Physical Therapy

Physical Therapists Recognized as Preferred Providers for Musculoskeletal Ultrasound

Hands-On Seminars has some exciting news to share!

As of early November, the AIUM (American Institute of Ultrasound in Medicine) announced that Physical therapists can perform musculoskeletal ultrasounds and now be recognized in the same capacity as physicians.

What is the AIUM and What is the Impact of this Announcement?

The AIUM is an organization that advocates ultrasound in the medical field and accredits labs for musculoskeletal ultrasound. The AIUM is an influential institution in that it is the organization various insurance carriers use to guide them on which medical providers get reimbursed for performing musculoskeletal ultrasounds. This announcement places Physical Therapists among two other professionals (MDs and Chiropractors) who can perform and get reimbursed for performing musculoskeletal ultrasounds.

Because the APCA (Alliance for Physician Certification & Advancement) also recognizes PTs as approved providers for testing musculoskeletal ultrasounds, this announcement reinforces the right for Physical Therapists to get reimbursed for these studies. One important note is that some insurance carriers require Physical Therapists to be RMSK Certified in order to be reimbursed.

Requirements for Physical Therapists Who Perform Musculoskeletal Ultrasounds

As per the AIUM, in addition to having a clear understanding of the principles and procedures of performing musculoskeletal ultrasounds, Physical Therapists must also be familiar with the following:

  • ultrasound technology and instrumentation
  • ultrasound power output, equipment calibration, and safety
  • anatomic, physiologic, and pathophysiologic characteristics of areas examined
  • complementary imaging and diagnostic procedures 

Additional Requirements Include:

completion of an accredited Doctor of Physical Therapy (DPT) program (or t-DPT) (although not a requirement for RMSK certification) or an accredited PA program and documentation of involvement in the performance, interpretation, and reporting of 150 diagnostic MSK ultrasound examinations within the previous 36 months. Ultrasound examinations must be under the supervision of a licensed medical provider(s).


Completion of 30 AMA PRA Category 1 Credits™ specific to MSK ultrasound and at least 1 ultrasound course  that provided hands-on training in diagnostic MSK ultrasound within the previous 36 months.

Physical Therapists who perform musculoskeletal ultrasounds must also maintain competence with a minimum of 50 diagnostic MSK ultrasound examinations per year. All licensed medical providers who perform and/or interpret diagnostic MSK ultrasound examinations must complete 10 hours of AMA PRA Category 1 Credits™, AOA Category 1-A Credits, or CPME-approved credits specific to MSK ultrasound every 3 years.

Benefits of Performing MSKUS

X-Rays, CT Scans and MRI’s have been, for the longest time, the tests to evaluate musculoskeletal problems. Recent advances in sonar and ultrasound technology have created a more functional and practical approach to evaluate joints, muscles, ligaments and even nerves. This technology is called musculoskeletal ultrasound.

Clinical evidence and research support using ultrasound as the first diagnostic test for numerous musculoskeletal conditions. Diagnostic ultrasound offers a number of important advantages compared to X-Ray, CT and MRI, in terms of safety and effectiveness. Musculoskeletal ultrasound simply uses sonic waves, and there is no exposure to radiation. At the same time, diagnostic ultrasound is noninvasive and offers real-time imaging, allowing for examinations of structures at rest and in motion. This ability to capture the movement of musculoskeletal components differentiates it from other imaging modalities, and can permit more accurate diagnoses.

For a variety of reasons, healthcare providers have gravitated toward more expensive imaging modalities over time. The use of such imaging modalities as CT and MRI, instead of lower-cost alternatives, such as ultrasound, may not ensure better outcomes, and also increases the cost to the healthcare system and your patients.

How Does Musculoskeletal Ultrasound Work

Through MSKUS one can visualize different structures based on the echoes they reflect as different tissues transmit different amounts of echoes. Skin is the first layer visualized followed by fat. Skin and fat will not move like muscles, tendons or nerves but will deform with compression from the transducer. Tendons are viewed as hyperechoic densely packed collagen fibrils, which appear in long axis. Meanwhile, muscle fibers are not as densely packed. Muscles have hypoechoic fiber echotexture and intervening hyperechoic connective tissue. On the other hand, nerve fibers are loosely packed allowing for visualization of the epineurium as bright signals and the nerve fascicles as dark ones. So, the nerve fascicles are hypoechoic and hyperechoic epineurium. Cross-section nerves appear as “honey-combs” with hypoechoic fascicles lying inside a hyperechoic background.

To learn more about how Physical Therapists can perform musculoskeletal ultrasound please view Hands-On Seminars Certification Program. The program can also be sponsored for facilities and private practices who would like their Physical Therapists to perform musculoskeletal ultrasounds.