Fundamentals of Musculoskeletal Ultrasound, 3rd Edition

Jacobson JA. Fundamentals of Musculoskeletal Ultrasound. 3rd ed. Elsevier; 2017; 472 pp; $99.99

Cover of Jacobson

Ultrasound as an imaging modality has proven to be a very useful and cost-effective tool in the diagnosis of musculoskeletal disorders. Recent improvements in portability and imaging resolution have further expanded its value and turned it into one of the primary methods for initially evaluating musculoskeletal injuries.

Dr. Jon A. Jacobson, Professor of Radiology at the University of Michigan, crowns his vast research and academic activities with this well-organized and easily accessible textbook.

Now in its third edition, this title provides a comprehensive review of the utility of ultrasound in the assessment of musculoskeletal disorders and covers all of the salient points needed to make an accurate diagnosis, including the basics of anatomy, scanning techniques, patient positioning, pathologies, imaging pitfalls, and controversies.

The volume is comprised of 9 chapters and a preface, designed to help the reader understand the principles of musculoskeletal ultrasound and therefore practice with more confidence. Numerous examination checklists and sample reports make it an excellent resource for quick consults.

The text contains almost 1200 high-quality images and over 200 narrated video clips of real-time dynamic ultrasound imaging. The high-resolution images in each chapter effectively demonstrate normal anatomy and pathology. The narrated videos (available online) splendidly demonstrate not only normal anatomy and pathology, but also patient positioning and technique. Together, they turn this edition into a helpful teaching tool that enables the dynamic character of ultrasound to be studied and assessed more effectively by the reader.

Chapter 1 outlines some of the basic concepts concerning the use and purpose of ultrasound explicitly. These basics range from understanding how to properly use the machine to best interpret what is visualized to different scanning techniques needed to more accurately depict musculoskeletal pathologies. It begins by outlining normal anatomy, an often overlooked but much-needed first step in the learning process, particularly by residents-in-training. Chapter 2 then looks at the general concepts of pathologies seen on ultrasound. It covers an interesting range of abnormalities, including muscle, tendon, and bone injuries, musculoskeletal infections, arthritis, muscle infarction, and soft-tissue masses, giving the reader a good reference for usual pathologic patterns that can be applied to different anatomic structures. The limitations of musculoskeletal ultrasound are also delineated in these 2 chapters.

Chapters 3–8 are each dedicated to a particular body part and include detailed discussions of related pathologies and ultrasound-guided treatments. Each of these chapters begins with a helpful review of the gross anatomy in order to help the reader put the upcoming ultrasound images into the right perspective. The sections provide thorough discussions of common abnormalities, sample radiology reports of actual musculoskeletal cases, and checklists that outline how to evaluate ultrasound images. Along with the anatomy review, there are figures that demonstrate the proper technique and placement of the ultrasound probe with its corresponding ultrasound imaging. Postoperative changes  as seen on ultrasound are also covered, in addition to common errors that may lead to misinterpretation. At the end of each chapter, the author provides a list of updated references and their respective website links, so the reader can expand their research and understanding of the given subject. Chapter 4, in particular, serves the reader with a remarkable review on rotator cuff injuries, as it goes into detail on normal anatomy and the most common lesions that affect each of the structures of the joint, with a rich description of every subtopic, helped by a vast number of imaging examples.

A nice wrap-up takes place with a meaningful discussion in Chapter 9 of musculoskeletal interventional radiology, a rapidly growing field. The most common percutaneous ultrasound-guided musculoskeletal procedures are described, including optimal transducer and needle positioning. Even if somewhat concise, it still gives the reader a good overview of the different ultrasound-guided procedures and their roles in serving the patient’s best interest.

Although the textbook comments on some pediatric musculoskeletal pathologies, it would be improved if it offered an in-depth discussion of the common pediatric musculoskeletal disorders and their corresponding ultrasound images. This could have been accomplished by either adding standard pediatric ultrasound images related to the musculoskeletal system in the respective chapters, or by dedicating a chapter specifically to high-yield pediatric musculoskeletal ultrasound findings. Furthermore, it would have been helpful if discussions regarding the differences in probe size for the pediatric population and how to properly evaluate growth plates on ultrasound would have been included.

Another potentially useful future addition could be an expanded section on emergency and trauma musculoskeletal ultrasound. This subject is appraised briefly in Chapter 2, which mentions some of the advantages of ultrasound when compared with plain films in specific scenarios such as occult ankle and foot fractures. Nevertheless, it would be interesting to see a more complete review of this topic, especially considering the fast-developing role of point-of-care ultrasound in the emergency department.

Overall, this textbook is an extensive and comprehensive review of ultrasound and its application to musculoskeletal medicine. It is an excellent resource for the beginner radiologist and a great reference for the advanced specialist. This book is one of the more practical texts in musculoskeletal ultrasound that are currently available and it is recommended to students interested in the topic. Though tailored for the radiologist, this text can be used by anyone interested in the field of diagnostic musculoskeletal imaging.

Fundamentals of Musculoskeletal Ultrasound, 3rd Edition
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