Clinical Decision Making and the Application of Musculoskeletal Ultrasound Imaging (MSKUS) in Advanced Orthopaedic Physical Therapy Practice
The addition of musculoskeletal ultrasound imaging is advancing the practice of orthopedic physical therapy. The importance of a thorough history and physical examination has always been the foundation of clinical decision-making and prescriptive care for a physical therapist managing a musculoskeletal disorder. With the rise of direct access, a patient’s ability to receive care from a physical therapist directly and without a physician’s referral continues to advance in the United States. Direct access to physical therapy expedites a patient’s recovery, reduces health care costs, and improves the efficiency of care[i] [ii]. The application of musculoskeletal imaging to the practice of autonomous physical therapy, as an adjunct to the examination, to screen for medical referral and differential diagnosis can increase the effectiveness and efficiency of care [iii]. Studies have shown that 60% of musculoskeletal diagnosis and treatment plans are modified after musculoskeletal ultrasound imaging (MSKUS) is added to the evaluation[iv].
Research has demonstrated that physical therapists providing musculoskeletal care can appropriately order imaging in over 80% of the cases and diagnostic accuracy is equivalent to orthopedic surgeons and significantly better than non-orthopedic providers[vi]. The diagnostic musculoskeletal imaging has been shown to assist physical therapists in the referral of their patients to secondary or specialist care[vii]. Musculoskeletal ultrasound allows a quick and significant impact on the clinical diagnosis after the physical evaluation and immediately directs the plan of care [viii]. The use of MSKUS imaging in physical therapy has grown and adds to the delivery of precise, high-value, and personalized rehabilitation [ix]. Efforts have been initiated and are now in place for physical therapists to obtain competency-based education and certification on the application and use of musculoskeletal ultrasound imaging in the physical therapy practice [x] [xi].
Therapeutic Associates Hillsboro Physical Therapy has a mission of providing “clinical excellence and unparalleled service.” This mission drives our decisions with patient care and training to continually strive to be the experts in our field. Since 2021 Tim Brinker, PT, DPT, MBA, OCS, COMT, FAAOMPT, our clinic director, has been training on the use of musculoskeletal ultrasound imaging for the purpose of diagnostic imaging in rehabilitation and in preparation for certification. He has trained at the American Institute of Ultrasound Medicine and the American Physical Therapy Association’s Combined Section Meetings on the use and application of musculoskeletal ultrasound imaging. The addition of musculoskeletal ultrasound imaging to our clinical practice provides expedited and expert physical therapy care or referral to the appropriate medical provider. Hillsboro Physical Therapy now has Musculoskeletal Ultrasound on-site and when indicated will utilize it with our physical therapy evaluation and for our plan of care development.
[i]Demont A, Bourmaud A, Kechichian A, Desmeules F. The impact of direct access physiotherapy compared to primary care physician led usual care for patients with musculoskeletal disorders: a systematic review of the literature. Disabil Rehabil. 2021 Jun;43(12):1637-1648.
[ii]Yang M, Bishop A, Sussex J, Roland M, Jowett S, Wilson ECF. Economic evaluation of patient direct access to NHS physiotherapy services. Physiotherapy. 2021 Jun; 111:40-47.
[iii] Boyles RE, Gorman I, Pinto D, Ross MD. Physical therapist practice and the role of diagnostic imaging. J Orthop Sports Phys Ther. 2011 Nov;41(11):829-37.
[iv] Micu, M.C., Alcalde, M., Sáenz, J.I., Crespo, M., Collado, P., Bolboacă, S.D. and Naredo, E. (2013), Impact of Musculoskeletal Ultrasound in an Outpatient Rheumatology Clinic. Arthritis Care Res, 65: 615-621.
[v] Crowell MS, Dedekam EA, Johnson MR, Dembowski SC, Westrick RB, Goss DL. Diagnostic Imaging in a Direct-Access Sports Physical Therapy Clinic: A 2-year Retrospective Practice Analysis. Int J Sports Phys Ther. 2016;11(5):708-717.
[vii] Thoomes-de Graaf M, Ottenheijm RPG, Verhagen AP, Duijn E, Karel YHJM, van den Borne MPJ, Beumer A, van Broekhoven J, Dinant GJ, Tetteroo E, Lucas C, Koes BW, Scholten-Peeters GGM. Agreement between physical therapists and radiologists of stratifying patients with shoulder pain into new treatment related categories using ultrasound; an exploratory study. Musculoskelet Sci Pract. 2019 Apr; 40:1-9.
[viii] Micu, M.C., Alcalde, M., Sáenz, J.I., Crespo, M., Collado, P., Bolboacă, S.D. and Naredo, E. (2013), Impact of Musculoskeletal Ultrasound in an Outpatient Rheumatology Clinic. Arthritis Care Res, 65: 615-621.
[ix] Whittaker JL, Ellis R, Hodges PW, et al. Imaging with ultrasound in physical therapy: What is the PT’s scope of practice? A competency-based educational model and training recommendations Br J Sports Med 2019; 53:1447–1453.
[x] Whittaker JL, Ellis R, Hodges PW, et al. Imaging with ultrasound in physical therapy: What is the PT’s scope of practice? A competency-based educational model and training recommendations Br J Sports Med 2019; 53:1447–1453.
[xi] Alliance for Physician Certification and Advancement. (2022) RMSK for Physical Therapists
