Musculoskeletal (MSK) diseases are most common among elderly patients, affecting nearly three out of four people aged 65 and older in the United States. Although trauma, back pain, and arthritis are among the most common MSK conditions among the elderly population (and the leading driver of physician visits)[1], it remains vulnerable to a wide variety of others.
Ultrasound has long been a core pillar of diagnostic assessment for geriatric and elderly residents.[2] Beyond real-time diagnosis of acute injury, it can help clinicians monitor the progression of pre-existing health issues and identify the potential risk of new ones. MSK conditions, often treated and managed in emergency settings, can now be managed elsewhere, such as general practitioners' (GPs) offices, [3] thanks, in large part, to the growing accessibility of ultrasound scans.
Practical benefits of primary care ultrasound for elderly patients
Patients of advanced age face a unique set of challenges when it comes to interacting with their care providers. Logistics, mobility, and other factors may prevent them from seeing their care team as often as they should. At the same time, as patients age, they grow more susceptible to co-occurring health issues that require treatment from multiple specialists; this circumstance reveals the criticality of comprehensive and coordinated care.
As the clinicians who diagnose and treat the majority of MSK issues,[2] GPs are uniquely empowered to leverage ultrasound to expedite and enrich related patient quality of care. Primary care office scans can spare patients a series of challenges, offering a time-sensitive diagnosis without the logistical burden of traveling to a separate location.
Additionally, patients in long-term care facilities can have MSK ultrasounds performed right at their bedside, thanks to the portability of some of today's systems.
Clinical benefits of MSK ultrasound for patients of advanced age
MSK ultrasound is an effective resource in the diagnosis and treatment of a wide range of conditions common among older patients, including, but not limited to:
Impact-related injuries from falls
Trips and falls are unfortunately common among people of advanced age: The Centers for Disease Control and Prevention (CDC) reports that one in four older adults suffer falls each year.[4] When patients do suffer falls, ultrasound can help assess the extent of the damage, the subsequent risk of further injury, and even the risk of infection.
Degenerative and rheumatic joint diseases
Ultrasound is one of the most viable diagnostic tools for determining the risk, onset, and progression of osteoarthritis, bursitis, rheumatoid arthritis, and other degenerative diseases. Many of today's systems offer clearer-than-ever images of tissue, nerves, and tendons, allowing clinicians to assess the full scope of degeneration.
MSK scans can address multiple phases of a patient's condition, whether they're just starting to experience wear-and-tear on their joints or have been living with pain for years. Ultrasound can help with early detection, dictate the course of treatment, and inform maximum patient comfort and quality of life. For example, scans can help evaluate and assess synovitis, erosions, and cartilage changes to accurately measure the progression of arthritis.[5]
Peripheral nerve issues
Ultrasound is a fundamental component in diagnosing entrapment neuropathies, such as carpal tunnel syndrome or ulnar neuropathy, affecting ~8% of adults aged 55 or older; these conditions become much more prevalent with progressing age. Scans can help detect and evaluate traumatic, inflammatory, infective, neoplastic, and compressive pathologies of the peripheral nerves.[6]
MSK infections
Hospitals, nursing homes, and long-term care and other facilities housing elderly patients are prone to higher rates of infection. Soft-tissue infection is the second-leading cause of musculoskeletal infection, behind osteomyelitis, which is not generally detectable through ultrasound. High-resolution scans have become instrumental in diagnosing soft tissue and joint infections, allowing for prompt treatment and decreased risk of complications. These conditions include soft tissue edema and hyperemia, lymphadenopathy, thrombophlebitis, joint effusion/synovitis, bursal distention and inflammation, tenosynovitis, soft tissue abscesses, and periosteal abscesses.[7]
MSK scans can also help localize nerve abnormalities and assess nerve size, shape, and mobility. Guided nerve blocks or injections can be used for targeted pain management.
Choosing the right system for MSK ultrasound
While innovations in ultrasound make it easier for GPs to deftly perform MSK scans, regardless of their experience level, the right system makes all the difference. Features that allow you to evaluate MSK inflammatory disease clearly, define distinct structure borders, and obtain an intuitive representation of non-quantitative hemodynamics in vascular structures help optimize scan clarity.
Your system should also offer scalable probe configuration that allows you to perform more complex and diverse scans as your needs and capabilities evolve. Image optimization features can help you automatically adjust clarity and brightness mid-scan. Needle-recognition software can provide a precise and accurate display of the needle, anatomy, and motion, while intuitive workflow features like hands-free voice commands and automated presets allow you to save time and perform optimal scans with less assistance.
Additionally, follow-up tools allow for the quick and easy comparison of current and past scans, enabling an efficient assessment of condition progression. All of these features shrink the learning curve for general practitioners, whose patients rely on them for timely and accurate diagnosis. The right ultrasound device can help guide your MSK patients toward better-informed, higher-quality treatment, all while helping you grow your practice.
REFERENCES:
- Weinstein S, Watkins-Castillo S, et al. The burden of musculoskeletal diseases in the United States. United States Bone and Joint Initiative. 2024. https://www.boneandjointburden.org/
- Mashov R & Tabenkin H. How family physicians estimate their knowledge and skills in musculoskeletal problems. Harefuah. 2011 Mar;150(3):242-5, 304. https://pubmed.ncbi.nlm.nih.gov/21574357/
- De Jesús K, Ramos-Guasp W, et al. Musculoskeletal conditions in older men and women: an emergency room study. Puerto Rico Health Sciences Journal. 2022; 41(2), 56–62.
- Gogtay M, Choudhury RS, et al. (2023). Point-of-care ultrasound in geriatrics: a national survey of VA medical centers. BMC Geriatrics. 2023;23(1), 605. https://doi.org/10.1186/s12877-023-04313-2
- Ramadan A, Tharwat S, et al. Ultrasound detected synovitis, tenosynovitis and erosions in hand and wrist joints: a comparative study between rheumatoid and psoriatic arthritis. Reumatologia. 2021;59(5), 313–322. https://doi.org/10.5114/reum.2021.110550
- Lawande AD, Warrier SS, et al. (2014). Role of ultrasound in evaluation of peripheral nerves. The Indian Journal of Radiology & Imaging. 2014;24(3), 254–258. https://doi.org/10.4103/0971-3026.137037
- Weaver JS, Omar I, et al. High-resolution ultrasound in the evaluation of musculoskeletal infections. Journal of Ultrasonography. 2023;23(95), e272–e284. https://doi.org/10.15557/jou.2023.0034
