Musculoskeletal Imaging And Physiotherapy

Musculoskeletal Imaging Via X-Ray

X-rays are a form of electromagnetic radiation. As a radiological tool X-rays have been used successfully in musculoskeletal imaging for decades. Despite more detailed investigatory tools being available, X-rays are still recognized as a valuable medical tool. They invaluable in providing information for a wide variety of examinations, and procedures. X-rays are used as a non-invasive and painless method for helping diagnose, monitor, and treat many medical conditions.
Some conditions that may call for a musculoskeletal X-ray include the assessment of:

• Fractures
• Dislocations
• Arthritis
• Osteoporosis
• Spinal Posture
• Joint alignment and positioning
• Infections
• Bone tumors

Risks Verses Benefits Of Musculoskeletal Imaging Via X-Ray

There is some risk associated with getting an X-ray. Seeing as X-rays use small amounts of radiation to create images of your tissues and bones. But for most people, the potential benefits will outweigh the risks. However, due to radiation exposure, clearly a risks to benefit ratio needs to be considered. 
The level of radiation exposure is considered safe for most adults. But no so for a developing baby. If you’re pregnant, or believe you may be pregnant you must advise the referring practitioner before considering an X-ray. In pregnancy, depending on the suspected condition, a different imaging method such as an MRI, ultrasound may be more appropriate. Otherwise simply moving forward with a working clinical diagnosis, without imaging, may also be more appropriate than having an X-ray.

Getting A Referral For An X -ray From Your Physio

A Sydney physio can refer you for X-rays. However physiotherapists can only Bulk Bill X-rays under Medicare for the neck (cervical spine), mid back (thoracic spine) low back, or pelvis (lumbar spine and SIJ). Physiotherapists can not be Bulk Billed via Medicare for referral of X-rays for other areas of the body such as the ankle, shoulder or knee… Physios can still refer for X-ray on other areas of the body but these will be billed privately by the radiology department doing the imaging at their fee schedule.
As an example, in our experience the cost of a knee X-ray ranges from around $40-$150. This is depending on geographical location, and the number of views requested. 

Musculoskeletal Imaging By Ultrasound

Ultrasound imaging (also know as sonography) uses high-frequency sound waves to view the body. Unlike with X-rays, there is no ionizing radiation exposure associated with sonography.
Ultrasound images are captured in real-time. Meaning they can be carried out whist the area being examined is being moved. This is beneficial in showing how movement, or position is impacting the tissue in question. As well as this sonography can be useful in showing movement of the body’s internal organs. Even the movement of blood flowing through the body’s blood vessels.

In an musculoskeletal ultrasound examination, a thin layer of ultrasonic coupling gel is applied to the skin prior to the ultrasound probe (transducer) being placed directly on the skin over the area to be assessed. The ultrasound waves are then transmitted from the probe through the gel into the body. And levels of tissue impedance to the applied ultrasound waves, help create the image the sonographer makes sense of. 

How Ultrasound Imaging Works

Ultrasound imaging uses the reflection of the waves off of the body’s tissues. The strength of the sound signal, and the time it takes for the sound wave to travel through the body provides the information necessary to produce an image. Different tissues offer different impedance to the sound waves. So as a result a picture of the body can be painted from this information.
Common conditions that use musculoskeletal imaging via ultrasound include:

• Muscle strain. Ultrasound imaging can be useful in grading the severity of injury.
• Tendinopathies. Such as rotator cuff complaints, tennis elbow, or achilles tendon issues.
• Shoulder Bursitis. Bursitis and shoulder impingement can be successfully assessed via ultrasound imaging. 
• Ligament sprains. Similar to muscle injury the grading of ligamentous injury can be graded with relative accuracy with ultrasonic imaging in superfical ligaments. Including MCL of the knee, ATFL of the ankle…
• Bone sonometry. This from of ultrasound imaging is used to assess bone fragility.
• Doppler ultrasound. Used to visualize blood flow through a blood vessel, in physiotherapy this would be relevant in the detection of a DVT.
• Ultrasound-guided injections. The use of ultrasound imaging can help in accurately administering cortisone injections to specific tissues. Injecting to treat shoulder bursitis is a common example of when ultrasound imaging can assist in having cortisone injection. 

Risks Verses Benefits Of Musculoskeletal Imaging By Ultrasound

Although ultrasound imaging is generally considered safe. And is based on non-ionizing radiation unlike X-rays and CT imaging. Ultrasound energy still has potential to produce biological effects on the body. Ultrasound waves can heat the tissues slightly. In some cases, ultrasound imaging can also produce small pockets of gas in body fluids, or tissues (referred to as cavitation). The long-term consequences of cavitation, or heating are unknown.

Getting Referred For Ultrasound Imaging By Your Physio

A Sydney physio can refer you for ultrasound imaging. However physiotherapists can not be bulk billed through Medicare for ultrasound imaging to any part of the body. Meaning it will be a private cost to the patient. A referral from your GP will be bulk billed, so many of our patients choose to see their doctor to obtain a referral for this form of investigation. 

Disclaimer: Sydney Physio Clinic provides this information as an educational service and is not intended to serve as medical advice. Anyone seeking specific advice or assistance on Musculoskeletal Imaging And Physiotherapy should consult his or her general practitioner, physiotherapist, sports medicine specialist, orthopedic surgeon or otherwise appropriately skilled practitioner.