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Year : 2018  |  Volume : 13  |  Issue : 5  |  Page : 2

Musculoskeletal ultrasound in India: Journey so far

Department of Rheumatology, Sir Ganga Ram Hospital, New Delhi, India

Date of Web Publication1-Aug-2018

Correspondence Address:
Dr. Ved Chaturvedi
Department of Rheumatology, Sir Ganga Ram Hospital, New Delhi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0973-3698.238191

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How to cite this article:
Chaturvedi V. Musculoskeletal ultrasound in India: Journey so far. Indian J Rheumatol 2018;13, Suppl S1:2

How to cite this URL:
Chaturvedi V. Musculoskeletal ultrasound in India: Journey so far. Indian J Rheumatol [serial online] 2018 [cited 2022 May 22];13, Suppl S1:2. Available from:

In the year 2003, while serving in the Army Hospital (R&R) New Delhi, we were excited to get a Philips ultrasound (US) machine with high-frequency US probe. A Baker's cyst was the only indication to use ultrasound in rheumatology at that time. Around the same time, I attended the first musculoskeletal (MSK) US workshop of the European League against Rheumatism (EULAR). It was very satisfying for me that even in Europe, not many people were there to perform MSK US. I was also happy to know that even the best of people in the international scene were also in the learning phase. Since then, I attended most of the Initial EULAR workshops and conducted the first MSK Workshop at the IRACON 2004 in Chennai.

I gradually learned to recognize synovial thickening and Doppler signals for disease activity, ruptured Baker cyst, Achilles tendon enthesopathy, plantar fasciitis, fluid around hand tendons, and various other findings. The utility of US to differentiate between synovial fluid versus synovial thickening came very handy during dry tap joint injections. Sometimes, despite of the presence of effusion, there might be a dry tap because of the malpositioning of the needle, which can be confirmed by US. One more interesting outcome was that the satisfaction level of patients in the Rheumatology OPD sharply increased. Notwithstanding, the resistance and difficulties I continued to practice the art and science of MSK US.

The practice of MSK US in rheumatology is a rapidly developing field and forms an integral part of the curriculum of rheumatology training programs in other parts of the world. In 1972, Daniel McDonald and George Leopold first described the use of US scanner to differentiate Baker's cyst from thrombophlebitis. However, now, MSK US is done routinely to diagnose and prognosticate rheumatoid arthritis. MSK US is also often performed to differentiate between arthralgia and arthritis The US joint probe is likened to a “stethoscope” for the rheumatologist.

Another good reason of the popularity of MSK US is the accuracy with which intra-articular injections can be given. The other advantages of MSK US are lack of radiation exposure as well as the ability to look at tissue perfusion and inflammation all in real time. The disadvantages are that it is highly operator dependent, and it takes time to acquire the necessary skills, and those skills need to be maintained by regular performance. The EULAR conducts US course at three levels (basic course, intermediate course, and advanced course) on an annual basis as part of its educational activity. The Indian Rheumatology Association at the IRACONs and SGPGI Lucknow led by Prof. Ramnath Misra and other medical establishments also conduct workshops to impart education.

Dr. Prasan Deep Rath and Dr. Sajjan Shenoy are among the leading personalities in India who have carried this invaluable tool forward along with others. It is therefore apt that this special supplement of the Indian Journal of Rheumatology on MSK US is being brought out under their joint editorship. I sincerely hope that it would go long way to help establish this tool in rheumatology practice in India and elsewhere. After using this tool for more than a decade, I am convinced it is worth it!

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