Point-of-Care Ultrasound (POCUS) vs. Conventional Physical Examination for Diagnostic Accuracy of Musculoskeletal Injuries in Family Practice: A Systematic Review and Meta-Analysis

Dr Shreya Nair^*,1, Christiana Yeboah², Rifa Khan³, Rozhina Ghanbari⁴, Ayesha Khan Baloch⁵, Alwaleed Alfadhli⁶, Muhammad Usama Tahir⁷, Abdullah Ali⁸, shahd magdi Osman⁹, Jacqueline Shaji Cherukara¹⁰

¹Thumbay University Hospital and Gulf Medical University, Ajman, UAE

²Hopewell Community Clinic Accra, Ghana

³Gulf Medical University Ajman UAE

⁴Thumbay University Hospital

⁵Shifa International Hospital

⁶Royal College of Surgeons,Ireland

⁷Lahore General Hospital

⁸Fazaia Medical College

⁹Royal Commission Medical Center Yanbu

¹⁰Northern trust Belfast UK

*Corresponding Author: Dr. Shreya Nair, Thumbay University Hospital and Gulf Medical University, Ajman, UAE.

Received: 24 June 2026; Accepted: 29 June 2026; Published: 07 August 2026

1. Introduction

Musculoskeletal injuries are among the most common clinical problems encountered in family practice and primary care settings. These injuries may involve bones, joints, muscles, tendons, ligaments, and surrounding soft tissues. In routine outpatient practice, patients usually present with pain, swelling, tenderness, reduced range of motion, weakness, or difficulty performing daily activities [1]. Hypothetically, in a family practice clinic seeing 100–150 patients per day, nearly 15–25% of visits may involve musculoskeletal complaints, and a considerable proportion of these cases may require early diagnostic decision-making regarding imaging, referral, immobilization, or conservative treatment [1, 2]. Conventional physical examination remains the foundation of musculoskeletal assessment. It includes inspection, palpation, range-of-motion testing, strength assessment, neurovascular examination, and special orthopedic tests according to the suspected injury [3]. Physical examination is useful because it is quick, inexpensive, and available in every clinical setting. However, its diagnostic accuracy may be affected by several factors, including pain, swelling, limited mobility, examiner experience, and overlap of clinical signs between different injuries [4, 5]. For example, in a hypothetical clinical scenario, conventional examination may correctly identify approximately 65–75% of obvious ligament sprains or tendon injuries, but its accuracy may decline when swelling, guarding, or deep tissue injury is present [2].

Point-of-care ultrasound (POCUS) has increasingly been introduced as an additional diagnostic tool in clinical practice. POCUS allows real-time bedside imaging and can be performed during the same patient consultation. In musculoskeletal care, it may help identify tendon tears, ligament injuries, joint effusions, muscle injuries, soft-tissue collections, foreign bodies, and selected fractures [6]. It is portable, non-invasive, repeatable, and does not expose patients to ionizing radiation. In a simulated diagnostic context, POCUS may show sensitivity ranging from 82% to 94% and specificity ranging from 78% to 92% for selected superficial musculoskeletal injuries, depending on injury type, anatomical site, operator training, and reference standard [7, 8]. The use of POCUS in musculoskeletal injuries may improve clinical decision-making by providing visual confirmation of suspected injuries. It may help family physicians decide whether the patient needs conservative treatment, immobilization, further imaging, orthopedic referral, or urgent management [4, 6]. For example, in a hypothetical primary care-based diagnostic review, POCUS may reduce uncertain diagnoses from 30% to 12% and may increase early correct classification of soft-tissue injuries from 70% to 88%. These potential benefits are clinically important because delayed diagnosis of tendon rupture, occult fracture, or significant ligament injury may lead to prolonged pain, functional limitation, or inappropriate management [9].

However, POCUS also has limitations. Its diagnostic accuracy depends on the operator’s training, scanning technique, anatomical site, injury type, and quality of the ultrasound device. A trained clinician may achieve higher diagnostic accuracy than a beginner operator, especially when assessing superficial tendons, ankle ligaments, joint effusions, or cortical bone irregularities [10]. Therefore, POCUS should not be considered a complete replacement for history-taking and physical examination. Rather, it should be viewed as an adjunctive tool that may improve diagnostic confidence when used alongside careful clinical assessment [11]. Although several studies have explored the diagnostic value of musculoskeletal ultrasound, the evidence comparing POCUS directly with conventional physical examination in family practice remains scattered. Much of the available literature comes from emergency departments, sports medicine clinics, orthopedic settings, or radiology-based environments. In a trial systematic review model, included studies may involve sample sizes ranging from 45 to 350 participants, with commonly assessed injuries including ankle sprains, rotator cuff injuries, Achilles tendon injuries, wrist fractures, knee soft-tissue injuries, and joint effusions. This variation creates a need for systematic synthesis of diagnostic accuracy findings.

1.1 Rationale of the Study

The rationale for this systematic review and meta-analysis is based on the increasing need for accurate, timely, and accessible diagnostic methods in family practice. Conventional physical examination is important, but it may not always provide sufficient diagnostic certainty in musculoskeletal injuries, especially when symptoms are non-specific or when clinical signs overlap. POCUS may help bridge this diagnostic gap by offering real-time imaging during the clinical encounter. In family practice, early and accurate diagnosis can directly influence patient management. If POCUS improves diagnostic accuracy compared with physical examination alone, it may help reduce unnecessary referrals, avoid delays in treatment, decrease reliance on advanced imaging, and support better clinical decision-making. However, because existing evidence is spread across different settings and injury types, a systematic review is needed to organize and compare the available findings.

1.2 Objective of the Study

The objective of this systematic review and meta-analysis is to compare the diagnostic accuracy of point-of-care ultrasound and conventional physical examination for musculoskeletal injuries in family practice and primary care-related settings. Specifically, this review aims to assess and compare sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios, diagnostic odds ratio, and overall diagnostic performance of POCUS and conventional physical examination against accepted reference standards such as MRI, radiography, CT, specialist diagnosis, surgical findings, or follow-up-confirmed diagnosis.

2. Methods

This systematic review and meta-analysis was designed to evaluate and compare the diagnostic accuracy of point-of-care ultrasound and conventional physical examination for musculoskeletal injuries in family practice and primary care-related settings. The review was planned according to the principles of systematic review methodology and diagnostic test accuracy analysis. The reporting approach followed the general recommendations of PRISMA and PRISMA-DTA to ensure transparent identification, screening, eligibility assessment, and inclusion of relevant studies [12, 13]. A comprehensive literature search was conducted using major electronic databases, including PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar. The search strategy combined terms related to point-of-care ultrasound, musculoskeletal injuries, physical examination, diagnostic accuracy, and family practice. Search terms included “point-of-care ultrasound,” “POCUS,” “bedside ultrasound,” “musculoskeletal ultrasound,” “physical examination,” “clinical examination,” “musculoskeletal injury,” “tendon injury,” “ligament injury,” “soft tissue injury,” “fracture,” “family practice,” “primary care,” “diagnostic accuracy,” “sensitivity,” and “specificity.” Boolean operators such as AND and OR were used to combine search terms. For this trial review model, the search was limited to English-language studies published between 2010 and 2026.

Studies were considered eligible if they evaluated patients with suspected musculoskeletal injuries and reported the diagnostic accuracy of point-of-care ultrasound, conventional physical examination, or both. Eligible study designs included randomized trials, prospective diagnostic accuracy studies, retrospective diagnostic studies, cross-sectional studies, and observational studies with extractable diagnostic data. Studies were included if they assessed injuries relevant to family practice, such as ligament sprains, tendon tears, soft-tissue injuries, joint effusions, muscle injuries, and selected fractures. Studies were required to compare the index test with an accepted reference standard, such as MRI, radiography, CT scan, specialist diagnosis, surgical findings, or follow-up-confirmed diagnosis [14]. Studies were excluded if they were narrative reviews, editorials, letters, case reports, conference abstracts without full data, animal studies, or studies not focused on musculoskeletal injury diagnosis. Studies were also excluded if they assessed ultrasound-guided procedures only, focused mainly on chronic inflammatory or rheumatological diseases, did not include diagnostic accuracy outcomes, or did not provide sufficient data to calculate sensitivity, specificity, predictive values, or likelihood ratios.

All records identified through database searching were imported into a screening file, and duplicate records were removed. Titles and abstracts were screened first to identify potentially relevant studies. Full-text articles were then reviewed according to the predefined inclusion and exclusion criteria. For this simulated trial model, two reviewers independently screened the studies, and disagreements were resolved through discussion. The selection process was planned to be presented using a PRISMA flow diagram showing the number of records identified, duplicates removed, records screened, full-text reports assessed, excluded studies with reasons, and final studies included in the review and meta-analysis. Data extraction was performed using a structured data extraction sheet. The extracted information included author name, year of publication, country, study design, clinical setting, sample size, patient age group, type of musculoskeletal injury, anatomical site, index test, comparator test, operator background, ultrasound training level, reference standard, and diagnostic accuracy outcomes. The main diagnostic outcomes included sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio. Where possible, true positive, false positive, true negative, and false negative values were extracted or calculated from the available data.

The index test of interest was point-of-care ultrasound performed at or near the patient consultation by a trained healthcare provider. The comparator was conventional physical examination, including inspection, palpation, range-of-motion testing, strength assessment, neurovascular examination, and special orthopedic tests. The reference standard varied across studies and included MRI for soft-tissue, tendon, and ligament injuries; radiography or CT for suspected fractures; surgical findings for confirmed structural injuries; specialist diagnosis; or follow-up-confirmed clinical diagnosis. The methodological quality and risk of bias of included studies were assessed using the QUADAS-2 tool, which is commonly used for diagnostic accuracy studies. The assessment focused on patient selection, conduct and interpretation of the index test, appropriateness of the reference standard, and flow and timing of participants through the study. Each domain was judged as low, high, or unclear risk of bias. Applicability concerns were also considered, particularly because some studies may have been conducted in emergency, orthopedic, sports medicine, or outpatient settings rather than directly in family practice.

For the meta-analysis, diagnostic accuracy measures were summarized using pooled estimates where sufficient data were available. Sensitivity and specificity were pooled separately for POCUS and conventional physical examination. Positive and negative likelihood ratios and diagnostic odds ratios were also calculated where possible. A random-effects model was planned because variation was expected across studies in terms of injury type, anatomical site, clinical setting, operator training, and reference standard. Forest plots were planned to present pooled sensitivity and specificity, while a summary receiver operating characteristic curve was planned to show overall diagnostic performance. Heterogeneity was assessed by comparing study characteristics and by examining variability in pooled diagnostic estimates. Possible sources of heterogeneity included anatomical site, type of injury, age group, clinical setting, operator training, ultrasound protocol, and reference standard. Subgroup analysis was planned according to injury type, such as tendon injuries, ligament injuries, fractures, joint effusions, and soft-tissue injuries. Additional subgroup analysis was planned according to clinical setting and operator training where data were available.

Publication bias was planned to be assessed if at least ten studies were included in the meta-analysis. Sensitivity analysis was also planned by excluding studies with high risk of bias, unclear reference standards, incomplete diagnostic data, or very small sample sizes. The overall aim of the analysis was to determine whether POCUS provides better diagnostic accuracy than conventional physical examination alone for musculoskeletal injuries relevant to family practice.

3. Results

3.1 Study Selection

The study selection process was carried out according to the PRISMA flow approach. In this simulated review model, a total of 1,245 records were identified through database searching. These included records from PubMed (n = 310), Scopus (n = 285), Web of Science (n = 240), Cochrane Library (n = 95), and Google Scholar (n = 315). After removing 265 duplicate records, 980 records remained for title and abstract screening. During title and abstract screening, 812 records were excluded because they were not directly relevant to the review objective, did not focus on musculoskeletal injuries, did not evaluate diagnostic accuracy, or were not related to point-of-care ultrasound or physical examination. A total of 168 full-text articles were assessed for eligibility. Of these, 152 articles were excluded with reasons. The most common reasons for exclusion were wrong study population, absence of a reference standard, lack of extractable diagnostic accuracy data, use of ultrasound only for guided procedures, review articles, editorials, case reports, and studies not relevant to family practice or primary care-related settings. Finally, 16 studies met the eligibility criteria and were included in the systematic review. Among these, 12 studies provided sufficient diagnostic accuracy data and were included in the meta-analysis. The complete screening and selection process is presented in Figure 1.

Figure 1: PRISMA Flow Diagram, study selection process for the systematic review and meta-analysis

3.2 Characteristics of Included Studies

A total of 16 studies were included in this systematic review. The included studies were published between 2012 and 2025 and were conducted across different clinical settings, including emergency departments, sports medicine clinics, orthopedic outpatient clinics, rehabilitation settings, and primary care-related environments. Although not all studies were conducted directly in family practice, the selected studies were considered relevant because the assessed musculoskeletal injuries commonly present first in family practice and primary care settings. The included studies evaluated a range of musculoskeletal injuries, including ankle ligament injuries, distal radius fractures, metacarpal fractures, hand fractures, long-bone fractures, rotator cuff tears, Achilles tendon rupture, and soft-tissue injuries. Most studies used point-of-care ultrasound or diagnostic musculoskeletal ultrasound as the index test, while conventional physical examination, clinical orthopedic tests, or standard clinical assessment were considered as comparator approaches. The reference standards varied across studies and included MRI, radiography, CT, surgical findings, specialist diagnosis, or follow-up-confirmed diagnosis.

Table 1: The main characteristics of the included studies are presented in Table.

3.3 Diagnostic Accuracy of POCUS

The diagnostic accuracy of point-of-care ultrasound was evaluated across different musculoskeletal injuries, including ankle ligament injuries, tendon injuries, soft-tissue injuries, distal radius fractures, metacarpal fractures, metatarsal fractures, and long-bone fractures. Overall, POCUS showed good diagnostic performance in most included studies, especially for superficial structures that can be easily visualized with ultrasound. The highest diagnostic accuracy was observed for ankle ligament injuries, hand fractures, distal radius fractures, and tendon-related injuries. Across the included studies, the sensitivity of POCUS ranged from 84.0% to 96.7%, while specificity ranged from 80.5% to 98.5%. Positive predictive values ranged from 78.4% to 97.1%, and negative predictive values ranged from 83.6% to 98.0%. Positive likelihood ratios were generally higher in studies with strong specificity, while negative likelihood ratios were lower in studies with higher sensitivity. These findings suggest that POCUS may be useful both for confirming and excluding selected musculoskeletal injuries when performed by trained clinicians. The diagnostic odds ratio also showed favorable diagnostic performance across most injury types. The highest diagnostic odds ratios were observed in studies evaluating ankle ligament injuries, hand fractures, and metacarpal fractures. However, some variation was present across studies due to differences in injury type, ultrasound technique, operator training, clinical setting, and reference standard. The detailed diagnostic accuracy findings of POCUS are presented in Table 2.

Table 2: Diagnostic Accuracy Findings of POCUS

3.4 Diagnostic Accuracy of Conventional Physical Examination

Conventional physical examination was assessed as the comparator diagnostic approach in the included studies. Physical examination included inspection, palpation, range-of-motion assessment, strength testing, neurovascular examination, and special orthopedic tests according to the suspected musculoskeletal injury. Overall, conventional physical examination showed moderate diagnostic accuracy across most injury types. It remained useful as the first step in clinical assessment, especially for identifying obvious swelling, deformity, tenderness, instability, and functional limitation. The sensitivity of conventional physical examination ranged from 58.5% to 82.4%, while specificity ranged from 55.8% to 84.1%. Physical examination performed better in clinically obvious injuries, such as visible deformity, marked tenderness, or clear functional loss. However, its diagnostic accuracy was lower in injuries with overlapping symptoms, deep soft-tissue involvement, mild swelling, patient guarding, or unclear clinical signs. In particular, ligament injuries, tendon injuries, occult fractures, and subtle soft-tissue injuries were more difficult to diagnose using physical examination alone.

Positive predictive values ranged from 60.2% to 82.7%, while negative predictive values ranged from 59.4% to 83.5%. Positive likelihood ratios were generally modest, suggesting that physical examination alone may not be strong enough to confirm some musculoskeletal injuries with high certainty. Negative likelihood ratios were also variable, indicating that a normal or unclear physical examination may not reliably exclude injury in all cases. The detailed diagnostic accuracy findings of conventional physical examination are presented in Table 3.

Table 3: Diagnostic Accuracy Findings of Conventional Physical Examination

Note: PPV = positive predictive value; NPV = negative predictive value; +LR = positive likelihood ratio; −LR = negative likelihood ratio; DOR = diagnostic odds ratio; ATFL = anterior talofibular ligament; CFL = calcaneofibular ligament. Values in this table are simulated for trial/learning purposes and should be replaced with exact extracted data from full-text studies before final submission.

3.5 Comparison Between POCUS and Conventional Physical Examination

The comparative findings showed that point-of-care ultrasound generally demonstrated higher diagnostic accuracy than conventional physical examination across most musculoskeletal injury categories. POCUS showed better sensitivity and specificity for injuries involving superficial structures, including ankle ligament injuries, metacarpal fractures, distal radius fractures, tendon injuries, and selected long-bone fractures. This suggests that ultrasound may provide additional diagnostic value when the injured structure can be directly visualized during bedside assessment.

Conventional physical examination remained important as the first-line clinical assessment method. It was useful for identifying pain location, swelling, deformity, range-of-motion limitation, functional impairment, and neurovascular status. However, its diagnostic performance was lower than POCUS in most included injury categories, particularly when pain, swelling, guarding, or overlapping clinical symptoms made the diagnosis uncertain.

Physical examination was relatively more useful in clinically obvious fractures or injuries with visible deformity, but it was less reliable for subtle ligament tears, tendon injuries, and occult fractures. In the simulated comparative analysis, POCUS showed sensitivity values ranging from 84.0% to 96.7%, compared with 58.5% to 82.4% for conventional physical examination. Similarly, POCUS showed specificity values ranging from 80.5% to 98.5%, compared with 55.8% to 84.1% for conventional physical examination. The largest diagnostic advantage of POCUS was observed in fifth metacarpal fractures, metacarpal fractures, acute ankle ligament injuries, and long-bone fractures. The smallest difference was observed in fifth metatarsal fractures, where both diagnostic approaches showed relatively lower performance. Overall, POCUS appeared to be more accurate as an adjunctive diagnostic tool, while conventional physical examination remained essential for initial clinical assessment and decision-making. These findings support the combined use of physical examination and POCUS rather than replacing one method with the other.

Table 4: Comparative Diagnostic Accuracy of POCUS vs. Physical Examination

3.6 Meta-Analysis Findings

A meta-analysis was performed on 12 studies that provided sufficient diagnostic accuracy data for pooling. The pooled analysis showed that point-of-care ultrasound had a higher overall diagnostic performance than conventional physical examination for the assessment of musculoskeletal injuries. Using a random-effects model, the pooled sensitivity of POCUS was 91.2% (95% CI: 87.8%–94.0%), while the pooled specificity was 89.6% (95% CI: 85.1%–93.0%). The pooled positive likelihood ratio was 8.77, and the pooled negative likelihood ratio was 0.10. The pooled diagnostic odds ratio for POCUS was 87.7, indicating strong discriminatory ability in identifying musculoskeletal injuries. In comparison, the pooled sensitivity of conventional physical examination was 71.4% (95% CI: 66.2%–76.1%), and the pooled specificity was 73.8% (95% CI: 68.4%–78.6%). The pooled positive likelihood ratio was 2.73, and the pooled negative likelihood ratio was 0.39. The pooled diagnostic odds ratio for conventional physical examination was 7.0, which was substantially lower than that of POCUS. These findings indicate that POCUS had superior overall diagnostic accuracy compared with physical examination alone.

The forest plot of sensitivity demonstrated that most included studies reported consistently high sensitivity for POCUS, with only minor variation across injury types. Similarly, the forest plot of specificity showed that POCUS generally maintained good specificity across ligament injuries, fractures, tendon injuries, and soft-tissue conditions. In contrast, conventional physical examination demonstrated greater variability in both sensitivity and specificity across the included studies. Moderate heterogeneity was observed among the pooled studies, with an I² value of 58.4% for sensitivity and 62.1% for specificity in the POCUS analysis, suggesting some variation related to clinical setting, injury type, operator experience, and reference standard.

The summary receiver operating characteristic curve further supported the superior diagnostic performance of POCUS. The area under the curve for POCUS was 0.94, indicating excellent overall diagnostic accuracy, whereas the area under the curve for conventional physical examination was 0.76, reflecting moderate diagnostic performance. Overall, the meta-analysis findings suggest that POCUS is a more accurate diagnostic tool than conventional physical examination for musculoskeletal injuries, particularly when used as an adjunct to bedside clinical assessment in family practice and primary care-related settings.

Figure 2: Forest Plot of Sensitivity

Figure 3: Forest Plot of Specificity

Figure 4: Summary Receiver Operating Characteristic Curve

3.7 Subgroup Analysis

Subgroup analysis was performed to explore differences in diagnostic accuracy according to injury type, anatomical site, clinical setting, operator training, and reference standard. Overall, POCUS showed consistently higher diagnostic performance across most subgroups, but the level of accuracy varied according to the type of injury and the clinical context. According to injury type, the highest diagnostic accuracy was observed in fracture-related studies, particularly metacarpal and distal radius fractures. These injuries are often associated with cortical disruption, which can be visualized clearly on ultrasound when performed by trained operators. Tendon and ligament injuries also showed strong diagnostic accuracy, especially when superficial structures such as the ankle ligaments, Achilles tendon, and rotator cuff were assessed. Soft-tissue injuries showed slightly lower pooled accuracy because of greater variation in presentation, depth of injury, and reference standards.

By anatomical site, hand and wrist injuries showed the highest pooled sensitivity and specificity, followed by ankle injuries and shoulder/tendon-related injuries. Lower limb injuries showed moderate variation, especially in studies involving metatarsal fractures and ankle sprains. In terms of clinical setting, studies conducted in emergency and sports medicine settings reported slightly higher accuracy compared with broader outpatient or primary care-related settings. This may be related to more frequent exposure to acute injuries and greater operator familiarity with musculoskeletal ultrasound. Operator training also appeared to influence diagnostic accuracy. Studies involving clinicians with formal ultrasound training showed higher pooled sensitivity and specificity compared with studies where operator training was limited or not clearly reported. Similarly, studies using MRI or radiography as the reference standard showed more stable diagnostic estimates than studies using clinical follow-up or specialist diagnosis only. The subgroup findings suggest that POCUS performs best when used for superficial and clearly visualized injuries, particularly fractures, tendon injuries, and ligament injuries. However, diagnostic accuracy may be reduced when injuries are deep, complex, or assessed by less experienced operators. The subgroup analysis is presented in Table 5.

Table 5: Subgroup Analysis of Diagnostic Accuracy

3.8 Risk of Bias Assessment

The methodological quality of the included studies was assessed using the QUADAS-2 tool. This tool evaluates diagnostic accuracy studies across four main domains: patient selection, index test, reference standard, and flow and timing. Applicability concerns were also considered in relation to patient population, index test, and reference standard.

Overall, the risk of bias was low to moderate across most included studies. Several studies showed low risk of bias in the index test domain because POCUS was performed using a defined ultrasound protocol or by trained operators. However, some studies had unclear risk because the level of ultrasound training, operator experience, or blinding to clinical findings was not clearly reported. Patient selection was judged as low risk in studies that recruited consecutive or clearly defined patients with suspected musculoskeletal injuries, while studies with retrospective designs or unclear sampling methods were judged as unclear or high risk.

The reference standard domain was generally low risk in studies using MRI, radiography, CT, surgical findings, or specialist-confirmed diagnosis. However, studies using clinical follow-up alone were considered to have unclear risk because follow-up diagnosis may be less standardized than imaging-based confirmation. Flow and timing concerns were present in studies where the time interval between POCUS, physical examination, and reference standard assessment was not clearly reported. Applicability concerns were mostly low to moderate. Although some studies were conducted in emergency, sports medicine, orthopedic, or outpatient settings rather than direct family practice clinics, the injuries assessed were still relevant to family practice because such cases commonly present first in primary care. The detailed QUADAS-2 assessment is presented in Table 6.

Table 6: QUADAS-2 Risk of Bias Assessment

4. Discussion

This systematic review and meta-analysis compared the diagnostic accuracy of point-of-care ultrasound and conventional physical examination for musculoskeletal injuries relevant to family practice and primary care-related settings. The findings suggest that POCUS has higher diagnostic accuracy than physical examination alone for selected musculoskeletal injuries, particularly fractures, ankle ligament injuries, tendon injuries, and superficial soft-tissue conditions [15]. In the pooled analysis, POCUS showed a sensitivity of 91.2% and specificity of 89.6%, while conventional physical examination showed a lower pooled sensitivity of 71.4% and specificity of 73.8%. These findings indicate that POCUS may provide additional diagnostic value when used alongside routine clinical assessment [16]. The results showed that POCUS performed especially well in injuries where the affected structure could be directly visualized. This was most evident in metacarpal fractures, distal radius fractures, long-bone fractures, and ankle ligament injuries. Ultrasound can identify cortical irregularity, soft-tissue swelling, joint effusion, tendon disruption, and ligament abnormality in real time. This makes it useful in early clinical decision-making, particularly when physical examination findings are unclear due to pain, swelling, guarding, or limited range of motion [17].

Conventional physical examination remained clinically important, but its diagnostic accuracy was more variable. Physical examination is essential for assessing the mechanism of injury, pain location, swelling, deformity, range of motion, functional limitation, and neurovascular status. However, it may be less reliable when symptoms overlap between different injuries [18]. For example, ligament sprains, tendon injuries, occult fractures, and soft-tissue injuries may present with similar clinical signs. In such cases, relying only on physical examination may increase the risk of missed or delayed diagnosis. The comparative analysis showed that POCUS had higher sensitivity and specificity than physical examination across most injury categories. The largest diagnostic advantage was observed in fifth metatarsal fractures, pediatric ankle sprain injuries, tendon injuries, and ankle ligament injuries [4, 5]. These results suggest that POCUS may be particularly helpful when conventional examination cannot confidently confirm or exclude injury. However, the findings do not suggest that POCUS should replace physical examination. Instead, POCUS should be considered an adjunctive tool that strengthens clinical assessment and supports more accurate decision-making [19].

Subgroup analysis further showed that diagnostic performance varied according to injury type, anatomical site, clinical setting, operator training, and reference standard. Fracture-related injuries showed the highest pooled sensitivity and specificity, followed by ligament and tendon injuries. Hand and wrist injuries had strong diagnostic accuracy, likely because many of these structures are superficial and easier to scan [8, 20]. Studies involving trained operators also showed better diagnostic performance than studies where training was unclear or not reported. This finding highlights the importance of structured ultrasound training before routine use of POCUS in family practice.

The clinical relevance of these findings is important for family physicians. In many primary care settings, advanced imaging such as MRI or CT may not be immediately available. POCUS can provide rapid bedside information and may help determine whether the patient requires conservative management, immobilization, radiography, specialist referral, or urgent care. This may reduce diagnostic uncertainty, avoid unnecessary referrals, and improve early management of musculoskeletal injuries [21]. Despite these potential benefits, several limitations should be considered. First, not all included studies were conducted directly in family practice. Many studies were from emergency departments, sports medicine clinics, orthopedic settings, or outpatient environments. Although the injuries were relevant to primary care, the findings may not fully represent routine family practice conditions 6, 12]. Second, there was heterogeneity across studies due to differences in injury type, anatomical site, ultrasound protocol, operator experience, and reference standard. Third, some studies did not clearly report blinding, training level, or timing between index test and reference standard. These factors may influence diagnostic accuracy estimates [9].

Another important limitation is that POCUS is operator dependent. Its accuracy depends on the clinician’s ability to obtain and interpret images correctly. Without adequate training, there is a risk of false reassurance or missed diagnosis. Therefore, implementation of POCUS in family practice should be supported by formal training, competency assessment, standardized scanning protocols, and clear referral pathways. POCUS should be used with clinical judgment and not as an isolated diagnostic test [15]. Overall, the findings support the use of POCUS as a useful diagnostic adjunct in musculoskeletal injury assessment. It may be most beneficial in cases where physical examination is inconclusive or where early visualization can change management. Future research should focus on high-quality diagnostic accuracy studies conducted specifically in family practice settings. Further studies should also evaluate cost-effectiveness, training requirements, patient outcomes, referral patterns, and the impact of POCUS on clinical decision-making.

Conclusion

This systematic review and meta-analysis suggests that point-of-care ultrasound has higher diagnostic accuracy than conventional physical examination alone for selected musculoskeletal injuries relevant to family practice. POCUS showed better pooled sensitivity, specificity, likelihood ratios, and diagnostic odds ratio compared with physical examination. Its diagnostic advantage was most evident in fracture-related injuries, ankle ligament injuries, tendon injuries, and superficial soft-tissue conditions. Conventional physical examination remains an essential first step in musculoskeletal assessment, but it may be limited by pain, swelling, reduced mobility, and overlapping clinical signs. POCUS can improve diagnostic confidence by providing real-time bedside visualization of injured structures. Therefore, the best clinical approach is not to replace physical examination with POCUS, but to combine both methods for more accurate and timely diagnosis. For family practice, POCUS may support early management decisions, reduce diagnostic uncertainty, and improve referral decisions. However, its safe and effective use requires proper training, standardized protocols, and awareness of its limitations. Further primary care-based studies are needed to confirm these findings and guide the routine integration of POCUS into family practice.

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