Clinical Applications of Ultrasonography in the Shoulder and Elbow.

In the past 30 years, the use of ultrasonography in the field of orthopaedics has evolved. As ultrasonography has been refined, smaller machines with higher fidelity and better transducers have become available at a lower cost. Diagnostic and therapeutic applications of ultrasonography in the shoulder and elbow have expanded imaging options and provided alternatives to surgical management. Ultrasonography is a dynamic tool that affords immediate diagnostic assessment for clinical correlation and can be used for serial examinations and image guidance during therapeutic procedures. This imaging modality is highly reliable and accurate and may limit the need for costly imaging referrals, particularly in geographic areas where advanced imaging is not readily available. However, clinical expertise is paramount for ultrasonography, which is an operator-dependent modality. Ultrasonography is an effective educational resource; therefore, the curriculum in orthopaedic residency training programs should include education on this modality as the use of ultrasonography increases among orthopaedic surgeons.

Whole body and local muscle vibration reduce artificially induced quadriceps arthrogenic inhibition.

OBJECTIVE: To evaluate the effects of whole body vibration (WBV) and local muscle vibration (LMV) on quadriceps function after experimental knee effusion (ie, simulated pathology). DESIGN: Randomized controlled trial. SETTING: Research laboratory. PARTICIPANTS: Healthy volunteers (N=43) were randomized to WBV (n=14), LMV (n=16), or control (n=13) groups. INTERVENTIONS: Saline was injected into the knee to induce quadriceps arthrogenic muscle inhibition (AMI). All groups then performed isometric squats while being exposed to WBV, LMV, or no vibration (control). MAIN OUTCOME MEASURES: Quadriceps function was assessed at baseline, immediately after effusion, and immediately and 5 minutes after each intervention (WBV, LMV, control) via voluntary peak torque (VPT) and the central activation ratio (CAR) during maximal isometric knee extension on a multifunction dynamometer. RESULTS: The CAR improved in the WBV (11.4%, P=.021) and LMV (7.3%, P<.001) groups immediately postintervention, but they did not improve in the control group. Similarly, VPT increased by 16.5% (P=.021) in the WBV group and 23% (P=.078) in the LMV group immediately postintervention, but it did not increase in the control group. The magnitudes of improvements in the CAR and VPT did not differ between the WBV and LMV groups. CONCLUSIONS: Quadriceps AMI is a common complication following knee pathology that produces quadriceps dysfunction and increases the risk of posttraumatic osteoarthritis. Quadriceps strengthening after knee pathology is often ineffective because of AMI. WBV and LMV improve quadriceps function equivocally after simulated knee pathology, effectively minimizing quadriceps AMI. Therefore, these stimuli may be used to enhance quadriceps strengthening, therefore improving the efficacy of rehabilitation and reducing the risk of osteoarthritis.