Musculoskeletal Ultrasound Education in Hand Surgery Fellowships.

PURPOSE: The use of ultrasound in upper-extremity surgery has increased dramatically in diagnostics, therapeutics, and ultrasound-guided procedures. Despite the growing relevance, it is unclear how much structured musculoskeletal ultrasound (MSK US) education is being provided by hand surgery fellowship programs.

METHODS: Two qualitative, cross-sectional online surveys were distributed to all Accreditation Council for Graduate Medical Education-accredited Hand Surgery Fellowship Program Directors in 2024 and 2025. Surveys contained six questions (2024) and nine questions (2025) and required approximately 1 minute to complete.

RESULTS: Thirty-one of 94 programs responded to the survey in 2024 and 40/93 in 2025. Ultrasound was included in fellowship training in 21 responding programs in 2024 and 23 in 2025. Among programs that include ultrasound, it was used for diagnostic (69% in 2024, 60% in 2025), therapeutic (59% in 2024 and 50% in 2025) and surgical applications (17% in 2024, 21% in 2025). Training under a hand surgeon with MSK US expertise increased from 69% in 2024 to 81% in 2025. Many programs were unaware of online MSK educational materials available through either AAOS ROCK (55% in 2024 vs 33% in 2025) or American Society for Surgery of the Hand Handthology (30% in 2025).

CONCLUSIONS: Survey responses in both 2024 and 2025 show a substantial interest in MSK US utilization and education among hand surgery fellowships, with >90% of responding programs reporting current or planned integration of ultrasound training. Despite this, hand surgery training lacks a standardized curriculum comparable to those established in emergency medicine, PM&R, rheumatology, and sports medicine.

CLINICAL RELEVANCE: Further integration of ultrasound in clinical practice and establishing a core MSK US curriculum for hand surgery fellowship training could be critical steps to ensure competency, support credentialing, and align with the evolving needs of clinical practice. Limitations of this study are response rate and potential response bias.