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 protected].
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
1530
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%
Dhaka
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
Knee
Shoulder
Hip
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
Foot
Hand
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
Thigh
Sacroilliac joint
Other
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
DMCH
BIRDEM
BSMMU
NITOR
Series1
1st 6 month-34.45% 2nd 6 month- 65.55%
0
10
20
30
40
50
60
70
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?
Why I do MSK USG?
Why I do MSK USG?
Bicipital Tendinitis
Lateral wrist pain
Shoulder pain
Shoulder pain
Shoulder pain
Shoulder pain
LSST > IST > TM > SSC
Shoulder pain
Hip 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
Radial nerve tracking in arm
Radial nerve tracking in arm
Radial nerve tracking in arm
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.
