropriate adoption into clinical practice.
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Affiliation(s)
| | - Hung M Le
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA
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Pinto J, Azevedo R, Pereira E, Caldeira A. Ultrasonography in Gastroenterology: The Need for Training. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2018; 25:308-316. [PMID: 30480048 DOI: 10.1159/000487156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 01/24/2018] [Indexed: 11/19/2022]
Abstract
The use of ultrasonography (US) as an imaging modality in medicine has spread across almost every clinical specialty. This diffusion is based on the simplicity, accessibility, portability and affordability of the technique producing real-time high-resolution images using non-ionising radiation. On the other hand, this trend also extended the technique to settings other than healthcare, such as public facilities, private houses or remote sites. This tendency can be observed worldwide, from developing countries to prestigious medical schools and tertiary referral hospitals. Furthermore, point-of-care US (POCUS), i.e., US executed at the patient's bedside to obtain real-time objective information with diagnostic and clinical monitoring purposes or to guide invasive procedures, has been incorporated in many specialties. In gastroenterology, despite the essential role of endoscopy, clinical practice is highly dependent on non-endoscopic imaging techniques. However, as in other specialties, the indications of US in gastroenterology have been increasing steadily, covering a broad range of conditions. In response to the generalised employment of US by non-radiologists, institutions such as the European Federation of Societies for Ultrasound in Medicine and Biology and the Royal College of Radiologists issued recommendations to ensure high-quality practice. These theoretical and practical requisites include performing a certain number of examinations and mandatory skills in order to achieve certification to execute unsupervised US. Therefore, there is a need for modern gastroenterology to include US as a basic skill in its clinical practice. To ensure the provision of high-quality US, adequate instruction of future specialists should be guaranteed by the gastroenterology departments and required in the residency training programme.
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Affiliation(s)
- João Pinto
- Gastroenterology Department, Amato Lusitano Hospital, Castelo Branco, Portugal
| | - Richard Azevedo
- Gastroenterology Department, Amato Lusitano Hospital, Castelo Branco, Portugal
| | - Eduardo Pereira
- Gastroenterology Department, Amato Lusitano Hospital, Castelo Branco, Portugal
| | - Ana Caldeira
- Gastroenterology Department, Amato Lusitano Hospital, Castelo Branco, Portugal
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Sanz de la Garza M, Lopez A, Sitges M. Multiple pulmonary embolisms in a male marathon athlete: Is intense endurance exercise a real thrombogenic risk? Scand J Med Sci Sports 2016; 27:563-566. [DOI: 10.1111/sms.12680] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2016] [Indexed: 11/29/2022]
Affiliation(s)
- M. Sanz de la Garza
- Cardiovascular Institute; Hospital Clinic; IDIBAPS; University of Barcelona; Barcelona Spain
| | - A. Lopez
- Internal Medicine Department; Hospital Clinic; IDIBAPS; University of Barcelona; Barcelona Spain
| | - M. Sitges
- Cardiovascular Institute; Hospital Clinic; IDIBAPS; University of Barcelona; Barcelona Spain
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Kerkhof DL, Gleason CN, Basilico FC, Corrado GD. Is There a Role for Limited Echocardiography During the Preparticipation Physical Examination? PM R 2016; 8:S36-44. [DOI: 10.1016/j.pmrj.2016.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 12/24/2015] [Accepted: 01/01/2016] [Indexed: 01/29/2023]
Affiliation(s)
| | - Courtney N. Gleason
- Brown University Warren Alpert Medical School, Departments of Orthopedics and Pediatrics, Rhode Island Hospital, Providence, RI
| | | | - Gianmichel D. Corrado
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, 319 Longwood Ave, Boston, MA 02115; Harvard Medical School, Boston, MA; Northeastern University, Boston, MA; The Micheli Center for Sports Injury Prevention, Waltham, MA
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Kidder W, Nguyen S, Larios J, Bergstrom J, Ceponis A, von Drygalski A. Point-of-care musculoskeletal ultrasound is critical for the diagnosis of hemarthroses, inflammation and soft tissue abnormalities in adult patients with painful haemophilic arthropathy. Haemophilia 2015; 21:530-7. [PMID: 25623830 DOI: 10.1111/hae.12637] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2014] [Indexed: 01/11/2023]
Abstract
We previously demonstrated in adult patients with haemophilia (PWH) that hemarthrosis is present in only ~1/3rd of acutely painful joints by using point-of-care-musculoskeletal ultrasound (MSKUS). Therefore, other unrecognized tissue abnormalities must contribute to pain. Using high resolution MSKUS, employing grey scale and power Doppler, we sought to retrospectively (i) investigate soft tissue abnormalities in painful haemophilic joints and (ii) to determine to what extent MSKUS findings, functional or radiographic joint scores correlate with biomarkers of inflammation in PWH. Findings were correlated with Hemophilia Joint Health Scores (HJHS), Pettersson scores, high sensitivity C-reactive protein and von Willebrand factor activity and antigen levels. A total of 65 MSKUS examinations for acute and chronic joint pains were performed for 34 adult haemophilia patients, mostly for chronic joint pains (72.3%). The most prominent findings (66.5%) pertained to inflammatory soft tissue changes including synovitis, tendinitis, enthesitis, bursitis and fat pad inflammation. Effusions were present in 55.5% and 46.8% of MSKUS performed for acute and chronic pain, respectively. Of those, 90.0% were bloody during acute and 47.6% during persistent pains. While inflammatory biomarkers correlated well with overall HJHS and total Pettersson scores (P < 0.05), they did not differ between those patients with synovitis and those without. MSKUS is emerging as an important modality to diagnose treatable musculoskeletal abnormalities contributing to pain in haemophilic arthropathy, and therefore seems critical for a personalized approach to haemophilia care. The role of biomarkers in this setting remains less clear and requires further investigation.
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Affiliation(s)
- W Kidder
- Division of Hematology/Oncology, Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - S Nguyen
- Division of Hematology/Oncology, Department of Medicine, University of California San Diego, San Diego, CA, USA.,College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - J Larios
- Department of Rehabilitation and Physical Therapy, University of California San Diego, San Diego, CA, USA
| | - J Bergstrom
- Division of Epidemiology, Family and Preventive Medicine, University of California San Diego, San Diego, CA, USA
| | - A Ceponis
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - A von Drygalski
- Division of Hematology/Oncology, Department of Medicine, University of California San Diego, San Diego, CA, USA.,Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA
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Abstract
Musculoskeletal imaging includes radiographs, computed tomography scans, bone scans, magnetic resonance imaging, and musculoskeletal ultrasonography. Each modality has its advantages and disadvantages. This article presents general guidelines regarding which imaging modality to order when evaluating patients with musculoskeletal complaints. However, it must be remembered that imaging is not meant to replace a thorough history and physical examination, but instead should be seen as a suite of methods to confirm suspected diagnoses.
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Affiliation(s)
- Peter H Seidenberg
- Penn State Sports Medicine, Penn State University, State College, 1850 East Park Avenue, Suite 112, PA 16803, USA.
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Hull CM, Hopkins CL, Purdy NJ, Lloyd RC, Harris JA. A case of unprovoked venous thromboembolism in a marathon athlete presenting atypical sequelae: What are the chances? Scand J Med Sci Sports 2014; 25:699-705. [DOI: 10.1111/sms.12262] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2014] [Indexed: 01/18/2023]
Affiliation(s)
- C. M. Hull
- Institute of Life Science 1; College of Medicine; Swansea University; Swansea UK
| | - C. L. Hopkins
- Penmaen Residence; University Health Centre; Swansea UK
| | - N. J. Purdy
- Institute of Life Science 1; College of Medicine; Swansea University; Swansea UK
| | - R. C. Lloyd
- Penmaen Residence; University Health Centre; Swansea UK
| | - J. A. Harris
- Penmaen Residence; University Health Centre; Swansea UK
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