When a high school or college athlete goes down mid-game, sports medicine physicians don’t have long to make the right call. A physical exam of the injury is helpful, but not always definitive. Meanwhile, the player, parent and coach are waiting anxiously for a verdict.
Enter “sideline ultrasound,” a device small enough to fit in a fanny pack and advanced enough to produce clear evidence of a fracture, dislocation or soft tissue injury.
MetroHealth sports medicine physicians Kimberly Fazio, MD, and Allison Schroeder, MD, use sideline ultrasound at high school games throughout the Cleveland area to assess:
- Possible fractures
- Tendon injuries, such as MCL tears and Achilles tendon ruptures
- Muscle injuries, such as contusions and strains
- Dislocated shoulders, fingers and toes
- Joint effusions
Drs. Fazio and Schroeder learned how to use ultrasound in the sports medicine setting as part of their fellowship training. (Ultrasound became a core competency of sports medicine training in 2017.) The clinicians use it routinely in their clinical practice as well as on the sidelines.
A New Tool in the Toolbox
Providers began offering point-of-care ultrasound for sports teams about 10 years ago. Until recently, the equipment was bulky and included a computer monitor, multiple wires and a rolling cart. Today’s hand-held transducers fit easily into a small bag and connect to a tablet or smartphone.
“Ultrasound is my go-to triage tool when evaluating athletes during the game,” Dr. Fazio says. “I use it to answer questions like, ‘Should I clear them to play or recommend they sit on the bench or even go to the Emergency Department?’ and ‘Do they need to come see me tomorrow in clinic or can it wait until next week?’”
Dr. Schroeder adds, “With the portable device, you lose a little bit in terms of image quality. But we find it’s more than enough to confirm many acute injuries quickly on the sidelines.”
Persuading Athletes, Parents and Coaches
The ability to demonstrate pathology is often a turning point with young athletes who want to keep playing. “High school kids will say, ‘I can play through this,’” Dr. Schroeder says. “But if I can show them the gap in a torn structure or the swelling around the joint, they realize they shouldn’t.”
She recalls a Division I prospect who insisted he could return after an ankle injury. “One of our fellows sent me the images from Pittsburgh to confirm we were both seeing the same thing,” she explains. “It was a clear high ankle sprain, and the athlete absolutely needed to come out of the game. The visual confirmation helped him and his parents accept the decision immediately.”
Ultrasound is beneficial when the physical exam is limited. “If an athlete is very muscular or has large legs or is guarding because of pain, my exam may not be enough,” Dr. Fazio says. “I’ve used ultrasound to show a large effusion when I’m worried about a deeper injury, and that alone is enough to hold them out of the game and get them appropriate follow-up.”
Making the Subjective Objective
Because many of the schools MetroHealth covers have limited access to medical resources, providing immediate clarity is valuable. “It expedites care,” Dr. Fazio says. “There’s less guessing. I can tell them right away whether they need to see me, whether they need a surgeon or whether this is something we rehab with the athletic trainer.”
Dr. Schroeder agrees. “If you can make a subjective problem more objective, they’re more likely to follow up. And for a lot of these kids, having that information in the moment prevents weeks of playing through something serious.”
Looking Ahead
Drs. Fazio and Schroeder expect that the quality of portable ultrasound will continue to improve. “In terms of image clarity, the portable devices now are close to what the laptop-sized units were when I started training,” Dr. Schroeder says. “Technology will keep getting better. One day, every sports medicine specialist may have an ultrasound device in their pocket.”
