What to Expect from a Musculoskeletal Ultrasound

What is musculoskeletal ultrasound?

Musculoskeletal (MSK) ultrasound is an imaging technique that uses high-frequency sound waves to produce real-time pictures of your joints, tendons, muscles, and surrounding soft tissues. It’s the same basic technology used to image a baby during pregnancy — just applied to your joints instead.

Unlike X-rays or CT scans, ultrasound uses no radiation. Unlike MRI, it requires no contrast dye, no enclosed scanner, and no lengthy appointment at a separate imaging center. It’s done right here in the exam room, during your regular visit.

What can it show?

MSK ultrasound gives us a detailed, real-time look at what’s happening inside and around your joints. It can detect:

• Synovitis — inflammation of the joint lining, one of the earliest and most important signs of active inflammatory arthritis
• Joint effusion — excess fluid inside a joint
• Tendon damage — tears, thickening, or inflammation (tendinitis and tenosynovitis)
• Erosions — early bone damage caused by inflammatory arthritis, sometimes visible on ultrasound before they appear on X-rays
• Crystal deposits — the needle-shaped urate crystals of gout or the calcium pyrophosphate deposits of pseudogout (CPPD)
• Bursitis — inflammation of the fluid-filled sacs that cushion your joints
• Soft tissue swelling — helping distinguish between joint inflammation, tendon problems, and other causes of pain

This information helps us figure out what’s driving your symptoms — is it active inflammation? Structural damage? A tendon problem? A crystal flare? — so we can treat the right thing.

No preparation needed

There is nothing you need to do before a musculoskeletal ultrasound.

• No fasting required
• No special clothing — we just need access to the joints being examined, so wear clothing that can be easily rolled up or adjusted
• No medications to stop or start
• No referrals or separate appointments — it’s done during your regular visit

Just show up for your appointment. If Dr. Fellows determines that ultrasound will be helpful that day, we do it right then and there.

How the exam works

The ultrasound is performed by Dr. Fellows using our Mindray MX7 — a high-resolution diagnostic ultrasound system designed for musculoskeletal imaging.

• A small amount of gel is applied to the skin over the joint or area being examined — it’s the same water-based gel you’ve probably seen used in other ultrasound exams. It’s room temperature and wipes off easily
• A handheld probe (transducer) is placed on the skin and moved gently over the area — there’s no pressure, no needles, and no pain
• Real-time images appear on the screen as the probe moves — Dr. Fellows examines the structures as he scans, often pointing out what he’s seeing so you can follow along
• The exam takes 10 to 20 minutes depending on how many joints or areas need to be evaluated

That’s it. The gel gets wiped off, and we move on to discussing what we found.

Done by your rheumatologist — not a technician

At many practices, imaging is ordered and sent out to a radiology center. You schedule a separate appointment, go to a different facility, have the images taken by a technician, and then wait for a radiologist to read them — sometimes days later. Only then can your rheumatologist see the results and make decisions.

We do it differently. Dr. Fellows is RhMSUS certified — that stands for Registered in Musculoskeletal Ultrasound through the American College of Rheumatology. This certification means he has completed rigorous training and testing in performing and interpreting MSK ultrasound specific to rheumatologic conditions.

Having your rheumatologist perform the ultrasound matters because:

• Context — Dr. Fellows already knows your history, your exam findings, and your current medications. He’s not interpreting images in isolation
• Real-time decision making — if the ultrasound shows active synovitis, we can adjust your treatment plan in the same visit rather than waiting for results
• Dynamic examination — unlike a static set of images, ultrasound allows us to move the joint, watch tendons glide, and assess inflammation under real-world conditions

Same-visit answers

One of the biggest advantages of in-office ultrasound is speed. There’s no waiting for a report. There’s no follow-up appointment to discuss results. During your visit, we can:

• Confirm or rule out active inflammation — helping us decide whether to adjust your medications
• Track disease activity over time — comparing today’s images to previous exams to see if your treatment is working
• Identify problems that may not be obvious on physical exam — some joints can feel normal on the outside while harboring significant inflammation underneath
• Decide whether an injection is appropriate — and if so, guide that injection with ultrasound for precise needle placement (see our separate injection guide)

This means faster answers and faster treatment adjustments — which translates to better disease control and less time spent waiting and wondering.

Ultrasound-guided procedures

Beyond diagnosis, ultrasound serves as a guidance tool for joint and soft tissue injections. When Dr. Fellows uses ultrasound guidance, he can:

• Visualize the needle in real time as it enters the joint or tissue
• Confirm precise placement of the medication exactly where it needs to go
• Avoid nearby structures — tendons, nerves, and blood vessels — that you’d rather not hit
• Access difficult joints that are hard to inject by feel alone — such as the hip, small joints of the hands and feet, or deep bursae

Ultrasound-guided injections are more accurate than landmark-guided (by feel) injections, and studies show they tend to provide better and longer-lasting relief.

Common questions

Does it hurt? No. MSK ultrasound is completely painless. The probe sits on top of the skin with gel — there’s no pressure, no needles, and no discomfort.

Is it safe? Yes. Ultrasound uses sound waves — not radiation. It can be repeated as often as needed without any cumulative risk.

Will my insurance cover it? In most cases, yes. MSK ultrasound performed by a physician during an office visit is a standard covered service. We’ll verify your coverage as part of the normal billing process.

Can it replace MRI? In many situations, yes — particularly for evaluating superficial joints, tendons, and soft tissues. For certain questions — like evaluating deep internal structures of the spine or assessing bone marrow — MRI is still the better tool. We use whichever imaging modality gives us the best answer for your specific question.

This handout is provided for educational purposes and does not replace individualized medical advice. Always follow the specific instructions given by your rheumatologist.