Is elastography type technology useful for quantifying the characteristics of fascia tissues, who uses diagnostic ultrasound in a musculoskeletal setting, and what are the beliefs of users and non-users?

Detection of stiffness in muscle and fascia tissues through the application of subjective palpation helps guide the musculoskeletal practitioner to a working diagnosis. Elastography represents a new technology that measures the stiffness of these tissues quantitatively. Interest in fascia tissues has grown over the last two decades and its role in body movement and other physiological functions has seen a rapid growth in research during this time. This paper aims to investigate the potential of utilising elastography to quantitatively measure fascia tissue stiffness in a musculoskeletal setting. A mixed method approach was followed using a systematic narrative review and survey. The target population of the survey involved rheumatologists, musculoskeletal/sports doctors, chiropractors, physiotherapists, and osteopaths. Most musculoskeletal practitioners are not aware of elastography, hence diagnostic ultrasound was considered an appropriate substitution to gain the beliefs and attitudes of both users and non-users. No studies were found in the literature that utilised elastography to measure stiffness in fascia tissues other than in tendons. However, studies of tendons identified in the review illustrated very good to excellent sensitivity and specificity to detect pathological from non-pathological tissues. Additionally, preferred protocols to enhance elastography scanning were identified. The most likely users of diagnostic ultrasound are currently rheumatologists and musculoskeletal/sports doctors with the most common reason given by non-users being a lack of training/education. All professions mostly agree (>70%) that diagnostic ultrasound is able to produce reliable images of pathologic and non-pathologic tissues, should only be taken by trained professionals, can aid a clinician with good palpation skills, and may be useful to quantify diagnostic findings. This paper concludes that elastography may be useful to quantify tissue stiffness, however more research is required for elastography to be reliably utilised in a musculoskeletal setting