Ultrasound - Musculoskeletal

Ultrasound imaging uses sound waves to produce pictures of muscles, tendons, ligaments, nerves and joints throughout the body. It is used to help diagnose sprains, strains, tears, trapped nerves, arthritis and other musculoskeletal conditions. Ultrasound is safe, noninvasive, and does not use ionizing radiation.

Ultrasound can also be used to guide injections allowing the clinician to visualize the needle tip in the appropriate target.

What is ultrasound imaging of the musculoskeletal system?

Ultrasound imaging is a noninvasive medical test that helps physicians diagnose and treat medical conditions which is safe and completely painless. It produces pictures of the inside of the body using sound waves. It uses a small probe called a transducer and gel placed directly on the skin. High-frequency sound waves travel from the probe through the gel into the body. The probe collects the sounds that bounce back and a computer uses those sound waves to create an image. Ultrasound exams do not use any radiation making them safe for everyone. Because ultrasound captures images in real time, it can show structure and movement. The images can also show blood flowing through blood vessels.

Ultrasound images of the musculoskeletal system provide pictures of muscles, tendons, ligaments, joints, nerves and soft tissues throughout the body.

Ultrasound also allows visualization of a needle making joint and soft tissue injections extremely accurate

What are some common uses of the procedure?

Ultrasound images are typically used to help diagnose:

  • Tendon tears or tendinitis. Common areas are the rotator cuff and Achilles tendon and “tennis elbow”
  • Muscle tears, masses or fluid collections.
  • Ligament sprains or tears.
  • Inflammation or fluid (effusions) within the bursae and joints.
  • Nerve entrapments such as carpal tunnel syndrome.
  • Foreign bodies in the soft tissues (such as splinters or glass).

How should I prepare?

Wear comfortable, loose-fitting clothing. The area being examined will need to be exposed. If needed you may change into a gown for the procedure.

No other preparation is required.

How is the procedure performed?

For certain ultrasound examinations of the musculoskeletal system, the patient may be seated on an examination table or a swivel chair. For other ultrasound exams, the patient is positioned lying face-up or face-down on an examination table. The clinician may ask you to move the extremity being examined or may move it for you to evaluate the anatomy and function of the joint, muscle, ligament or tendon.

A water-based gel is applied to the area of the body under examination which helps the transducer make secure contact with the body. The clinician places the transducer on the body and moves it back and forth over the area of interest until it captures the desired images.

There is usually no discomfort from pressure as they press the transducer against the area being examined. However, if the area is tender, you may feel pressure or minor pain from the transducer.

What are the benefits vs. risks?


  • Ultrasound imaging is extremely safe and does not use radiation.
  • Ultrasound scanning gives a clear picture of soft tissues that do not show up well on x-ray images.
  • Ultrasound provides real-time imaging. This makes it a good tool for guiding injections and fluid aspirations
  • Patients with cardiac pacemakers and certain types of metallic implants or fragments in the body often cannot have MRIs, however, patients can safely receive ultrasound imaging.
  • Ultrasound is also an excellent alternative to MRI for claustrophobic patients.
  • Compared to MRI, ultrasound may be superior in providing internal detail when assessing soft tissue structures such as tendons and nerves.
  • Because ultrasound images are captured in real time, they can show the movement of a soft tissue structure such as a tendon, joint or an extremity.


  • Standard diagnostic ultrasound has no known harmful effects on humans.

What are the limitations of ultrasound imaging of the musculoskeletal system?

Ultrasound has difficulty penetrating bone and, therefore, can only see the outer surface of bony structures and not what lies. Doctors typically use other imaging modalities such as MRI to visualize the internal structure of bones or certain joints. There are also limitations to the depth that sound waves can penetrate; therefore, deeper structures in larger patients may be difficult to see.


Ultrasound testing is used to better understand your condition.


Buffalo Spine and Sports Medicine was the first group in Buffalo to introduce ultrasound for the evaluation and management of joint and soft tissue and nerve disorders. It complements and allows for more accurate diagnosis and safer procedures.

• Direct external trauma
• Acute lesions - Strains, contusions/crush injury, muscle ruptures (common in athletics)
• Chronic lesions - Fibrous scars, cystic hematomas, myositis ossificans
• Neuromuscular pathologies - Progressive dystrophies, myotonic dystrophies, inflammatory myopathies spinal muscular atrophy (multifidus)
• Inflammatory and degenerative arthritis - RA, DJD
• Peripheral neuropathies - Carpal/tarsal tunnel

“The doctor conducted an ultrasound and then began manipulating my leg. He kept examining not only my calf, but my foot as well. Finally he determined that I had suffered a tear in the muscle, deep in the part of my calf that supports the big toe.” ~ Patrick