Response to the Letter to the Editor on “Point-of-Care Ultrasonography Findings and Care Use Among Patients Undergoing Ultrasound-Guided Shoulder Injections”

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To the Editor:
We appreciate the reader for thoughtful inquiries and comments on this article. Musculoskeletal ultrasonography has increasingly used in the outpatient physiatric practice, becoming standard of care, from the state of art.1 For proper use of ultrasonography in musculoskeletal practice, it is essential for clinicians to be knowledgeable of its potential limitations as well as the benefits. Despite its advancement, it is still limited in the evaluation of certain pathologies including tissue edema (e.g., subacromial bursitis without gross thickening and effusion), resulting in low sensitivity compared with magnetic resonance imaging,2 and lesions obstructed by bony structures (e.g., subacromial portion of the subdeltoid bursa and intraarticular lesion). The correlation of imaging findings with a patient's symptom (particularly pain) has been difficult in many musculoskeletal conditions, such as asymptomatic rotator cuff tears3 and asymptomatic subacromial bursitis. Further research is necessary, including the effective management of patients with discordance between clinical findings and imaging. In this article, the authors decided to follow clinical impressions when there was a discord between clinical and ultrasonographic findings. It would be interesting to see whether the outcomes would be different if the intervention was based on imaging. Regarding the approach of injection to the glenohumeral joints, both lateral to medial and medial to lateral approaches are recommended and described in the literature.4 The authors agree with the point that clinicians should be vigilant for avoiding labral injury. The advantage of using imaging guidance is to place the needle accurately without injuring neighboring structures, such as the labrum, as illustrated in this study.

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