Musculoskeletal sonography technique: focused versus comprehensive evaluation.

Abstract

This article evaluates the utility of performing a focused musculoskeletal sonography examination on the basis of patients' presenting complaints. Six hundred two patients evaluated over 6 months were scanned using a routine protocol. At the completion of the routine examination, each patient was asked to indicate a focal point of discomfort and, if present, was rescanned over the area of discomfort. Patients were classified in one of five categories depending on whether there was a focal point of discomfort and the presence or absence of an underlying sonographic abnormality. Eighty-three percent of the 602 patients had a sonographically detectable abnormality, 2.2% of whom had an abnormality not detectable by routine protocol-based scanning. The more peripheral the body part, the more likely that abnormalities detected by sonography correlated with focal symptoms: 81% in the wrist and hand and 73% in the ankle and foot, compared with the more central body parts of 15% in the shoulder and 31% in the hip. Chi-square analysis showed a significant association between the body part scanned and a detectable abnormality (p < 0.0001). Although a focused examination of the distal extremities correlated with an abnormality in most cases, a protocol-based approach ensured identifying 97.4% of the symptomatic abnormalities. The addition of a focused examination to an examination by protocol further increased the identification of abnormalities.