Ultrasound of two symmetrical joints

Ultrasound of two symmetrical joints - for example, both knees, shoulders or ankles - is a non-invasive method for evaluating articular and periarticular structures in real time.

The examination allows assessment of joint fluid and the synovial membrane, articular cartilage, tendons, ligaments, joint capsule and adjacent soft tissues, as well as identification of signs of inflammation, edema, fluid collections, and degenerative, traumatic or other structural changes.

Examination of symmetrical joints allows them to be compared directly and helps identify even subtle differences between the right and left sides.

When necessary, color and power Doppler may be used to assess blood flow and signs of inflammatory activity.

Indications

• joint pain, discomfort or stiffness;
• joint swelling or edema;
• limited mobility;
• pain during movement or physical activity;
• suspected inflammatory joint disease;
• suspected synovitis, bursitis or tenosynovitis;
• suspected degenerative joint changes;
• injuries and post-traumatic changes;
• assessment of tendons and ligaments;
• follow-up of previously identified changes;
• assessment of treatment effectiveness;
• comparison of symmetrical joints;
• other indications as recommended by the physician.

Limitations

The diagnostic value of the examination may depend on the depth of the structures being assessed, the degree of edema, anatomical features, deformities, and post-traumatic or postoperative changes.

Ultrasound provides effective visualization of soft tissues, tendons, ligaments, joint fluid and other superficially located structures, but has certain limitations in assessing some bone abnormalities and deeply located structures. When necessary, the physician may recommend additional investigations such as X-ray, CT or MRI.

Contraindications

There are no absolute contraindications to diagnostic ultrasound.

In cases of significant tenderness, skin lesions or other local changes, the examination technique may be adapted according to the patient's condition.

Procedure

The patient is positioned on the examination table in the position required for a complete assessment of the joints being examined.

Ultrasound gel is applied to the area being examined. The physician sequentially examines the two symmetrical joints, assessing their articular and periarticular structures.

Depending on the clinical situation, joint fluid, synovial membrane, cartilage, tendons, ligaments, joint capsule and adjacent soft tissues are assessed.

When necessary, color and power Doppler are performed to evaluate blood flow and inflammatory activity.

The examination usually takes approximately 20–30 minutes, depending on the area being examined and the findings identified.

Sources:

https://www.radiologyinfo.org/en/info/musculous https://pmc.ncbi.nlm.nih.gov/articles/PMC9958559/
https://link.springer.com/book/10.1007/978-3-540-28163-4
https://www.ccjm.org/content/85/4/283      
https://www.radiologyinfo.org/en/info/musculous
https://smw.ch/index.php/smw/article/view/1793/2470
https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-019-2050-4