Case 1 – Lateral Epicondylitis



Appendix 2 – MSK Diagnostic Ultrasound - Example Cases

Below are 6 selected example cases that highlight the benefit of diagnostic ultrasound to MSK physiotherapists and I have seen many similar cases over the past 18 months.

I have selected these as they are the type of cases that the MSK physiotherapy service will commonly see.

Case 1 – Lateral Epicondylitis

History – 57 year old female with 6/12 History of left lateral elbow pain. Failed physiotherapy over 3/12. Pain with gripping activities but also ache present at rest.

Session 1. U/S Findings – Swollen common extensor tendon at the teno-osseous junction with prescence of small osteophytes. Treatment – steroid injection and relative rest for 2/52 &

Session 2 – Normal clnical review at 2/52 post CSI. Pain resolved at rest and minimal on resisted wrist extension. Advice for graded increase in normal activities over 6/52

Session 3 – Normal Clinical Review 6/52 – symptoms resolved and D/C

Outcome – painfree and normal return to function. Normally CSI would not be performed for this condition. Orthopaedic referral avoided.

Case 2 – Achilles Tendonitis with Partial Rupture

History – 60 year old female with 6/12 history of painful swollen right achilles tendon. Limping gait affecting knee and hip.

Session 1- U/S massively thickened T/A with prescence of Doppler signal indicating tendonitis. Measurement suggestive of partial T/A tear. Discussed with orthopaedics and decision taking to place patient in walker boot partial weight bearing for 6/52. Active movement only

Session 2 – 6/52 later, patient reporting vastly reduced pain. Rescanned – No Doppler signal present. Patient able to commence increased weight bearing.

Outcome – 3/12 after initial assessment patient FWB walking for normal ADL’s no problems. Rescanned for interest – tendon remained thickened but with no acute signs of inflammation.

Case 3 – Trochanteric Pain

History – 50 year old female with orthopaedic clinical diagnosis of trochanteric bursitis over 6/12 period. Received CSI and sent to physiotherapy. Patient experienced no improvement in symptoms with CSI.

Session 1 – U/S revealed no evidence of trochanteric bursitis or insertional tendonitis.. I was able to explain the findings to the patient where she was happier to engage in conventional physiotherapy.

Case 4 – Flexor Carpi Radialis Tendonitis

History - 47 year old male with volar radial aspect wrist pain with gripping activities. Symptoms aggravated at gym with weight training and also with DIY type tasks. No improvement with relative rest and physiotherapy over 3/12 .

Session 1 – U/S scan revealed tendonitis of the flexor carpi radialis at it insertion. Carried out CSI and rested in wrist splint for 2/52. U/S used to aid skin marking– using paper clip technique (indirect needle approach).

Session 2 – 2/52 post assessment Pain abolished with active movement and gentle resisted loading. Advised graded increase in activity over 3/12 period – placed on hold

Outcome – no further contact from patient – assume to be doing fine.

Case 5 –Supraspinatus large tear.

History – 48 year old male with 6 month history of right shoulder pain and weakness diagnosed as chronic subacromial impingment syndrome. No improvement with conventional physiotherapy over 6 week period. Sent for ? CSI.

Session 1 – U/S revealed large partial thickness tear of supraspinatus with no evidence of active inflammation.

Outcome – CSI not indicated and patient referred for orthopaedic opinion.

Case 6 – Plantar Fasciitis

History – 3 month history of sole of foot pain diagnosed at physiotherapy as plantar fasciitis. Patient painful and not responding to usual physiotherapy intervention over 6 weeks.

Session 1 – U/S revealed thickened and inflamed plantar fascia at its calcaneal origin. CSI – carried out at same time. Relative rest for 2/52

Session 2 – Patient reported much reduced pain and able to continue with physiotherapy management.

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