Posts tagged ‘arthrography’

April 22, 2014

Knees: Scrapes, Twists and Tears

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Knees are famous for scrapes (and bees). Little kids play rough and tumble and when they do, they land on ‘em. Little band-aids on a child’s knees are almost – dare we say – cute. They remind us of learning to ride bikes and popsicles on summer days and swingset leaps. Luckily, kids’ knees are resilient.

 

As we get older – not so much. Knees take a beating and unfortunately they’re really only meant to bend in one direction. We could go on and on about knee maladies (arthritis anyone?) but let’s pick one: sports injuries.

 

As we graduate from learning to ride bikes to learning to ski and more, we introduce a lot more opportunities to scrape, bang, twist and torque our knees. Knee injuries are incredibly common, especially in sports. There are a variety of tissues to damage – from bone to muscle to tendons to ligaments. Imaging may be needed to see all of the complex structures.

 

With sports injuries, damage to ligaments may occur, especially with twisting or blows from the side – ligaments (connecting bone to bone) include the anterior cruciate (ACL) and posterior cruciate ligaments which cross (cruciate comes from the Latin for “cross”) the center of the knee. The medial and lateral collateral ligaments stabilize the inner and outer aspects of the knee respectively.

 

Sometimes with a twisting motion, multiple structures will be involved in the injury. MRI is an excellent means of imaging the knee, allowing us to look at bone, soft tissue and cartilage all at the same time. You can even give a good estimation of the way a knee was injured based on the pattern of injuries present on the MRI. Injury to the ACL happens in athletes of all ages. The ligament can be torn partially or completely, and knee instability in a classic pattern will often be found on clinical exam of the knee.  ACL tears are often associated with bone bruises in classic places, and may be associated with damage to the other soft tissue structures, from other ligaments to meniscal tears.

Tendons (which connect muscles to bone) may also be injured – either the quadriceps tendon  coming to the top of the patella (kneecap), or the patellar tendon, coming from the bottom of the patella.  Often the tears can be felt by your doctor on exam. Imaging, often with MRI or with ultrasound, may be necessary to see if the tear is complete and look for other injuries. Muscle injury can also occur, and is well-imaged by MRI.

The menisci are discs of cartilage between the femur and tibia which provide cushioning and which can get torn. This can cause a sensation of something locking in the knee with motion (although other things can also do that) or may just cause pain. Meniscal tears are well-seen on MRI, and may also be evaluated with arthrography.

 

As with shoulders – you want to take care of your knees and keep ‘em strong. This doesn’t mean don’t play – it just means play smart. Other things you can do to help protect your knees can be found here.

(Photo credit: trufflekneehighs by boocub via Flickr Copyright Creative Commons Attribution- NonCommercial- NoDerivs 2.0 Generic (CC BY-NC-ND 2.0))

Diagnostic Imaging Centers blogs on regularly about women’s health at www.mammographykc.com and general radiology at www.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

April 17, 2014

Shoulder Pain: When You Can’t Shrug It Off

Shoulder joint by National Institute Of Arthritis And Musculoskeletal And Skin Diseases (NIAMS) via Wikipedia Copright Public DomainThe shoulder is a complex joint of mythical strength (at least if your name is Atlas and you’re carrying the weight of the world on it).

 

From baseball pitching to carrying little kids to lifting overhead, the shoulder gets quite the workout. It’s important to take care of this joint – especially if it’s been injured. One of the most common injuries is to the rotator cuff tendons.

 

There are four tendons surrounding the shoulder to provide stability and assist in the normal range of motion. Pain and limited range of motion are often the first indicators that something could be wrong with those tendons. They can be inflamed, torn partially or torn full-thickness.

 

After an initial evaluation with your primary healthcare professional, you may be sent for imaging. Typically, this area can be evaluated with MRI or an  ultrasound. Some shoulder injuries are difficult to see without some fluid in the joint – this is when an MR arthrogram might be performed. MR arthrograms can evaluate partial tendon tears and provides an excellent evaluation of the labrum or cartilage lining the joint. Labral injuries may be seen in patients who have had a dislocation of their shoulder joint as well as in athletes.

 

Some of the rotator cuff tendons sit underneath the acromioclavicular joint – the smaller part of the joint on top of the shoulder. Changes in the acromioclavicular joint, either differences in the shape of the acromion or degenerative arthritis, may predispose you to problems with the rotator cuff tendons or may lead to chronic tendon irritation or tears.

 

The shoulder is a complex joint, and vital to many daily functions we don’t even think about, such as brushing your hair or lifting your groceries. So if you have an injury, pain or develop difficulty in moving your shoulder, don’t hesitate to see your doctor.

 

And remember – prevention is the best medicine! Stronger shoulders are less likely to incur injury, and strengthening the rotator cuff can be achieved. Here’s a Real Simple way to improve your shoulder health.

(Photo credit: Shoulder joint by National Institute Of Arthritis And Musculoskeletal And Skin Diseases (NIAMS) via Wikipedia Copright Public Domain)

Diagnostic Imaging Centers blogs on regularly about women’s health at www.mammographykc.com and general radiology at www.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

 

April 15, 2014

Shoulders, Knees and Toes, Knees and Toes

Head, Shoulders, Knees, and Toes by james.swenson13 via Flickr Copyright Creative Commons Attribution-NonCommercial 2.0 Generic (CC BY-NC 2.0)

Over the next few posts we’re going to highlight some common injuries affecting familiar joints. As the title suggests, we’re starting near the top.

 

But before we get ahead of ourselves and start talking about these individual parts, let’s talk about how we image them…

 

There are many techniques for imaging the body, and the ones we use depend upon the type of injury and the most likely tissues injured. Here’s a gimme: broken bones? We’ll start with an x-ray – perhaps a CT if it’s complex. Here’s a not-so-gimme: soft tissue injury like torn ligament? Options here include MRI, ultrasound and arthrograms.

 

First off, not every injury is imaged. Why? Sometimes a careful exam by your doctor can answer the question – imaging in these cases is not done, unless symptoms do not improve in the expected manner. There are carefully developed rules helping your doctors determine who will benefit the most from imaging in the case of many of the common injuries, for instance ankle sprains.

 

After your doctor’s initial evaluation, you may be sent for imaging. In many cases this will start with conventional films (x-rays) to exclude fractures or other bony changes. Beyond that, a patient will be directed based on the clinical concern.

 

Imaging of patients who have multiple sites of injury from a fall or motor vehicle accident for instance may be done with CT. This allows quick evaluation of bones as well as some types of soft tissue injuries. Multiple structures can be evaluated at the same time with CT, such as looking for fractures in the lower back, while also assessing the abdomen for signs of damage to internal organs.

 

Soft tissue damage, such as torn cartilage or ligaments, will often not be apparent on a conventional film. Visualizing soft tissues can be done with ultrasound, MRI or an arthrogram (where contrast material or dye is introduced into the joint space). We may follow the arthrogram with imaging with MRI or CT.

 

So… we will start our journey of the joints with your shoulders! (See you Thursday!)

 

(Photo credit: Head, Shoulders, Knees, and Toes by james.swenson13 via Flickr Copyright Creative Commons Attribution-NonCommercial 2.0 Generic (CC BY-NC 2.0))

Diagnostic Imaging Centers blogs on regularly about women’s health at www.mammographykc.com and general radiology at www.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

September 24, 2013

Arthrography: What happens after? – Dr. Angela Noto

September 17, 2013

Arthrography: When is it not used? – Dr. Angela Noto

September 12, 2013

Arthrography: Is lidocaine always used? – Dr. Angela Noto

September 10, 2013

Arthrography: Does it hurt? – Dr. Angela Noto

September 5, 2013

Arthrography: Why is contrast required? – Dr. Angela Noto

September 3, 2013

Arthrography: let’s talk about contrast. – Dr. Angela Noto

August 29, 2013

Arthrography: What are the steps of the procedure? – Dr. Angela Noto