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Original Research
Hand-Held Portable Versus
Conventional Cart-Based Ultrasound
in Musculoskeletal Imaging
Anna L. Falkowski,*
†‡
MD, MHBA, Jon A. Jacobson,
†
MD, Michael T. Freehill,
§
MD,
and Vivek Kalia,
†
MD, MPH
Investigation performed at the University of Michigan, Ann Arbor, Michigan, USA
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 ¼30), elbow (n ¼11), hand and wrist (n ¼15), hip (n ¼10), knee (n ¼11), foot and
ankle (n ¼12), and others (n ¼11). 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 dis-
cordant 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 ¼1), ganglion cyst (n ¼1), hernia (n ¼1), and underestimated tendon tear (n ¼1).
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: diagnostic ultrasound; musculoskeletal ultrasound; portable ultrasound; cart-based ultrasound
Ultrasound has been shown to be an effective imaging
method in evaluation of the musculoskeletal system, such
as tendons, muscles, ligaments, and joints. Accurate diag-
nosis is important because musculoskeletal disorders
account for approximately $850 billion per year in health
care costs and lost wages in the United States.
13
Conven-
tional cart-based ultrasound equipment in this application
has been used, producing detailed high-resolution images;
however, the cost of such equipment (often >$100,000 US)
and lack of portability can be significant limitations. The
use of portable ultrasound units could overcome these lim-
itations, given that hand-held portable ultrasound units
cost approximately $2000 to $7000, and smaller hand-
held devices could further improve accessibility. Without
such barriers, hand-held ultrasound devices can potentially
have a positive effect in medical education
5,11,13,14
and
patient care, bringing ultrasound to classrooms, clinics,
sidelines of the playing field, the battle ground,
13
rural
locations, and countries with limited resources.
4,16
Portable ultrasound machines are now common, used for
point-of-care applications and needle guidance for percuta-
neous procedures.
2
More recently, ultrasound equipment
has been developed that includes hand-held devices, where
a transducer is connected to a tablet or phone to view
images.
4
Such equipment has been used in several applica-
tions, such as trauma, cardiorespiratory assessment, and
invasive procedures
4
; however, the effectiveness of portable
ultrasound in evaluation of the musculoskeletal system has
The Orthopaedic Journal of Sports Medicine, 8(2), 2325967119901017
DOI: 10.1177/2325967119901017
ªThe Author(s) 2020
1
This open-access article is published and distributed under the Creative Commons Attribution - NonCommercial - No Derivatives License (https://creativecommons.org/
licenses/by-nc-nd/4.0/), which permits the noncommercial use, distribution, and reproduction of the article in any medium, provided the original author and source are
credited. You may not alter, transform, or build upon this article without the permission of the Author(s). For article reuse guidelines, please visit SAGE’s website at
http://www.sagepub.com/journals-permissions.
not been fully assessed.
7,9,10,12
Thus, the purpose of this
study was to evaluate the use of a portable hand-held ultra-
sound device in the evaluation of the musculoskeletal sys-
tem compared with conventional cart-based ultrasound.
The hypothesis was that portable hand-held ultrasound
would be as effective as conventional cart-based
ultrasound.
METHODS
Institutional review board approval was obtained to
prospectively evaluate 100 consecutive patients (single-
center, evidence level 2 study) who underwent musculo-
skeletal ultrasound at an outpatient radiology clinic as part
of routine patient care.
15
Written informed consent was
obtained from all patients.
Ultrasound imaging was performed by 1 fellowship-
trained musculoskeletal radiologist (J.A.J.; 23 years of
experience in musculoskeletal ultrasound). Ultrasound
imaging was first performed by use of a portable hand-
held ultrasound device (Philips Lumify 12-5 MHz trans-
ducer; Nvidia 5 8.8-inch tablet) directed by the imaging
requisition and patient history, and the resulting diagnosis
was recorded. This was immediately followed with ultra-
sound imaging using a conventional cart-based ultrasound
unit (Philips Epiq 7G 12-5 MHz transducer), and a result-
ing diagnosis was also recorded. The 12-5 MHz transducer
was chosen rather than a higher frequency transducer to
allow direct comparison with the portable hand-held ultra-
sound unit (only a 12-5 MHz linear transducer was avail-
able for the portable ultrasound unit). Additionally, when
gray-scale abnormality was detected, color Doppler rather
than power Doppler was used on the cart-based ultrasound
unit, as power Doppler was not available on the portable
hand-held ultrasound unit. Ultrasound examinations were
focused to the area of concern, except for the shoulder,
which received a comprehensive evaluation.
Diagnoses from the portable hand-held and conventional
cart-based ultrasound units were later reviewed by the
radiologist who performed the ultrasound imaging in con-
sensus with a board-certified orthopaedic surgeon (M.T.F.).
Agreement between the portable and conventional ultra-
sound diagnoses was determined by consensus along with
expected changes in clinical management if disagreement
was present (definitely no, probably no, uncertain, probably
yes, definitely yes).
Descriptive statistics including mean, standard devia-
tion, range, and percentage were used to evaluate the data
of the consensus reading. Correlation was also made with
magnetic resonance imaging (MRI) and surgical results if
available, which were completed in some patients as part of
routine clinical care. The decision to obtain MRI or pursue
surgery was based on clinical judgment and may have been
influenced by the conventional cart-based ultrasound imag-
ing findings as part of routine patient care.
RESULTS
Demographics
The study group of 100 patients consisted of 42 male and 58
female patients with a mean ±SD age of 53 ±13 years
(range, 25-83 years). Anatomic areas scanned included
shoulder (n ¼30 patients), elbow (n ¼11 patients), hand
and wrist (n ¼15 patients), hip (n ¼10 patients), knee (n ¼
11 patients), foot and ankle (n ¼12 patients), and others (n
¼11 patients; neck, chest wall, abdominal wall, groin),
imaged over a time period of 20 months. The time interval
from the completion of patient scanning to retrospective
consensus review of results was 6 months.
Ultrasound Results
Scanning with the conventional cart-based ultrasound
machine revealed abnormality in 92%(92/100) of patients
*Address correspondence to Anna L. Falkowski, MD, MHBA, Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann
Arbor, Michigan, 48103, USA (email: falkowski.anna@gmail.com) (Twitter: @AnnaFalkowskiMD).
†
Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.
‡
Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland.
§
Department of Orthopaedic Surgery, University of Michigan, Domino’s Farms, MedSport, Ann Arbor, Michigan, USA.
Final revision submitted October 24, 2019; accepted November 1, 2019.
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.
Ethical approval for this study was obtained from the University of Michigan Medical School Institutional Review Board (study No. HUM0013683).
TABLE 1
Primary Abnormalities Found on Conventional Cart-Based
Ultrasound Evaluation
Abnormality No. of Cases
Tendon abnormality 49
Mass or cyst 17
Joint degeneration 7
Bursal abnormality 6
Hernia (groin, abdominal wall) 5
Joint effusion 4
Plantar fasciopathy 3
Ulnar collateral ligament injury
(first metacarpophalangeal)
3
Inflammation or infection 3
Nerve abnormality 2
Dupuytren contracture 1
2Falkowski et al The Orthopaedic Journal of Sports Medicine
(Table 1). Comparison of portable hand-held and cart-based
ultrasound findings showed that results were concordant in
65%(65/100) (Figure 1) and discordant in 35%(35/100) of
patients. In the 35 patients with discordant results
(Table 2), the discrepancy in diagnosis resulted in no
change in clinical management in 46%(16/35) (Figure 2 and
Table 3), probably no change in 29%(10/35) (Table 4),
uncertain change in 14%(5/35) (Table 5), probable change
in 11%(4/35) (Figure 3 and Table 6), and definite change in
0%(0/35) of patients. The diagnoses changing management
included the following (Table 6): nondetection of a satellite
nodule of 2 mm associated with a superficial mass (1
patient), incorrect interpretation of a 5-mm ganglion cyst
as a possible solid mass (1 patient) (Figure 3), overlooked
direct inguinal and femoral hernias (1 patient), and misdi-
agnosis of partial gluteus medius tendon tear as tendinosis
(1 patient). Overall, the results from portable hand-held
ultrasound were concordant or discordant without clinical
relevance in 96%(96/100) of patients compared with those
from conventional cart-based ultrasound.
Regarding conventional color Doppler evaluation, 11
patients showed a discrepancy where increased flow or
hyperemia was present with conventional cart-based
ultrasound and not detected with the portable hand-
held ultrasound. These cases of discrepancy included the
following anatomic areas: elbow (n ¼6), Achilles tendon
(n ¼2), groin (n ¼1), shoulder (n ¼1), and shin (n ¼1).
They included abnormalities in the tendons (n ¼7),
masses or lymph nodes (n ¼3), and a bursa (n ¼1).
Tendon abnormality was diagnosed with conventional
cart-based ultrasound in 49%of patients (49/100); discre-
pancies were found in 12 patients when portable ultra-
sound was used: tendinosis was misdiagnosed as normal
tendon (n ¼3), underestimated (n ¼1), and overestimated
(n ¼1); tendon tears were overlooked (n ¼2), underesti-
mated (n ¼2), and overestimated (n ¼3). Overall, only 1 of
these discrepancies would have caused a probable change
in the clinical outcome, which involved the gluteus medius
tendon.
With regard to calcifications, in 2 of the 6 affected
patients, visibility was difficult when using the hand-held
portable ultrasound unit compared with the conventional
ultrasound unit in the rotator cuff (1 patient) and plantar
aponeurosis (1 patient). In both patients, the lesser visibility
did not change the patients’ clinical management because
the calcifications were not completely overlooked.
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.
TABLE 2
Patients With Disagreement in Diagnosis Comparing
Hand-Held Portable Versus Conventional Cart-Based
Ultrasound and the Effect on Clinical Management
Influence
on Clinical
Management
No. (%)
of Patients Anatomic Area (No. of Patients)
Definitely no 16 (46) Shoulder (5), elbow (4), wrist/hand (1),
hip (1), knee (1), foot/ankle (2),
other (2)
Probably no 10 (29) Shoulder (6), elbow (1), wrist/hand (1),
other (2)
Uncertain 5 (14) Shoulder (1), elbow (1), wrist/hand (2),
other (1)
Probably yes 4 (11) Wrist/hand (2), hip (1), other (1)
Definitely yes 0 (0) None
The Orthopaedic Journal of Sports Medicine Portable Versus Cart-Based Ultrasound 3
In review of the medical records, 14%of patients (14/100)
had additional MRI evaluation where correlation confirmed
the cart-based conventional ultrasound diagnosis. Of these,
2 patients had surgery that confirmed the diagnosis of com-
plex ganglion cyst and lipoma. In the 7 patients with joint
degeneration on ultrasound, radiographs were present in 5
cases. In the 3 patients with inflammation or infection,
additional clinical history, clinical evaluation, and labora-
tory values confirmed the diagnoses of rheumatoid arthri-
tis, psoriasis, and abscess, respectively.
DISCUSSION
Although the use of portable hand-held ultrasound has
been described in general ultrasound applications, its use
in routine musculoskeletal applications has not been fully
assessed. Our study showed that the results from portable
hand-held ultrasound were concordant or were discordant
without clinical relevance in 96%(96/100) of patients com-
pared with conventional cart-based ultrasound.
Portable ultrasound was first developed for military pur-
poses to identify and diagnose serious injuries in the bat-
tlefield.
13
In clinical situations, portable ultrasound may be
of benefit when the transport of a patient to the ultrasound
department is not possible or the heavy conventional
ultrasound machine is less accessible to the patient. Such
point-of-care ultrasound applications may also include the
emergency department and the outpatient clinic, where an
urgent diagnosis may be important.
1,6
The lower cost of
such portable devices (approximately $2000-$7000) com-
pared with conventional machines (often >$100,000) cre-
ates another opportunity, especially for less economically
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.
4Falkowski et al The Orthopaedic Journal of Sports Medicine
developed regions.
2,4
Portable ultrasound has also been
described in the field of medical education.
5,11,13,14
Common
applications for portable ultrasound include evaluation for
cardiac or abdominal abnormality.
5,14
The use of portable
ultrasound in the musculoskeletal system has been
described for foreign body removal
7,9
and rib fracture
assessment.
12
One study evaluated 10 shoulders and con-
cluded that abnormality could be identified
10
; however, a
comprehensive evaluation of routine musculoskeletal
applications has not been previously assessed.
Our study showed the utility of portable hand-held ultra-
sound in the evaluation of common musculoskeletal appli-
cations that is typical of an outpatient clinic. In our study
population, evaluation for tendon abnormality was the
most common application (49%, or 49/100). Of these 49
patients, the results were concordant in 76%(37/49) when
both portable and conventional ultrasound equipment were
used. In the remaining 12 patients, the most common dis-
crepancy was a change in severity of tendinosis, either
increasing or decreasing; however, the diagnosis provided
TABLE 3
Discrepancies in the Diagnosis: No Definite Change in Management
Anatomic Area Diagnosis on Portable Ultrasound
Additional or Changed Diagnosis on Conventional
Cart-Based Ultrasound
Shoulder Postoperative changes and no cuff tear Supraspinatus and infraspinatus muscle fatty
infiltration (additional diagnosis)
Shoulder Subacromial-subdeltoid bursal thickening and impingement Mild supraspinatus tendinosis (additional diagnosis)
Shoulder Subacromial-subdeltoid bursal thickening, tear, subluxation of the
long head of the biceps brachii tendon
Tendinosis of subscapularis and supraspinatus
(additional diagnosis)
Shoulder Partial bursal-sided tear of the supraspinatus tendon, fatty muscle
infiltration
Tendinosis of the subscapularis tendon (additional
diagnosis)
Shoulder Mild supraspinatus tendinosis, bursal thickening, joint effusion Moderate supraspinatus tendinosis (changed
diagnosis)
Elbow Severe common extensor tendinosis and partial tearing Flow on color Doppler imaging (additional diagnosis)
Elbow Moderate common extensor tendinosis Flow on color Doppler imaging (additional diagnosis)
Elbow Moderate common extensor tendinosis, interstitial tear Flow on color Doppler imaging (additional diagnosis)
Elbow Olecranon bursal distention Flow on color Doppler imaging (additional diagnosis)
Thumb Carpometacarpal osteoarthritis, remote injury of radial collateral
ligament
Ganglion cyst (additional diagnosis)
Abdominal wall Soft tissue nodule Postoperative changes (changed diagnosis)
Hamstring Moderate to severe tendinosis of conjoined semitendinosus and biceps
femoris tendons
Mild to moderate tendinosis (changed diagnosis)
Knee Joint effusion, osteoarthritis, abnormal lateral collateral ligament Synovial proliferation (additional diagnosis)
Calf Gastrocnemius and plantaris tear Normal plantaris (changed diagnosis)
Achilles tendon Severe tendinosis, interstitial tear Flow on color Doppler imaging, peritendinitis
(additional diagnosis)
Heel Plantar fasciopathy Calcification (additional diagnosis)
TABLE 4
Discrepancies in the Diagnosis: Probably No Change in Management
Anatomic Area Diagnosis on Portable Ultrasound
Additional or Changed Diagnosis on Conventional
Cart-Based Ultrasound
Shoulder Tendinosis supraspinatus tendon Interstitial tear of supraspinatus tendon (changed diagnosis)
Shoulder Focal full-thickness tear of supraspinatus tendon Overestimated tear size on portable ultrasound (changed diagnosis)
Shoulder Full-thickness tear of subscapularis, partial-
thickness tear of supraspinatus
Partial-thickness tear of subscapularis, full-thickness tear of
supraspinatus (changed diagnosis)
Shoulder Solid mass Flow on color Doppler imaging (additional diagnosis)
Shoulder Calcification Possible small tendon cleft (additional diagnosis)
Shoulder Biceps tendon split tear, subluxation, bursal
thickening
Partial-thickness tear of subscapularis tendon (additional diagnosis)
Elbow Moderate common extensor tendinosis, partial-
thickness tear
Flow on color Doppler imaging (additional diagnosis), no tear (changed
diagnosis)
Thumb Remote injury of ulnar collateral ligament, no
Stener lesion
Partial-thickness tear of ulnar collateral ligament, nondisplaced
avulsion fragment (additional diagnosis)
Abdominal wall Lipoma Size underestimated on portable ultrasound (changed diagnosis)
Leg Soft tissue mass Flow on color Doppler imaging (additional diagnosis)
The Orthopaedic Journal of Sports Medicine Portable Versus Cart-Based Ultrasound 5
by the conventional ultrasound would have changed clini-
cal management in only 1 patient (2%, or 1/49), in whom the
gluteus medius was involved. Importantly, there were no
changes in clinical outcome involving the shoulder, which
was the most common joint included in our study (30%,or
30/100). A previous study evaluated 10 shoulder cases via
portable ultrasound versus conventional ultrasound and
could identify abnormality in 70%to 80%of the cases
10
;
however, the authors did not investigate whether the incor-
rect diagnosis would have changed the clinical outcome.
Previous studies have also not evaluated the use of portable
ultrasound for other musculoskeletal applications beyond
the shoulder; our study included a relatively uniform dis-
tribution of cases outside of the shoulder, evaluating the
elbow (11/100), wrist and hand (15/100), hip (10/100), knee
(11/100), ankle and foot (12/100), and other miscellaneous
applications, such as the neck, chest wall, abdominal wall,
and groin (11/100).
In our study, there were 4 discrepant results that could
have potentially changed the clinical management (see
Table 3), which included 2 superficial (hand and finger) and
2 deep (groin and hip) pathologic findings. One case was an
overlooked superficial satellite nodule measuring 2 mm
adjacent to a solid mass of the palmar hand that could have
potentially influenced the surgical management. The sec-
ond case was a 5-mm ganglion cyst of the finger on conven-
tional cart-based ultrasound where the portable ultrasound
could not distinguish cyst versus solid, which may have
TABLE 5
Discrepancies in the Diagnosis: Uncertain About Change in Management
Anatomic Area Diagnosis on Portable Ultrasound
Additional or Changed Diagnosis on Conventional
Cart-Based Ultrasound
Shoulder Mild tendinosis, calcifications in subscapularis Calcifications in infraspinatus tendon (additional diagnosis)
Elbow Moderate common extensor tendinosis, interstitial tear Flow on color Doppler imaging (additional diagnosis)
Finger Probably ganglion cyst Definite ganglion cyst (changed diagnosis)
Thumb Carpometacarpal osteoarthritis Small cyst (additional diagnosis)
Groin Direct hernia Femoral hernia (additional diagnosis)
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.
TABLE 6
Discrepancies in the Diagnosis: Probable Change in Management
a
Anatomic Area Diagnosis on Portable Ultrasound Diagnosis on Conventional Cart-Based Ultrasound
Hand Single solid mass Solid mass with satellite nodules
Finger Differential diagnosis of hyperechoic or anechoic cyst
versus solid mass
Ganglion cyst
Groin Iliopsoas bursitis Iliopsoas bursitis
Additionally, direct inguinal hernia and femoral hernia
Hip Hydroxyapatite deposition disease of the medial gluteus
tendon, tendinosis of the gluteus minimus tendon
Hydroxyapatite deposition disease of the medial gluteus tendon
Missed partial-thickness tear of the gluteus medius tendon
a
Probable changes in management are indicated with italics.
6Falkowski et al The Orthopaedic Journal of Sports Medicine
resulted in an unnecessary biopsy or excision. The third
case involved the hip and groin; trochanteric bursal disten-
tion was identified, but the direct inguinal and femoral her-
nias were overlooked with the portable ultrasound unit. In
the fourth case, a partial tear of the gluteus medius tendon
at the greater trochanter was misdiagnosed as tendinosis.
The diagnosis of partial-thickness tear could have changed
management from percutaneous tenotomy or fenestration
to whole blood or platelet-rich plasma injection to minimize
risk of complete tendon tearing.
3,8
One limitation of the portable hand-held ultrasound unit
was the low sensitivity of the color Doppler compared with
cart-based ultrasound. Although we chose the low-flow set-
ting, there were 11 patients in whom the portable ultra-
sound did not reveal internal blood flow in tendons (n ¼7),
masses (n ¼3), and an olecranon bursa (n ¼1); however, the
additional finding of hyperemia when using the conven-
tional cart-based ultrasound machine did not significantly
change clinical management. Another limitation of the por-
table ultrasound equipment was difficulty in identifying
small calcifications in the rotator cuff (n ¼1) and plantar
aponeurosis (n ¼1), which also did not change clinical
management.
We acknowledge that our study has some limitations. We
did not directly assess the image quality of the 2 different
ultrasound techniques; however, the goal of our study was
to evaluate the clinical effect of diagnosis discordance using
a hand-held portable ultrasound unit. Second, imaging was
performed by only 1 observer without assessment of inter-
observer or intraobserver variability. Also, this observer
had significant experience in musculoskeletal ultrasound;
a study with multiple observers with different experience
would confirm generalization of our results. Another limi-
tation is that the images were obtained with the hand-held
portable examination performed first and interpreted in a
nonrandomized fashion not blinded toward the type of
ultrasound equipment used, which potentially introduced
bias. No statistical analysis (including power analysis) was
obtained. Also, the vast majority of patients did not have
additional imaging or surgical findings to correlate with
our results. An intrinsic limitation of the hand-held ultra-
sound machine is the lack of power Doppler and a linear
transducer with the highest frequency of 12-5 MHz; similar
settings and transducer frequency were used with the con-
ventional cart-based ultrasound unit to allow direct com-
parison. Although we determined overall concordance, we
were unable to determine concordances specific to each
joint given the low sample size.
CONCLUSION
In evaluation of the musculoskeletal system, our study
showed that the results from portable hand-held
ultrasound were concordant or were discordant without
clinical relevance in 96%(96/100) of patients compared
with conventional cart-based ultrasound. The most com-
mon joint evaluated was the shoulder, which showed no
clinically relevant discrepancies in diagnosis.
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