POCUS in Practice: Enhancing the Physical Exam in Rehabilitation - A Case Series

Case Diagnosis: Case 1: Right supra-patellar bursal effusion
Case 2: Mild right carpal tunnel syndrome
Case 3: Right partial-thickness supraspinatus tear

Case Description or Program Description: This case series highlights three patients with persistent musculoskeletal pain, where POCUS played a pivotal role in diagnosis and treatment planning. By providing immediate visualization of joint effusions, nerve compression, and soft tissue abnormalities, POCUS enabled targeted interventions, optimizing rehabilitation outcomes.

Setting: Post-Acute Rehabilitation Facility

Assessment/Results: Three patients underwent POCUS for persistent musculoskeletal pain. An 81-year-old woman with right knee pain was diagnosed with a supra-patellar bursal effusion, leading to multimodal pain management. A 59-year-old woman with wrist pain and numbness was found to have mild carpal tunnel syndrome, prompting bracing discussions. A 70-year-old man with right shoulder pain was diagnosed with a partial-thickness supraspinatus tear, resulting in adjusted rehabilitation strategies and consideration of a suprascapular nerve block.

Discussion (relevance): Ultrasound is increasingly used for musculoskeletal, nervous, and soft tissue evaluations. It improves nerve localization, aiding conduction studies, and electromyography. Additionally, ultrasound supports musculoskeletal diagnoses and procedural guidance in pain and regenerative medicine. However, its application in the post-acute rehabilitation setting remains underexplored with its expansion limited by the need for standardized training and diagnostic criteria. Further research should prioritize standardization of ultrasound protocols.

Conclusions: POCUS enhances physical exams through real-time imaging, improving diagnostic accuracy, clinical decision-making, and rehabilitation strategies. By providing real-time imaging and augmenting traditional physical examination techniques, POCUS serves as an invaluable extension of physiatrists' skill set.