Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

Musculoskeletal ultrasonography: Nomenclature, technical considerations, validation, and standardization

George AW Bruyn, MD, PhD
Section Editor
Robert H Shmerling, MD
Deputy Editor
Monica Ramirez Curtis, MD, MPH


Ultrasonography (US), also referred to as ultrasound imaging or sonography, is an imaging modality that utilizes reflected pulses of high-frequency (ultrasonic) sound waves to assess soft tissues, cartilage, bone surfaces, and fluid-containing structures. US imaging, at one time the sole province of radiologists, has become now widely available in rheumatology clinics and other ambulatory and emergency settings. However, the widespread use of US by clinicians who diagnose and treat musculoskeletal disorders has been hampered by questions related to the reliability, validity, standardization, methodology, and ability to detect changes over time. These issues and technical aspects of musculoskeletal US are addressed in detail separately. (See "Musculoskeletal ultrasonography: Clinical applications".)

The use of US to assess patients with rheumatic diseases in the clinic was fostered by the development of compact real-time US systems in the 1980s. Synovitis of the knee was the earliest musculoskeletal disorder assessed ultrasonographically in the clinic [1]. US assessment of synovitis of the small joints of the hands in patients with rheumatoid arthritis (RA) followed by a decade [2]. Availability in the 1990s of high-resolution transducers made detailed assessment of superficial structures feasible.

The nomenclature, technical considerations, validity, and reliability of musculoskeletal US are discussed here. Imaging modalities generally used to diagnose disorders of the musculoskeletal system and guidelines for selecting imaging studies (eg, plain film radiography, computed tomography [CT scan], magnetic resonance imaging [MRI], and US) for selected musculoskeletal problems are presented separately. (See "Imaging techniques for evaluation of the painful joint" and "Radiologic evaluation of the painful hip in adults" and "Radiologic evaluation of the painful shoulder".)

The use of US to screen for, diagnose, and monitor the response of osteoporosis to treatment requires dedicated, special-purpose devices rather than US imaging systems to assess bone mineral content. (See "Screening for osteoporosis", section on 'Ultrasound'.)


Various terms are used to describe ultrasonographic (US) equipment, transducer and image orientation, normal and abnormal features in acquired images, and artifacts.


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Jan 2017. | This topic last updated: Fri May 08 00:00:00 GMT+00:00 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Cooperberg PL, Tsang I, Truelove L, Knickerbocker WJ. Gray scale ultrasound in the evaluation of rheumatoid arthritis of the knee. Radiology 1978; 126:759.
  2. De Flaviis L, Scaglione P, Nessi R, et al. Ultrasonography of the hand in rheumatoid arthritis. Acta Radiol 1988; 29:457.
  3. Torp-Pedersen S, Christensen R, Szkudlarek M, et al. Power and color Doppler ultrasound settings for inflammatory flow: impact on scoring of disease activity in patients with rheumatoid arthritis. Arthritis Rheumatol 2015; 67:386.
  4. Bruyn GAW, Schmidt WA. Introductory Guide to Musculoskeletal Ultrasound for the Rheumatologist, 2nd, Bohn Stafleu van Loghum, Houten 2011.
  5. Backhaus M, Burmester GR, Gerber T, et al. Guidelines for musculoskeletal ultrasound in rheumatology. Ann Rheum Dis 2001; 60:641.
  6. Torp-Pedersen ST, Terslev L. Settings and artefacts relevant in colour/power Doppler ultrasound in rheumatology. Ann Rheum Dis 2008; 67:143.
  7. Wakefield RJ, Balint PV, Szkudlarek M, et al. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 2005; 32:2485.
  8. Joshua F, Lassere M, Bruyn GA, et al. Summary findings of a systematic review of the ultrasound assessment of synovitis. J Rheumatol 2007; 34:839.
  9. Wakefield RJ, Gibbon WW, Conaghan PG, et al. The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography. Arthritis Rheum 2000; 43:2762.
  10. Scheel AK, Schmidt WA, Hermann KG, et al. Interobserver reliability of rheumatologists performing musculoskeletal ultrasonography: results from a EULAR "Train the trainers" course. Ann Rheum Dis 2005; 64:1043.
  11. Naredo E, Möller I, Moragues C, et al. Interobserver reliability in musculoskeletal ultrasonography: results from a "Teach the Teachers" rheumatologist course. Ann Rheum Dis 2006; 65:14.
  12. Wakefield RJ, D'Agostino MA, Iagnocco A, et al. The OMERACT Ultrasound Group: status of current activities and research directions. J Rheumatol 2007; 34:848.
  13. Karim Z, Wakefield RJ, Quinn M, et al. Validation and reproducibility of ultrasonography in the detection of synovitis in the knee: a comparison with arthroscopy and clinical examination. Arthritis Rheum 2004; 50:387.
  14. Bruyn GA, Naredo E, Damjanov N, et al. An OMERACT reliability exercise of inflammatory and structural abnormalities in patients with knee osteoarthritis using ultrasound assessment. Ann Rheum Dis 2016; 75:842.
  15. Bruyn GA, Naredo E, Möller I, et al. Reliability of ultrasonography in detecting shoulder disease in patients with rheumatoid arthritis. Ann Rheum Dis 2009; 68:357.
  16. Bruyn GA, Möller I, Garrido J, et al. Reliability testing of tendon disease using two different scanning methods in patients with rheumatoid arthritis. Rheumatology (Oxford) 2012; 51:1655.
  17. Taylor PC, Steuer A, Gruber J, et al. Comparison of ultrasonographic assessment of synovitis and joint vascularity with radiographic evaluation in a randomized, placebo-controlled study of infliximab therapy in early rheumatoid arthritis. Arthritis Rheum 2004; 50:1107.