Shawn C. Roll, Julie McLaughlin Gray, Gelya Frank, Monique Wolkoff; Exploring Occupational Therapists’ Perceptions of the Usefulness of Musculoskeletal Sonography in Upper-Extremity Rehabilitation. Am J Occup Ther 2015;69(4):6904350020. https://doi.org/10.5014/ajot.2015.016436
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© 2020 American Occupational Therapy Association
OBJECTIVE. To identify the potential utility of musculoskeletal sonographic imaging in upper-extremity rehabilitation.
METHOD. Two occupational therapists in an outpatient hand rehabilitation clinic were recruited by convenience, were trained in the use of sonography, and implemented sonographic imaging in their clinical practice. Qualitative data were obtained during and after the implementation period by means of questionnaires and interviews. Data collection, analysis, and interpretation were completed in an iterative process that culminated in a thematic analysis of the therapists’ perceptions.
RESULTS. The data indicate four potential areas of utility for musculoskeletal sonography in upper-extremity rehabilitation: (1) mastering anatomy and pathology, (2) augmenting clinical reasoning, (3) supplementing intervention, and (4) building evidence.
CONCLUSION. Numerous potential uses were identified that would benefit both therapist and client. Further exploration of complexities and efficacy for increasing patient outcomes is recommended to determine best practices for the use of musculoskeletal sonography in upper-extremity rehabilitation.
This is another way to just scan yourself or your friend and see that a muscle is deeper down than another muscle, or see what happens when you flex. So I think it’s just a great way for people to learn, even beyond 3-D models or videos, as opposed to flash cards or anatomy coloring books and things like that. (T1)
Just observing [T2], who’s a beginner, I think she picked it up really fast, and it was a great way for her to learn anatomy because you can definitely see superficial and deeper muscles, and you’re seeing them as they’re working. I would look at her and say, “Do you know how lucky you are instead of just looking at a still from a book?”
I did one scan of a client with a diagnosis of thumb extensor tenosynovitis. Initially I was looking for edema around the extensor pollicis longus. I was expecting to just see a black area around the tendon indicating some liquid. I found this circular black area in the joint space between the radius and the carpal bones. I thought I had found inflammation that was impacting her movement. We reviewed it with [the trainer] later. He scanned his own hand and showed that there is actually that amount of fluid in this joint space in normal anatomy.
For cases where the diagnosis is not very specific, it’s nice to be able to get some information about where the inflammation is occurring, or what type of inflammation it might be, because it could be inflammation within the tendon itself or just tenosynovitis around the tendon.
We were curious whether there is any glide of the tendon, and we were able to scan and see that the tendon really ends and turns into scar tissue at the proximal phalanx. So there's no gliding of the tendon; the movement that we're seeing is purely the tendon pulling on the scar tissue. (T2)
[Seeing the scarring] definitely changed how I'm going to approach treatment because treatment now is going to probably mostly focus on increasing his MP flexion and strengthening lumbricals. I don't think he has interossei. It’s definitely going to have an impact on how I spend my time throughout therapy. (T2)
Right now when I work with clients, I’ll pull out a picture from a book. But, how cool is it when it’s your own hand, and it’s your own hand moving, versus a picture in a book? So, I think motivation; visualizing your own healing and where you’re stuck, I think, is very powerful.
It was just a little incision, and [she said] “It’s really bothering me. I can’t type. I can’t go back to work. I can’t hold the mouse. It’s driving me insane.” I think that was validating to say, “Yes, it is stuck underneath, and what you’re describing is right.” It calmed her anxiety to see pictures of her own hand and that I was spending time with her about it. (T1)
There’s a lot more in health care that we’re finding out that we have this big [mind–body] connection, so I try to bring that in with the people that I treat, and I think that [sonography] is just such a visual motivator. (T1)
Sonographic imaging may assist therapists in mastering anatomy and pathology, inform clinical reasoning, and improve the planning and delivery of interventions.
Sonography may enhance client motivation and engagement in the treatment process through education and biofeedback.
The inclusion of sonography in clinical practice may prove a viable tool for outcomes research and increase the evidence base for upper-extremity rehabilitation.
Further studies are necessary to develop effective training models, identify best practices for implementation, and evaluate the relationship between the clinical use of sonographic imaging and client motivation, engagement, adherence, and outcomes.
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