Physical Therapists Use of Diagnostic Ultrasound Imaging in Clinical Practice: A Review of Case Reports.

Objective: Ultrasound diagnostic imaging (USI) is widely utilized in sports medicine, orthopaedics, and rehabilitation. Its use in physical therapy clinical practice is increasing. This review summarizes published patient case reports describing USI in physical therapist practice. Design: Comprehensive literature review. Literature Search: PubMed was searched using the keywords "physical therapy" AND "ultrasound" AND "case report" AND "imaging". In addition, citation indexes and specific journals were searched. Study Selection Criteria: Papers were included if the patient was attending physical therapy, USI was necessary for patient management, the full text was retrievable, and the paper was written in English. Papers were excluded if USI was only used for interventions, such as biofeedback, or if the USI was incidental to physical therapy patient/client management. Data Synthesis: Categories of data extracted included: 1) Patient presentation; 2) Setting; 3) Clinical indications; 4) Who performed USI; 5) Anatomical region; 6) Methods of USI; 7) Additional imaging; 8) Final diagnosis; and 9) Case outcome. Results: Of the 172 papers reviewed for inclusion, 42 were evaluated. Most common anatomical regions scanned were the foot and lower leg (23%), thigh and knee (19%), shoulder and shoulder girdle (16%), lumbopelvic region (14%), and elbow/wrist and hand (12%). Fifty-eight percent of the cases were deemed static, while 14% reported using dynamic imaging. The most common indication for USI was a differential diagnosis list that included serious pathologies. Case studies often had more than one indication. Thirty-three cases (77%) resulted in confirmation of a diagnosis, while 29 case reports (67%) documented significant changes in physical therapy intervention strategies due to the USI, and 25 case reports (63%) resulted in referral. Conclusion: This review of cases provides details on unique ways USI can be used during physical therapy patient care, including aspects that reflect the unique professional framework.