Use of Ultrasound for Identification of Musculoskeletal Injury in Active Populations

Lower extremity tendinopathies and fasciopathy conditions are prevalent amongst sedentary individuals,1,2 athletes,3,4 elite runners,5,6and military personnel7 and can lead to chronic disability and reduction in quality of life. 8,9 Both tendinopathy and fasciopathy are thought to be mechanical in nature and caused by acute or chronic overloading leading to a disruption in the uniformity of the soft tissue structure. Ultrasound imaging has gained popularity in the last decade among many sports medicine clinicians to gain information regarding tissue structure for musculoskeletal injury (MKSI) management. Ultrasound imaging allows for the evaluation of in-vivo structures and at a relatively low cost with minimal assessment times.10–12 However, the relationship between tendon structure and other signs and symptoms of overuse injuries such as these are not fully understood. The overarching purpose of this dissertation was to investigate the role of musculoskeletal ultrasound imaging in identifying abnormal soft tissue changes and the relationship between abnormal structure and function. The first study evaluated whether those with plantar heel pain had significant differences in tendon structure than those without plantar heel pain. Results identified that those with plantar heel pain did have significant thickening of the patellar tendon via ultrasound evaluation; thus, providing evidence that ultrasound assessments may be useful in identifying structural changes in overuse pathologies. The second study sought to describe the relationship between patellar tendon morphology and lower extremity function. The systematic review revealed a high amount of variability in methodological approaches within included studies; thus, identifying a need in future research to identify a uniform approach to evaluating patellar tendon structural changes of interest and outcomes of lower extremity function. Furthermore, it did reveal that there is a weak relationship between self-reported function and focal thickening or echogenicity changes. Additionally, there is low level evidence to support differences in landing patterns in those with patellar tendon abnormality (PTA) compared to controls; however, it may be task dependent. Lastly, the third study primarily explored whether PTA was predictive of future patellar tendinopathy and lower extremity MSKI in military trainees. Those with PTA were found to not have an increased risk of lower extremity MSKI and the risk of patellar tendinopathy was unclear due to a lack of patellar tendinopathy cases. Secondarily, the study investigated the relationship between PTA and lower extremity function. In congruence with previous findings from the systematic review, there were no significant associations between self-reported or objective measures of function. Further research is still needed to assess the relationship between structure and function and the importance of abnormal structure to long term musculoskeletal health in broader populations and larger cohorts. Ultrasound evaluation may still provide useful information in the evaluation of MSKI but should be used in conjunction with other clinical tests and self-reported symptoms to guide diagnosis and management.