Use of musculoskeletal ultrasound in clinical studies in physiatry: the "stethoscope" is also becoming the "pen".

In parallel with the ever-increasing use of musculoskeletal ultrasound (MSUS) in physical and rehabilitation medicine (PRM), the number of publications by physiatrists on this subject is also increasing (1). In order to provide a worldwide overview of the literature on this topic, we have reported previously on the country/journal/year distribution (2). However, in an attempt to draw the attention of physiatrists towards other possible topics to be studied with MSUS, the aim of the current paper is to provide an in-depth analysis of the relevant literature, with special emphasis on topic distribution. As it is likely that MSUS will soon become one of the most important diagnostic tools for physiatrists (similar to, or more important than, electromyography), we believe that such analysis is essential in developing the future plans of our society. A PubMed search was performed in December 2012 using the following key words: " musculoskeletal ultrasound " , " musculoskeletal ultrasonography " , " muscle ultrasonography " , " tendon ultrasonography " , " joint ultrasonography " , " nerve ultrasonography " , and " ultrasound guided injection ". The key word " rehabilitation " was added to all of these search alternatives (e.g. " musculoskeletal ultrasonography " AND " rehabilitation ") in order to include publications by physiatrists and papers published in the field of rehabilitation. A total of 268 publications was found for the period January 1988 to December 2012. The journal categories and article types are listed in Tables I and II, respectively. The study types were as follows: randomized controlled 33 (12.3%), controlled (non-randomized) 60 (22.4%), cross-sectional 71 (26.5%), cohort/case studies 46 (17.2%), review 16 (6%) and case report 42 (15.6%). A total of 245 (91.5%) papers were in vivo human studies, 21 (7.8%) were cadaver studies, and 2 (0.7%) were studies conducted in bovine animals. The body regions and tissues studied are summarized in Fig. 1; knee (18.7%), shoulder (13.4%), muscle (26.1%) and tendon (17.2%) were the most commonly studied regions and tissues. Concerning pathologies, orthopaedic problems (29.9%) were the overwhelming category, followed by peripheral neuropathies (particularly entrapments) (16.4%), neurologi-cal disorders (stroke, spinal cord injury, traumatic brain injury, cerebral palsy, and spasticity) (13.1%), osteoarthritis and rheumatological disorders (12.7%), muscle disorders (myositis, mass lesions, myofascial pain syndrome) (7.1%), and physiological conditions of muscles or tendons (13.8%). In 182 studies (67.9%) MSUS was used as a diagnostic tool, in 63 studies (23.5%) it was used …