Ultrasound vs MRI and X-ray
In most office settings, you’re limited to sending someone out for x-ray, which just shows the bony pathology. Most pain related to musculoskeletal complaints tends to be soft tissue related, meaning pain in the muscles, tendons, or the ligaments. In order to image those structures, the patient has to get an MRI, which is very expensive. It’s also very time-consuming for both the patient and the office because for insurance reasons you’re having to call, pre-certify these tests, get them set up, and then hope the patient actually shows up to the appointment on time and gets it done. There are a lot of steps involved.
With ultrasound it’s right there at the point of care. It’s in the room and it’s relatively inexpensive compared to an MRI so most insurance companies don’t mind covering it. If it’s a cash pay patient, the fee can be about ten times less than an MRI. You can see the superficial structures in just as much resolution as with an MRI. It’s possible to diagnose the patient right there in the office and offer treatment on the same day of service, which is really beneficial.
Does ultrasound have advantages over an MRI besides cost?
One of the big advantages of ultrasound that MRI can’t even get close to is dynamic testing. In a MRI, the patient has to remain very still, with ultrasound I can actually put the patient under stress and see what those tissues do under stress. You can see if the meniscus in the knee subluxes out of the joint line when it’s put under stress. And that same concept holds true for the shoulder as well. A lot of times, these subtle rotator cuff tears won’t show up unless you actually put the tendon under stress and then watch it. With ultrasound systems you can watch the soft tissues of the shoulder impinge because you can scan while the patient is performing the motion that causes them pain. This is something that MRI cannot do.
This is the third of five blog posts featuring our conversation with Nr. Nall about injections and other orthopedic and pain management treatments. Last week in part two Dr. Nall explained that learning to use ultrasound is a lot easier than many physicians think.
Our education page features two e-books on learning to use ultrasound for musculoskeletal applications, you can find the download links here.