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Ultrasound Capabilities

The Ryan Center for Sports Medicine offers ultrasound-guided injections for sports-related and non-sports related injuries. Ultrasound does not involve radiation; instead, it uses sound waves to form images that doctors can use to perform therapeutic interventions. It is typically used on large and small joints, including the shoulder, elbow, wrist, hand, hip, knee, ankle, and foot, as well as other soft tissue.

Ultrasound allows clinicians to be very precise with the placement of medication. With ultrasound, doctors can see blood vessels, large nerves, surrounding tissues, and other structures to avoid when treating an affected area. This often helps to greatly reduce the discomfort associated with a procedure.

Conditions treated with ultrasound:

• Tendinitis and chronic tendinopathy (for example, Achilles tendon, patella tendon, tennis elbow, golf elbow, shoulder impingement/rotator cuff pain)
• Arthritis (shoulder, elbow, wrist, hand, hip, knee, ankle and foot)
• Pain from labrum tears in the shoulder and hip

Ultrasound Q & A with Nathan Cardoos, MD, CAQSM

Dr. Nathan Cardoos specializes in ultrasound at the Ryan Center.

What types of patients are seen for ultrasound at the Ryan Center?

We treat all types of patients with ultrasound: athletes and non-athletes of all ages.

How is ultrasound used?

Ultrasound is a quick, safe way to look at soft tissue in the body to help make an accurate diagnosis. For some conditions, ultrasound may be an alternative for patients who can’t undergo an MRI test.

Ultrasound is used to guide therapeutic injections, such as corticosteroid injections. It is also used during tenotomy, which is a procedure to relieve tendinosis (sometimes called chronic tendinitis, chronic tendinopathy, or chronic tendon injury). During tenotomy, we disrupt the scar tissue within a tendon by essentially “poking holes” into it, so that the body brings fresh blood into the area to stimulate healing. At the Ryan Center, we also have the capability of performing platelet-rich plasma injections (PRP). These types of procedures, along with good physical therapy, can often help patients avoid having more invasive surgery.

Ultrasound is also used to break up calcifications in the rotator cuff, to drain cysts (such as Baker’s cysts in the back of the knee and ganglion cysts in the wrist), and to perform viscosupplementation, which involves injecting a gel-like fluid called hyaluronic acid into the knee joint to help relieve symptoms of arthritis.

Is there an alternative to ultrasound-guided injections?

Yes, a more traditional method is called “landmark-guided” injection. This approach relies on the clinician using touch and knowledge of human anatomy to guide the needle to the affected area. A recent position statement from the American Medical Society for Sports Medicine found that ultrasound-guided injections are more accurate than landmark-guided injections. This is not surprising, because with the ultrasound we can see the location of the needle down to the millimeter.

Are there situations where ultrasound can’t be used?

Ultrasound is not very good for looking at bone problems such as fractures or arthritis. Sound waves can’t travel through bone, so ultrasound isn’t used to examine the brain (since it can’t see through the skull). In general, we do not use ultrasound to look at the spine. In these situations, X-ray, CT, or MRI may be used.

What kind of specialized training do ultrasound technicians have?

Ultrasound requires a skilled operator, who has undergone highly focused training and performed hundreds of procedures under direct supervision. I completed an intensive sports medicine fellowship with a focus on ultrasound-guided procedures and now perform many of these procedures daily.

Tell us about ultrasound services at the Ryan Center for Sports Medicine

Dr. Steven Huang also performs ultrasound-guided procedures at the Ryan Center.  Between the two of us, we can see referred patients quickly, sometimes within one or two days. After receiving an ultrasound, patients generally receive their follow-up care here at the Ryan Center so that we can help guide patients back to their desired level of function and quality of life. We may use ultrasound again to see how the tissue has changed after treatment. Patients’ course of care almost always includes physical therapy, and they can choose to do that here at the Ryan Center as well.