Scott Webb (Host): Most of us are familiar with MRIs and CT scans that help diagnose injuries, but musculoskeletal or sports ultrasounds can be done in the office and are becoming the norm for providers like my guest today. I'm joined today by Dr. Andrew Hills. He's a sports medicine specialist with Franciscan Health.

This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, it's nice to have you back again. Last time, we talked about running injuries, and today we're going to talk about musculoskeletal or sports ultrasounds. So, let's talk about that. What is that? What is a musculoskeletal or sports ultrasound?

Dr. Andrew Hills: Yeah. So in general, diagnostic ultrasound, it's something that's been in the medical field since the late '50s, early '60s, but has recently gained more traction in the Sports Medicine world, probably over the last 20 years or so. It's a device that uses sound waves and creates an image based off how those sound waves kind of change as it travels through our tissues. It's similar to what we learned kind of in grade school when bats are using kind of sonar to detect their prey. And probably the most popular environment that people are most aware of it is in OB-GYN when they're visualizing fetal development. And we're using the same technology in the Sports Medicine world to visualize muscles, tendons, ligaments, and other soft tissue structures,

Host: Yeah. And I've been through this recently, my daughter had a shoulder thing going on and, of course, they did an x-ray and said, "Well, we can't see enough there. So, we're going to have to do an MRI, you know, with contrast and all of that." So, I know today we're talking about ultrasounds, but I have at least had a recent experience of what x-rays can show versus what other imaging can. So, let's talk about that then a little bit, the difference between, you know, a sports ultrasound and an x-ray and when one is perhaps better than the other.

Dr. Andrew Hills: Right. So with the x-ray, the primary purpose, especially in Sports Medicine, is to rule out fractures or any underlying arthritis. With an ultrasound, our goal is more to visualize the soft tissue structures overlying those bones, which can include muscles, tendons, or ligaments, similar to what you mentioned with your daughter.

The nice thing with an ultrasound versus an MRI, we're also visualizing those same soft tissue structures, but we're able to make it a little bit more dynamic as we are able to take the athlete and kind of put them through some range of motion as we're scanning them at the same time.

The other thing I like to compare ultrasound to x-ray is almost like a forest. So with an x-ray, you're kind of looking at a forest from the top of the forest as a whole there. But then, with an ultrasound, you're getting down to more of the details and looking at one specific tree is kind of how I like to provide a reference for patients.

Host: Sure. Yeah. Like the finer details. So, it makes me wonder then, like, what conditions or injuries benefit ultrasounds?

Dr. Andrew Hills: Yeah. So, there's a very large variety of conditions. Usually, we're looking mostly for muscle tears, sprains to ligaments, and we're even able to evaluate the nerves. So, ultrasound tends to be one of the best tools to visualize nerves for people dealing with like carpal tunnel syndrome, and it's even better when you than using MRI in regards to nerve evaluation. The other nice thing about ultrasound is it doesn't expose a patient to radiation, so it makes it a safer option for pregnant women and children, and it tends to be a lot more affordable than techniques like MRIs or CT scans.

Host: Yeah. Interesting. It's making it seem and perhaps these sports ultrasounds really might be not only the present, maybe for you and your partners, but also maybe the future versus the traditional MRIs and that kind of imaging.

Dr. Andrew Hills: I would agree, at least in the short run or in the office evaluation.

Host: So, let's talk about the diagnosis and recovery and the benefits of these sports ultrasounds in terms, you know, specific to diagnosis and recovery.

Dr. Andrew Hills: Yeah. So, the main benefits, at least of what we're using in the office, is more from a diagnostic standpoint. There are other devices that are used by physical therapists or athletic trainers, and we like to call those more therapeutic ultrasounds. Those devices are also using kind of similar mechanisms where you're using sound waves, but they use it differently, whereas the sound waves are more designed to heat the nearby tissues, therefore increasing blood flow, promote tissue healing, and improve overall range of motion.

Mostly Sports Medicine physicians, at least in the office setting, are using more the diagnostic, where we're getting real time images. And the big uses we're using it for is, one, when we're performing injections, because we're able to see a needle as it goes into a joint or into a cyst. So, it makes our injections more accurate or in regards to the cyst. If we were trying to drain more fluid out, we're able to visualize that again in real time as we're doing the procedure. Similar to what I was talking about with your daughter. Again, I can, make an athlete move their arm or move that muscle as I'm imaging it, which is something that's very unique to ultrasound that you can't do with an MRI scanner.

Host: Yeah. You definitely can't do that in an MRI. That's like the number one thing, don't move.

Dr. Andrew Hills: Exactly.

Host: Yeah. And it seems like one of the real great benefits, both for, you know, doctors and patients is your ability to do it right there in the office, right?

Dr. Andrew Hills: Correct. And the technology is developing so quickly. Now, they're developing devices that you can hold in the palm of your hand, attach it to a tablet, attach it to the phone. So, these are devices one day that we'll be able to have on the sideline or in the athletic trainer's room to do evaluation at halftime or at the end of the game.

Host: Well, now you're really blowing my mind. You know, I just got done watching football yesterday and you always see the players go into the tent, under the tent, you know. And to think that you might be able, in the future, to diagnose almost in real time as an athlete's coming off the field, that's pretty crazy.

Dr. Andrew Hills: Yep, it's pretty much present. The handheld devices just need to be a little bit more accurate.

Host: Yeah. Yeah. Accuracy. It would be important for sure. So just wondering, as we wrap up here, can patients request this? Like, can I just walk in and say, "Hey doc, I got a thing and I want a musculoskeletal ultrasound or a sports ultrasound," or is that really determined by you, by a physician?

Dr. Andrew Hills: Yeah. So, the use is definitely determined by a physician, similar to an x-ray or an MRI. Unfortunately, a physician does have to place an order for that imaging study to be done. But it's definitely something that a patient can bring up just because not all physicians are aware of the numerous benefits, especially from a sports standpoint. So if someone's claustrophobic, and they can't tolerate an MRI, ultrasound becomes a great tool for them. Or if someone has had a prior surgery and there's hardware in that area, unfortunately, that hardware can cause artifacts or distortions in the images when you get an MRI. So, an ultrasound is another tool around that.

Host: Well, you definitely see, you know, especially like someone like yourself who specializes in sports medicine, sports injuries, you know, how you would be familiar with this. Whereas like the orthopedist my daughter went to, a good doctor and all of that, but he doesn't specialize specifically in Sports Medicine. We didn't go to a Sports Medicine clinic, right? So for him, of course, in his world, "Well, you need an MRI, right? And we're going to need contrast because we got to see the labrum and the rotator cuff and all that." And not suggesting he did anything wrong, but it makes me want to give you the opportunity here, I guess, maybe at the end and just talk a little bit about the benefits of seeing someone like yourself.

Dr. Andrew Hills: Yeah. So, I think, you know, again, being a Sports Medicine kind of specialist, we are able to triage patients like that. So, there's a lot of great benefits from an ultrasound standpoint, but one thing we haven't really talked about is the limitation. So, the one area you mentioned is the labrum, which is inside the shoulder joint. Unfortunately, ultrasound, the sound waves can't penetrate through bone. So, that would be a good limitation where an MRI is a little bit more valuable when you're trying to see something within a joint, just because the ultrasound, again, isn't able to penetrate to the bone there.

Host: I see what you mean. So, one way or the other, I'll be sure to tell her, "You were getting the MRI no matter what, no matter who you saw."

Dr. Andrew Hills: Yes, for that situation, I would agree.

Host: Yeah. As it turns out, it was the rotator cuff and minor damage, just needs some PT, but that's a different podcast. That's a dad podcast about daughter's injuries, right? So, as always, it's great to have you on, great to have your expertise. I'm sure we'll speak again in the future. Thanks so much.

Dr. Andrew Hills: Yeah. Thank you.

Host: And for more information about Sports Medicine services at Franciscan Health, go to franciscanhealth.org/sportsmedicine. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.