Economics of Musculoskeletal Ultrasound

Abstract

Purpose of review: Healthcare costs have exploded in the past 30 years and they are a major concern for governments worldwide. Care management of musculoskeletal disorders and advanced imaging account for a large part of this socioeconomic burden.

Recent findings: Musculoskeletal ultrasound is now performed primarily by nonradiologists. Both musculoskeletal ultrasound and MRI total utilization rates continue to increase. Despite the existence of evidence-based diagnostic recommendations and the potential cost-savings of using musculoskeletal ultrasound instead of MRI in certain clinical situations, ensuring appropriate use of imaging among health professionals remains difficult for various reasons.

Summary: In the context of healthcare budgets restraints, use of imaging must be shown scientifically, to improve patient outcomes and be cost-effective. Current evidence recommends musculoskeletal ultrasound as the primary imaging modality in the investigation of rotator cuff disease. Policies aiming at ensuring the application of imaging guidelines among physicians are needed.

Keywords: Economics; Healthcare costs; Imaging; Magnetic resonance imaging; Musculoskeletal system; Ultrasonography.

Fig. 1

Retromalleolar intrasheath peroneal tendon subluxation in a young downhill skier occult at MRI and demonstrated at dynamic ultrasound examination. a Transverse ultrasound scan at the level of the lateral malleolus with the ankle at rest shows the peroneus longus (L) and peroneus brevis, (B) tendons in anatomical position. The arrow points at a mildly thickened superior retinaculum. b During active ankle eversion, the tendons abruptly interchange position within the retromalleolar groove. Note the increased laxity of the superior retinaculum (arrow). c As the ankle is brought into neutral position, the tendons suddenly switched back to their anatomical position. (arrow = superior retinaculum)