At the MetroHealth Rehabilitation Institute, we actively seek ways for our clinical teams to collaborate, knowing this both enhances patient outcomes and the overall patient experience. Our Electrodiagnostic Lab serves as a prime example of this collaborative approach.
The Electrodiagnostic Lab is a partnership between the MetroHealth Rehabilitation Institute and the Neurology Department, which is a natural fit given the overlap in patient populations. The lab—headed by Daniel T. Benson, MD, Neurology, and Joelle M. Gabet, MD, Physical Medicine and Rehabilitation (PM&R)— incorporates the use of neuromuscular ultrasound to further enhance diagnostic capabilities.
Dr. Benson, along with Mankaran S. Sawhney, MD, Neurology, incorporated ultrasound into the lab when they joined MetroHealth in 2021. Since neuromuscular ultrasound wasn’t part of her fellowship training, Dr. Gabet joined Drs. Benson and Sawhney for two years during their weekly ultrasound clinic learning how the diagnostic tool is used for neuromuscular disorders and how to perform the study.
Now, Dr. Gabet has been able to expand neuromuscular ultrasound into the practices at the MetroHealth Rehabilitation Institute by offering these studies at the Parma campus. She hopes to incorporate these skills into treating her patients with amputations, as they have a risk of developing painful neuromas, which can be visualized on ultrasound.
“Electromyography and nerve conduction studies are the standard of care diagnostically, but there are limitations,” she says. “By adding ultrasound into the equation for diagnosis, we’re better able to pinpoint where an issue is and how to treat it.”
More Data, Personalized Care
While electromyography and nerve conduction studies measure electrical signals to determine how well muscles and the nerves that control them are working, it can’t always identify the location or extent of the issue.
“Because ultrasound is more dynamic, we can move it along the length of the nerve to get different images,” Dr. Gabet explains. “We get clearer pictures of muscles, nerves, tendons and soft tissues. This helps identify structural problems in the nerves to localize the injury better, but could also identify problems like tears or inflammation of the surrounding structures, or things like cysts or masses that may be compressing the nerve.”
Dr. Gabet views ultrasound as a supplemental tool, not a replacement for electrodiagnostic studies—it serves a different purpose.
“Typical electrodiagnostic tests look at the function of the nerve, whereas ultrasound allows us to look at the structure of the nerve,” she says. “It’s an augmentative tool for more data and better diagnosis.”
With ultrasound, physiatrists can watch nerves and muscles as they move, allowing them to spot issues that only appear during motion that might be missed on still images. This added clarity enables clinicians to diagnose, treat and monitor a wide range of musculoskeletal and nerve conditions—often more quickly, safely and comfortably than other imaging methods.
Dr. Gabet states that ultrasound can be used for a variety of conditions, including carpal tunnel syndrome, cubital tunnel syndrome, tarsal tunnel syndrome, polyneuropathies, some cases of myopathy, evaluation for neuroma and more.
“Some conditions may be limited by technical factors on an electrodiagnostic testing, or be too severe to pick up, and this is where neuromuscular ultrasound can shine. Similarly, structural issues like a neuroma can’t be seen with an EMG,” she explains.
Ultrasound in combination with electrodiagnosis also allows physiatrists and neurologists to track how muscles or nerves change over time during treatment or rehabilitation and adjust care plans as needed.
Training Tomorrow’s Caregivers
Thanks to Dr. Gabet’s initiative, now all new MetroHealth M&R residents will be able to learn how diagnostic ultrasound can complement electrodiagnosis as part of their curriculum.
“Electrodiagnosis and ultrasound are now an eight-week block in the curriculum,” she shares. “We want to make residents better diagnosticians, as that ultimately makes them better clinicians.”
