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. 2020 Feb 12;8(2):2325967119901017.
doi: 10.1177/2325967119901017. eCollection 2020 Feb.

Hand-Held Portable Versus Conventional Cart-Based Ultrasound in Musculoskeletal Imaging

Free PMC article

Hand-Held Portable Versus Conventional Cart-Based Ultrasound in Musculoskeletal Imaging

Anna L Falkowski et al. Orthop J Sports Med. .
Free PMC article


Background: Portable ultrasound machines are now common, used for point-of-care applications and needle guidance for percutaneous procedures; however, the effectiveness of portable ultrasound in evaluation of the musculoskeletal system has not been fully assessed.

Purpose: To prospectively evaluate the use of portable hand-held ultrasound in comparison with conventional cart-based ultrasound in evaluation of the musculoskeletal system.

Study design: Cohort study (diagnosis); Level of evidence, 2.

Methods: In this institutional review board-approved, prospective study, 100 consecutive patients with informed consent were imaged through use of both portable and cart-based ultrasound equipment using 12-5 MHz linear transducers. Agreement in ultrasound diagnosis was documented along with expected clinical changes in management if there was disagreement (definitely no, probably no, uncertain, probably yes, definitely yes). Imaging details of disagreement cases were recorded, and descriptive statistics were calculated.

Results: There were 42 male and 58 female patients (mean ± SD age, 53 ± 13 years) imaged over a time period of 20 months. Anatomic areas scanned were the shoulder (n = 30), elbow (n = 11), hand and wrist (n = 15), hip (n = 10), knee (n = 11), foot and ankle (n = 12), and others (n = 11). Scanning with conventional ultrasound revealed abnormality in 92% of patients. Agreement in diagnosis made between portable versus cart-based ultrasound was found in 65% of patients. In the 35% of patients with discordant results, the change in diagnosis resulted in no change in clinical management in 46%, probably no change in 29%, uncertain change in 14%, probable change in 11%, and definite change in 0%. The diagnoses changing management (4%; 4/100) included nondetection of a satellite nodule (n = 1), ganglion cyst (n = 1), hernia (n = 1), and underestimated tendon tear (n = 1).

Conclusion: When compared with conventional cart-based ultrasound, a musculoskeletal diagnosis using portable hand-held ultrasound was concordant or was discordant without clinical relevance in 96% (96/100) of patients. Knowledge of benefits and limitations of portable hand-held ultrasound will help determine areas where specific types of ultrasound equipment can be used.

Keywords: cart-based ultrasound; diagnostic ultrasound; musculoskeletal ultrasound; portable ultrasound.

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: A.L.F. has received grants from the Research Funds of the University of Basel, Swiss Society of Radiology, Gottfried und Julia Bangerter-Rhyner-Stiftung, and Freiwillige Akademische Gesellschaft Basel. J.A.J. is on the advisory board for Philips Medical Imaging and has received speaking fees from Philips. M.T.F. has received research support from Smith & Nephew, DJO, and RTI; speaking fees from Smith & Nephew; and consulting fees from Smith & Nephew. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.


Figure 1.
Findings for a 48-year-old man with full-thickness supraspinatus tear (concordant diagnoses). Images reveal tendon defect (arrows) shown on (A, B) portable hand-held ultrasound, (C, D) conventional cart-based ultrasound, and (E, F) magnetic resonance imaging. (A, C, E) Long axis of tendon. (B, D, F) Short axis of tendon. GT, greater tuberosity.
Figure 2.
Findings for a 53-year-old man with common extensor tendinosis (discordant results due to differences in color Doppler information with no change in clinical management). Images reveal severe tendinosis (arrows) shown on (A, B) portable hand-held and (C, D) conventional cart-based ultrasound, appearing as increased signal on (E) intermediate-weighted fat saturation magnetic resonance image. Note increased flow on color Doppler image of (D) conventional ultrasound compared with (B) the portable unit. H, humerus; R, radial head; arrowhead, radial collateral ligament.
Figure 3.
Findings for a 35-year-old woman with ganglion cyst (discordant results with probable change in clinical management). (A) Image made on the portable hand-held unit reveals focal abnormality (arrow) appearing hypoechoic, raising concern for solid mass. (B) On the image from the conventional cart-based unit, the abnormality appears anechoic consistent with cyst. Note increased conspicuity of the posterior increased through transmission (arrowheads) in A compared with B. P, proximal phalanx; T, flexor tendon.

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