Abstract
We have read the manuscript by Abogamal and col-leagues with interest. The article describes a com-parison of the 90-degree flexion/neutral position of theelbow, sometimes called the"crab"(usually used for theposterior window evaluation), with a standard pos-ition.
Their results showed a highly significant differencein favor of the 90-degree flexion position. We congratu-late the authors for their effort in drawing attention toimprove ultrasound elbow scanning ergonomy.
Import-antly, it has already been reported that repetitive ultra-sound examinations may result in musculoskeletal painin ultrasound practitioners. However, according toour experience, the proposed 90-degree flexion positionis not only uncomfortable for the examiner but also forthe patient, already presenting with preexisting elbowpain.
The position is coupled with internal rotation andextension of the shoulder, and as apparent from the Fig.3c also shoulder abduction and an excessive wrist exten-sion. Herewith, this position imposes abnormal pressureon the joints which may cause unnecessary loading ofthe musculoskeletal system of the patient.
Furthermore,the proposed positioning is coupled with a need tochange the position to assess the medial and lateralelbow compartments dynamically. In the medial com-partment, the examiner may need to perform the dy-namic valgus stress test to assess the integrity of theanterior bundle of the medial collateral ligament.
On thelateral side, the examiner may need to perform dynamicscanning to evaluate annular ligament and rule out pos-sible occult fractures of the radial head. On the contrary,Mezian and colleagues proposed and published a moreergonomic protocol for all elbow regions examinationwith the patient lying semisupine on the examinationbed.
In the future, we suggest a study to compare thesemisupine approach to a"standard"protocol. Webelieve this is of utmost importance for a smoothworkflow for musculoskeletal ultrasonographers to pre-vent chronic injuries and improve the quality of theexamination.