Feasibility and Impact of Adding Handheld Musculoskeletal Ultrasound Capabilities to Deployed Physical Therapists

Diagnostic ultrasound is an emerging skill for military physical therapists (PT). In addition to improving diagnostic accuracy, ultrasound informs management and return-to-duty decisions for musculoskeletal (MSK) injuries. This is particularly useful in deployed settings where access to radiologists, orthopedic physicians, or advanced imaging devices is limited.

Two U.S. Army PTs received training and handheld ultrasound devices designed for MSK imaging. During a 6-month deployment, the PTs completed a 6-item questionnaire after each ultrasound examination. They documented the body region examined, the indication, and the perceived value of the ultrasound information. They also rated their confidence levels on a 100-point scale. After the deployment, both PTs completed a qualitative survey to describe the benefits and challenges of using ultrasound in deployed environments.

The PTs performed 68 ultrasound examinations. They most frequently examined the foot and ankle (36.8%), followed by the shoulder (20.6%) and knee (19.1%). They primarily used ultrasound to evaluate ligament and tendon pathologies. In 23 cases, ultrasound findings guided the decision to either retain patients in the field (21 cases) or evacuate them for higher-level care (2 cases). The PTs adjusted care plans in 54.4% of cases, tailoring rehabilitation interventions, determining evacuation needs, and improving return-to-duty decisions and patient communication. The PTs identified several challenges, including the need for greater proficiency for complex diagnoses, limited battery life of the device, and access to ultrasound gel.

This study provides preliminary data demonstrating the benefit of training and equipping PTs with diagnostic ultrasound. Portable ultrasound augments diagnostic and rehabilitation decisions by PTs and offers the opportunity to enhance readiness and enable prolonged field care for MSK injuries.