Musculoskeletal sonography technique: focused versus comprehensive evaluation.
OBJECTIVE
This article evaluates the utility of performing a focused musculoskeletal sonography examination on the basis of patients' presenting complaints.


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Jamadar
David A
DA
Department of Radiology, University of Michigan Hospitals, 1500 E Medical Center Dr., TC2910, Ann Arbor, MI 48109, USA.
Jacobson
Jon A
JA
Caoili
Elaine M
EM
Boon
Tracy A
TA
Dong
Qian
Q
Morag
Yoav
Y
Girish
Gandikota
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005121:Extremities / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007596:Joints / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000002:abnormalities / Q000000981:diagnostic imaging; D009139:Musculoskeletal Abnormalities / Q000000981:diagnostic imaging; D009140:Musculoskeletal Diseases / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D013708:Tendon Injuries / Q000000981:diagnostic imaging; D014463:Ultrasonography