A 12 months retrospective study of musculoskeletal...

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A 12 months retrospective study of musculoskeletal ultrasound in daily practices in Tertiary Care Hosptial of Bangladesh. Moniruzzaman M1, Rahman M2, Azad KAK3, Rahman HZ4, Islam M5, Ahmed SM6, Saleq AKM7, Rahman MH8, Khasru MR9, Alam MA10

DR. M M ZAMAN FCPS,FIAS,MACR,MAAPMR(USA)

CLINICAL & INTERVENTIONAL PHYSIATRIST

ASSISTANT PROFESSOR

PHYSICAL MEDICINE & REHABILITATION DEPARTMENT

DHAKA MEDICAL COLLEGE

Moniruzzaman M1, Rahman M2, Azad KAK3, Rahman HZ4, Islam M5, Ahmed SM6, Saleq AKM7, Rahman MH8, Khasru MR9, Alam MA10

1. Dr. Mohammad Moniruzzaman, Assistant Professor, Physical Medicine and Rehabilitation Department, Dhaka Medical

College. Email-dr_mzaman38@yahoo.com.

2. Professor Dr. Matiur Rahman, Head of Rheumatology, Anower Khan Modern Medical College Hospital.

3. Professor Khan Abul Kalam Azad, Head of Medicine Dept, Dhaka Medical College.

4. Professor Hasan Zahidur Rahman, Department of Neurology, Bangbandhu Sheikh Mujib Medical University.

5. Dr. Monirul Islam, Associate Professor, Physical Medicine and Rehabilitation Department, National Institiute of Traumatology,

Orthopedic and Rehabilitation.

6. Professor Syed Mozaffar Ahmed, Physical Medicine and Rehabilitation Department, Bangabandhu Sheikh Mujib Medical

University.

7. Professor Dr. AKM Saleq, Physical Medicine and Rehabilitation Department, Bangbandhu Sheikh Mujib Medical University.

8. Professor M Habibur Rahman, Head of Physical Medicine and Rehabilitation Department, National Institiute of Traumatology,

Orthopedic and Rehabilitation.

9. Dr. Moshiur Rahman Khasru, Assistant Professor, Physical Medicine and Rehabilitation Department, Bangabandhu Sheikh Mujib

Medical University.

10. Dr. Md. Aminul Alam, Indoor Medical officer, Physical Medicine and Rehabilitation Department, Dhaka Medical College

Background

Why MSK USG ?

Advantages of MSK US

Real time No radiation No C/I As MRI

Standerd Cost

effective

Advantage..

Accurate Diagnosis

& Exclusion

Planning of

treatment

Prognostic value

Follow up after

treatment

MSK US

Advantage.. Portability

High resolution

Dopplar screen

Intervention

MSK US

Applications TENDONS MUSCLES LIGAMENTS JOINTS CARTILAGE BONES NERVES VESSELS LYMPHATIC CHANNELS

. >RAPIDLY EXPANDING FIELD >ADDING HELP TO VARIOUS CLINICAL PRACTICES >THAT DIAGNOSE AND TREAT MUSCULOSKELETAL, RHEUMATIC, ORTHOPEDIC, NEUROLOGICAL & SPORTS CONDITIONS.

PEN / STETHOSCOPE FOR THE.....

Study Design

Retrospective observational study

Objective

To know the demographic study and Performance of MSK US.

Study Population

Study Duration

1 June 2015 to 31 May, 2016

Study Place

Popular Medical College Hospital

Inclusion criteria

Any age. Referred from any hospital or doctors. Agree to enroll in this study

Exclusion criteria

Not agree to enroll this study.

Procedure

Daily patient was seen in between 3 pm-5 pm except Friday and Thursday. Volusion E8 US machine was used. All images were saved in computer. Data were collected by trained personal from registry of computer database. Data were processed, edited and analyzed by SPSS windows version 17. P value < 0.05 was considered statistically significant at 95% confidence Interval.

Result

Demographic study

Mean age- 42.00±14.01 Male: Female- 2:3. Occupation- Housewife- 60.13% (920) Office worker-13.88% (212) Buisenessman-10.55%(162) Student-8.44% (129) Farmer-5.66% (87) Child < 5 years-1.32% (20)

Housewife

Officeworker

Businessman

Student

Farmer

Child <5year

Divisions

Dhaka- 55%

Rajshahi-8% Rangpur-12% Barisal-10% Sylhet-5% Mymensingh-5% Chittagong-3% Khulna-2%

Rajshahi

Rangpur

Barisal

Sylhet

Mymensingh

Chittagong

Khulna

Outcome Most common area of US- Knee joint(24.9%),

Shoulder (19.87%) Hip joint (10.39%) and

Shoulder

Less common were-

ankle joint(5.56%), lower back muscle (5.36%), wrist joint (3.73%), Achillis tendon (3.53%), Elbow joint (3.07%) , ischeo-gluteal region (2.81%), different soft tissue (2.75%), planter fascia (2.55%), foot (2.16%), hand (1.83%), l muscle(1.83%),

ankle joint

lower back muscle

wrist joint

Achillis tendon

Elbow joint

Ischiogluteal

Diffferent soft tissue

Planter fascia

Muscle

Cont..

Enthesitis assay (1.7%), Other (1.63%) Median nerve (1.57%), Thigh (1.05%), Sacroiliac joint (1.05%), Forearm (1.11%), X-ray non-detectable fracture (.59%), Erosion assay in small joint(0.52%), Cervical spine (0.26%), Dorsal spine (0.20%).

Enthesitis

Median nerve

Sacroilliac joint

Forearm

x-ray non-detectable fracture

Erosion assay

Cervical spine

Dorsal spine

Referred by

OPD-95% In-patient-5% OPD

In-patient

Among OPD (95%)

Physiatrist-50% Rheumatologist-30% Internist-5% Neurologist-10% Orthopedist-3% Paediatrics-2%

0 5 10 15 20 25 30 35 40 45 50

Physiatrist

Rheumatologist

Neurologist

Internist

Orthopedist

Paediatrics

Series1

Among in-patient(5%)

DMCH-2.5% BIRDEM-1.5% BSMMU-0.5% NITOR-0.5%

0 0.5 1 1.5 2 2.5

BIRDEM

Series1

1st 6 month-34.45% 2nd 6 month- 65.55%

1st 6 month 2nd 6 month

Series1

Discussion

Is MSKUS Evidence Based?

RETROSPECTIVE STUDY OF 1,012 PATIENTS TREATED BY MSK AND SPORTS PHYSICIANS OVER A 10-MONTH PERIOD BY SIVAN ET AL. CONCLUDED THAT THE USE OF CLINIC-BASED MSK US ENABLES A ONE-STOP APPROACH, REDUCES REPEATED HOSPITAL APPOINTMENTS AND IMPROVES QUALITY OF CARE.

MUSCULOSKELETAL CARE. 2011;9(2):63-8

MSKUS vs. MRI

IN A PROSPECTIVE STUDY OF 124 PATIENTS, US AND MRI HAD COMPARABLE ACCURACY FOR IDENTIFYING AND MEASURING THE SIZE OF FULL-THICKNESS AND PARTIAL-THICKNESS ROTATOR CUFF TEARS, WITH ARTHROSCOPIC FINDINGS USED AS THE STANDARD.

J BONE JOINT SURG AM. 2004; 86-A(4):708-16

Why I do MSK USG?

Bicipital Tendinitis

Lateral wrist pain

Shoulder pain

LSST > IST > TM > SSC

Shoulder pain

Hip Pain

Elbow pain-unknown cause

Elbow pain

Soft tissue swelling

Arm pain

Pain in palm

Quadriceps Muscle Rupture

Rupture Achilles Tendon

Anatomic Anomalies

BIFID MEDIAN NERVE AND ARTERY

Tingling in hand

Radial nerve tracking in arm

MSK USG of Scar

take home massage

Superior visualization of skin, subcutaneous tissue, tendons, muscles, ligaments, nerves, synovium, bursa even bone

Less expensive without claustrophobia or contraindication

Established Diagnostic, Prognostic and Intervention utility

. Any regional pain or refractory joint pain or a sample of polyarthritis should be evaluated by US.

Even Follow up of prevoius report.

I may not do MSK US, but should know about the importance and clinical correlation of US.

take home massage

Finding effusion like report is not the only US findings.

Regarding advising MSK US, Referred physician should be cautious about the quality of report for the sake of patient other wise wastage of money.

Thank you! THANK YOU

A 12 months retrospective study of musculoskeletal...

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