MUSCULOSKELETAL ULTRASOUND: AN 
IRREVOCABLE PIECE OF PHYSICAL AND 
REHABILITATION MEDICINE 
MIŠIČNO-SKELETNI ULTRAZVOK: 
NEPOGREŠLJIV DEL FIZIKALNE IN 
REHABILITACIJSKE MEDICINE 
Levent Özçakar, MD, Professor
Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine
Ankara, Turkey
Poslano: 17. 9. 2019
Sprejeto: 18. 9. 2019
Avtor za dopisovanje/Corresponding author (LÖ): lozcakar@yahoo.com
Abstract 
The specialty of Physical and Rehabilitation Medicine (PRM) 
deals with a large variety of diseases involving the neuro-
musculoskeletal system. Accordingly, physiatrists need to 
diagnose, treat, and rehabilitate disorders affecting several 
tissues including muscles, nerves, tendons, ligaments, bones 
and cartilage. In this regard, the utility of ultrasound (US) im-
aging - which provides superior diagnostic and interventional 
opportunities for a musculoskeletal physician - is paramount 
for our specialty (1). Likewise, it is apparent that US imaging 
allows physiatrists to first see (without resecting), then assess/
quantify, and eventually have access to the anatomical struc-
ture or pathology (for any intervention) (2). This gives PRM 
physicians the liberty to conduct multiple explorations and 
provide “comfort” to physicians and patients alike. Further, 
taking into account the fact that the use of US in clinical 
practice is naturally coupled with scholarly publishing, this 
also means “academic superiority” (3). Physiatrists now have 
the chance to discuss new observations and data that were 
not available to them before. 
Herewith, other than being unable to image intraosseous 
tissues, the most important disadvantage of musculoskeletal 
US is its user-dependency. As such, there is indisputably 
need for a lengthy education before one can confidently 
make comments on a pathology or, in other words, before 
others can rely on his/her scanning. To this end, it is high-
time international standardized consensus was established 
on formal educational curricula and accreditation programs 
to better educate and then certify those who are competent 
Povzetek
Specialnost fizikalne in rehabilitacijske medicine (FRM) se 
ukvarja s široko vrsto bolezni, ki prizadenejo mišično-ske-
letni sistem. Zato morajo fiziatri diagnosticirati, zdraviti in 
rehabilitirati motnje različnih tkiv, vključno z mišicami, živci, 
kitami, vezmi, kostmi in hrustancem. S tega vidika je uporaba 
ultrazvočnega (UZ) slikovnega prikaza , ki mišično-skeletnemu 
zdravniku nudi odlične diagnostične in terapevtske možnosti, 
osrednjega pomena za našo specialnost (1). Očitno je tudi, da 
UZ slikanje omogoča specialistom FRM, da brez operativnega 
posega vidijo, ocenijo, kvantificirajo in dosežejo anatomske 
strukture ali patologije (zaradi kakršnegakoli zdravljenja) (2). 
To omogoča specialistom FRM prosto raziskovanje in hkrati 
nudi "varnost" tako njim kot pacientom. Ker uporabo UZ v 
klinični praksi praviloma spremlja strokovno objavljanje, to 
pomeni tudi "akademsko prednost" (3). Specialisti FRM imajo 
dandanes možnost razpravljati o opažanjih in podatkih, ki jim 
prej niso bili na voljo.
Poleg nezmožnosti prikaza znotrajkostnih tkiv je glavna pomanj-
kljivost UZ njegova odvisnost od izvajalca. Zato je nedvomno 
nujno dolgotrajno usposabljanje, preden lahko izvajalec UZ 
preiskave zanesljivo presoja o patologiji oziroma preden se 
lahko drugi zanesejo na njegove/njene izvide. Skrajni čas je 
torej, da se vzpostavi mednarodno standardizirano soglasje o 
formalnem izobraževalnem programu in akreditacijskih postop-
kih za usposabljanje in certificiranje tistih, ki lahko opravljajo 
diagnostični UZ. Prepričani smo, da se lahko ta pomemben 
proces uspešno izvede v okviru mednarodnih organizacij, kot sta  
 
Levent Özçakar / letn. XIX, supl. 1 (2020)
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Reference:
1. Özçakar L, Kara M, Chang KV , et al. Nineteen reasons why 
physiatrists should do musculoskeletal ultrasound: EURO-
MUSCULUS/USPRM recommendations. Am J Phys Med 
Rehabil 2015;94:e45-9.
2. Özçakar L, Onat ŞŞ, Gürçay E, Kara M. Are blind injections 
ethical or historical ? Think twice with ultrasound. Am J Phys 
Med Rehabil 2016;95:158-60. 
3. Akkaya N, Ulaşlı AM, Özçakar L. Use of musculoskeletal 
ultrasound in clinical studies in physiatry: the "stethoscope" 
is also becoming the "pen". J Rehabil Med 2013;45:701-2.
enough to perform US. We strongly believe that this important 
process can well be accomplished within the umbrella of 
international bodies like ESPRM (European Society of PRM) 
and ISPRM (International Society of PRM) whereby special 
interest scientific committees or working groups on US are 
already in play. 
ESPRM (Evropsko združenje za FRM) in ISPRM (Mednarodno 
združenje za FRM), kjer že obstajajo specializirani znanstveni 
odbori ali delovne skupine za UZ. 
Levent Özçakar / letn. XIX, supl. 1 (2020)
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