Say "ultrasound," and most people think of pregnant bellies. But ultrasound has a long history of diagnosing all sorts of medical conditions well beyond prenatal testing. As the technology has improved, the ultrasound is becoming an increasingly important tool in sports medicine, said Dr. Peter MacArthur, a primary care sports medicine physician who is part of the Inova Sports Medicine Team, the official hospital network and sports medicine partner of the Washington Nationals.
Ultrasound machines have gotten smaller, with better resolution for peering into the body. Meanwhile, providers who use the devices have gotten even better at interpreting the results, MacArthur said. "We've seen notable improvements even in the last five years."
Understanding Ultrasound
Ultrasound uses high-frequency sound waves to view structures inside the body. It is particularly useful for diagnosing injuries to soft tissues such as muscles, ligaments, tendons and nerves, MacArthur said.
Unlike X-rays, ultrasound doesn't rely on radiation to create images of the body. And while magnetic resonance imaging (MRI) usually creates sharper images of structures deep within the body, ultrasounds have the following clear advantages:
• Accessibility: People with pacemakers or metal implants can't undergo MRIs. Similarly, people with anxiety or claustrophobia might not be willing to get inside the MRI machine. Ultrasound is suitable for a wider degree of patients.

• Portability: If a player is injured on the field, he or she might not get in to the clinic for an X-ray or MRI until the next day. Ultrasound, on the other hand, is lightweight and portable. "You can bring it to the training room, or to away games, and get the exam done sooner," MacArthur said.

• Cost: Ultrasound is an inexpensive form of imaging. It's so cost-effective and quick to use that medical staff can use it to compare injured body parts to their un-injured counterparts. "If you have an injured elbow, you can also look at the other elbow to see how they differ," MacArthur explained. Those types of comparisons would be time consuming and costly with MRI.

• Dynamic examination: With ultrasound, the patient can move a painful limb or injured joint while you're doing the exam to see what structures are getting pinched or moving incorrectly. "You can place the probe exactly where the patient hurts" to zero in on the problem, MacArthur said.

New Uses for an Old Tool
Thanks to advances in ultrasound imaging, sports medicine doctors are finding new ways to use the old technology, MacArthur said.
For instance, sports medicine doctors can use ultrasound to create baseline images of joints at high risk of injury, such as the elbows of pitchers. By cataloguing existing wear to those joints, medical staff can have images to use for comparison if any pitchers suffer an injury.
Ultrasound is also useful for guiding injections to treat irritated muscles and tendons. Such injections include platelet-rich plasma (a blood product rich in growth factors that can promote healing) or corticosteroids (which can reduce inflammation). With ultrasound, doctors can guide those injections directly to the irritated tissue, MacArthur said.
While ultrasound has been a big advantage in the training room, it's just as vital in the clinic for patients of all ages, MacArthur said. It doesn't replace MRI, but it's a great tool for quick diagnosis, he added. "Ultrasound is great for patient care."