Musculoskeletal ultrasound did not become popular in orthopaedics formerly because of the lack of the ability to visualize superficial structures, which are the targets of general orthopaedic practice. As ultrasound technology has rapidly advanced in the last decade, musculoskeletal ultrasound has become an important imaging modality. Plain radiography was the first choice of diagnostic imaging in previous general orthopaedic practice, but this was not able to detect soft tissue injury. Musculoskeletal ultrasound enables diagnosis of musculoskeletal disorders including soft tissue injury by dynamic examination. And it is also a noninvasive, easy-to-use, and real-time diagnostic modality, so it should be considered as the first choice of diagnostic imaging. Musculoskeletal ultrasound can detect pulled elbow and injury after ankle sprain. Silent manipulation after ultrasound-guided selective cervical nerve root block (C5 and C6) can reduce the duration of pain and dysfunction. The first choice of diagnostic imaging could shift to musculoskeletal ultrasound from plain radiography in the near future.

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Recently, the portable ultrasound imaging system was released. The ultrasound imaging system became the necessary medical treatment tool for a sports doctor. Ultrasound imaging is useful for medical check and examination at sport field. In this paper, I will introduce the ultrasound imaging of ankle sprains and muscle damage.

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Musculoskeletal (MSK) ultrasonography enables us not only to perform structural evaluation of various musculoskeletal tissues but also to perform a dynamic assessment. In this report, we present some cases in which MSK ultrasonography was efficiently employed in the dynamic assessment. In the field of rehabilitation, physiotherapy in particular, evaluation of subjects mainly depends upon the therapist's inspection, palpation, and experience. MSK ultrasonography is a new and effective tool that makes evaluation of subjects more accurate and effective. It serves in the evaluation of muscle strength training, and assesses various risks by identifying structures such as vessels and nerves and/or motion. It also gives both the therapist and patient visual feedback, providing information on the MSK system easily and noninvasively, in comparison to electromyography and traditional imaging modalities such as X-ray, CT, and MRI. Despite its ease of use and noninvasiveness, MSK ultrasonography is in general regarded as an operator-dependent imaging modality, which indicates it inherently has a problem in terms of reproducibility. Therefore, in the present report, we introduce ultrasonographic techniques that have been validated in previous reports in the literature. We focused on the clinical application of MSK ultrasound in the treatment of quadriceps and core muscles, which are common problems in the field of rehabilitation, and also discussed the importance of MSK ultrasonography in the rehabilitation of the lumbar spine and medial patellofemoral ligament.

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The clinical application of musculoskeletal ultrasonography in rheumatology started with the use in early diagnosis of patients with rheumatoid arthritis, and now its role has expanded to evaluation of other common rheumatic diseases such as spondyloarthritis and crystal-associated arthropathy (i.e., gout and calcium pyrophosphate deposition disease). Introduction of high-frequency probes and power Doppler has enabled highly sensitive and reliable evaluation of a patient's condition and disease processes. Ultrasonographic assessments subsequently have become one of the important outcome measures in clinical studies, and its usefulness has been recognized in daily clinical practice. Ultrasonography is useful in early and differential diagnosis of inflammatory arthritis, and its property should be well adapted to evaluation of disease activity. Many data have proven that it is more sensitive and reliable than physical examination, and it can describe subtle pathology that cannot be detected by conventional radiography. Though further progress towards standardization of the technique and development of a consensus in scoring methods is needed, it is expected that ultrasonography will not only improve clinical outcomes but also contribute to gaining more insight into rheumatic diseases.

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Screening with ultrasonography for musculoskeletal disorders such as developmental dysplasia of the hip (DDH) or sports injuries has been done because of its many benefits. For DDH, ultrasonography is useful because it can show the cartilaginous femoral head before ossification, which cannot be shown by X-ray film. Osteochondritis dissecans of the capitellum (OCD) is one of the severest disorders for young baseball players. Screening of OCD has been done for about 30 years in Tokushima. Conventionally, only physical examinations had been performed at the venue by the staff, and the players who had abnormal findings were recommended to consult a doctor. Recently, players undergo ultrasonography in addition to a physical examination. The detection rate of OCD has increased since the start of screening with ultrasonography because OCD shows few abnormal findings in physical examination at the early stage. On the other hand, some problems have been pointed out. The first problem is a difference in image quality between ultrasound devices, the second is how to deal with performing the screening outdoors, and the third is comparison with other radiographic images.

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I described the usefulness of echography in upper-extremity musculoskeletal disorders, labor management of sonographers, and the actions being taken by medical societies for work-related musculoskeletal disorders. From the viewpoint of an industrial physician in a medical college hospital, I investigated safety considerations in the field of sonography. Sonographers should inspect their own extremities by echography, and consult an orthopedist or industrial physician.

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Purpose: It is difficult to obtain clear three-dimensional (3D) moving images with existing ultrasound systems. In order to investigate tongue movements during Japanese speech, we have developed a 3D tongue-shaped standard model (3D model) on a personal computer based on volume data of ultrasound tongue images. In this paper, the method for 3D model construction is discussed. Subjects and Methods: The subject was a 34-year-old female. Ultrasound tongue images while at rest and while producing five Japanese vowels were taken, and the tomographic data of the images were obtained with 4-mm slice intervals. To acquire the tongue surface line, inflection points of the tongue surface were selected as control points. A spline curve was derived based on the control points, and a tongue surface (spline surface) was generated from a set of spline curves that corresponded to the ultrasound slice images. Thus, the 3D model was constructed. Results and Discussion: By using our method, 3D models of the tongue surface were constructed. It will be possible to produce the 3D images in a shorter time by automating the selection of control points. In addition, it may be possible to observe tongue movement in detail by constructing 3D moving images based on the interpolation of a set of sequential 3D model data. Conclusion: By using our method, it may be possible to analyze disordered tongue movements during speech and explain the tongue status to patients in a clinical setting.

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