MSK/SOFT TISSUE

1/27/2021

Reviewer: Dr. Cameron Shoraka

Topic:

MSK/soft-tissue

Articles:

[1] An overview of point-of-care ultrasound for soft tissue and musculoskeletal applications in the emergency department https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-016-0173-0

Summary: Overview of various POCUS soft tissue applications. Soft tissue infections – identification and drainage of abscesses vs cellulitis vs necrotizing fasciitis; Identification and guided removal of foreign bodies that may be radiolucent – such as wood or plastic; joint effusion and arthrocentesis; long bone fractures; muscle and tendon injury or tears; DVT; Line-placement procedures.

[2] Use of point-of-care ultrasound in long bone fractures: a systematic review and meta-analysis

https://pubmed.ncbi.nlm.nih.gov/27916021/ 7916021/

Summary: Systematic meta-analysis of POCUS for diagnosis of long-bone fractures and post-reduction evaluation. N=3506, wide sensitivity and specificity ranges of 64.7-100% and 79.2%-100%, respectively. Best results found among pediatric forearm and adult ankle fractures. Recommended as an adjunct to radiographs for the evaluation of long bone fractures.

[3] Ultrasound-Guided Gleno-humeral Joint Evaluation and Aspiration

US-Guided Gleno-humeral Joint Evaluation and Aspiration

Summary: Step-by-step guide on how to identify and drain gleno-humeral joint effusion using US guidance. Discussion includes review of shoulder anatomy, primary indication for arthrocentesis – mainly clinical concern for septic joint; pre-procedural planning – including sterile technique and local anesthetic injection; US probe positioning for optimal view and needle guidance.

[4] How to Perform Ultrasound-Guided Knee Arthrocentesis

https://www.acepnow.com/article/how-to-perform-ultrasound-guided-knee-arthrocentesis/

Summary: Step-by-step guide on how to perform US-guided knee arthrocentesis. Discussion includes review of shoulder anatomy, primary indications for arthrocentesis – mainly clinical concern for septic joint; pre-procedural planning – including sterile technique and local anesthetic injection; US probe positioning for optimal view and needle guidance.

The American Journal of Emergency Medicine Volume 34, Issue 9, September 2016, Pages 1779-1782

11/30/18

Reviewer: Dr. Paul Eugene

Article: https://www.sciencedirect.com/science/article/pii/S0735675716302157

Prospective observational study performed in a gross anatomy laboratory on the lower extremities of a single embalmed human cadaver to determine the test characteristics of sonographic detection of FBs and to determine if injecting fluid into the soft tissue in the area of a suspected FB changed these test characteristics.

Limitations:

- Differences in cadaveric and live human tissue may likely resulted in sonographic differences in how the foreign body was depicted in the study

- Postinjection evaluation was performed 1 hour after injection of the foreign body, which was longer than the period for pre injection

- The density of the embalmed tissue may have impeded the distribution of the saline around the foreign body

- Sonographers performed 144 evaluations during the course of the experiment, which may have resulted in improved technique and accuracy over time

- The 2 sonographers had met the ACEP minimum requirements for soft tissue ultrasound and had emergency ultrasound fellowship training so the results may not be applicable to novice soongraphers

Practice changing? - No.

Take home point - There was no statistically significant improvement when hydrodissection was used for foreign body identification in this study.