Posts tagged ‘cartilage’

May 14, 2014

What’s Up with Your Neck? (and just below…)

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Have pain in your neck or upper back? You are not alone! While less common than low back pain, pain in the neck is a common complaint leading to doctor’s office visits. Pain in the upper back is somewhat less common, but we will include it in our discussion for completeness.

 

In a recent post we talked about imaging of the lumbar spine, the lower portion of the spine which sits behind your belly.  Much of the imaging for the rest of the spine is similar to what is done for the lumbar region.

 

The cervical spine (coming from the Latin word for neck) is sometimes referred to as the C spine. It consists of the first seven vertebrae (from the skull) and the cartilage discs between them, in addition to adjacent ligaments and muscles. A lot of motion (up,down, around!) occurs in this part of the spine during the day, so this is a common spot for symptoms of overuse or muscle strain to occur.

 

Patients with cervical spine problems may have pain in the neck with or without symptoms in the upper arms/shoulders – this can be pain or can be nerve type symptoms like numbness or tingling. How far the symptoms go down your arm can help indicate the level of involvement in the cervical spine.

 

The T Spine is the thoracic spine consisting of the 12 vertebral bodies, discs, adjacent muscles and ligaments at chest level. There is less movement of the spine at this level, so symptoms here are less common. Symptoms of thoracic spine problems may include pain in the upper back, shoulders, arms, or to the sides of the chest. Nerve symptoms like numbness, tingling or weakness may also be present.

 

As in the lumbar spine, there are a lot of age-related changes involving the discs and/or the adjacent bones; these may or may not be related to the patient’s symptoms. Imaging of the cervical and thoracic spine is generally performed after careful history and physical examination, and may be delayed to see if a trial of conservative treatment improves symptoms. Imaging immediately may be warranted if there are serious symptoms such as major trauma, weight loss, or nerve symptoms, particularly weakness of the arms or legs.

The spectrum of problems in the cervical and thoracic spine is similar to that in the lumbar spine and can include disc displacement, fractures, and muscle strain. Less common causes of neck and upper back symptoms include disease in the spinal cord itself, spinal cord tumors and things like multiple sclerosis. Note that the spinal cord ends at approximately the upper lumbar level; therefore, these problems do not directly affect the lumbar spine.

 

Imaging of the cervical and thoracic spine is similar to that for the lumbar spine. X-ray, CT and MRI can all be used to diagnose problems.Plain films or x-rays may be the best starting point as they can show alignment and fractures. X-rays can also show any narrowing in the spaces between the vertebra indicating disc disease. A CT shows bones and adjacent tissues and is the test of choice if we are concerned about fractures. CT can see the cord and nerve roots if we do it after a myelogram (more commonly done with C spine than with the T spine). Last, an MRI can show the spinal cord, nerve roots and discs and how they relate.

 

Ultimately, imaging of the neck and upper spine may be helpful to determine the proper course of action to get you on the road to your best possible health!

(Image credit: Illu vertebral column via Wikimedia Commons Copyright Public Domain)


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

May 8, 2014

Imaging of the Lumbar Spine

Lumbar vertebrae anterior by Anatomography via Wikimedia Commons Copyright Creative Commons  Creative Commons Attribution-Share Alike 2.1 JapanTo continue our conversation about back pain, today we’re going to focus on the different imaging tests that may be requested to evaluate someone with back pain, specifically lower back pain. Imaging for lower back pain will likely focus on the lumbar spine. It’s the lower back region, usually the lower 5 vertebral levels – the series of vertebrae highlighted in the picture here.

 

There are several modalities we use to examine the lumbar spine, including (but not limited to) x-ray, MRI  and CT.

 

Conventional films or X-rays are often the starting point when evaluating someone with back pain. This allows an overall assessment of alignment and can look for signs of a more serious issue requiring additional imaging, like a fracture or an area of abnormal appearing bone. If the back pain follows recent trauma, is seen in someone with known osteoporosis or is in someone over the age of 70, conventional films may be the imaging study of choice and may be the only imaging needed.

 

MRI (magnetic resonance imaging) of the lumbar spine is the most common imaging test for back pain because of its ability to see details of the soft tissues, including the nerves as well as the bones.  As an added benefit, no radiation is involved. Remember with MRI the images are made with a large magnet and radiofrequency pulses (those are the loud sounds you hear). With MRI we can examine all of the following:  the structure of the discs (the cartilage cushions between the vertebrae) and look for how the disc relates to adjacent nerve roots; the bones that make up the spine including the vertebral bodies;  the conus (the lower end of the spinal cord); and the soft tissues surrounding the area. Imaging takes about 30 minutes, and remember – you can’t have an MRI if you have a pacemaker (most types anyway!) or some implanted devices like stimulators. Lastly for the safety of all you cannot bring metal of any kind into the room!

 

CT (computed tomography) is an additional means of looking at the spine. Images with CT are made with x-rays that are created in a ring around the body allowing the body to be imaged in thin slices. CT allows an excellent look at the bones making up the spine. It may be the study of choice for evaluation of acute trauma or fracture. Changes in the discs can be seen, but the nerve roots are not visualized in a routine CT. There are times when a CT of the spine is performed after a myelogram – this is a procedure where contrast material is put in the fluid- containing space surrounding the spinal cord and nerve roots. This then allows CT to better evaluate the nerve roots and soft tissues of the spinal canal. A CT scan may be used to help with planning before back surgery. A CT lumbar spine takes around 10 minutes. It should not be used in those who are pregnant unless it is an emergency (as with severe trauma).

 

All of these are straightforward procedures that can give an excellent anatomic evaluation. Remember imaging of the spine will often reveal age-related changes in the discs and bones, not all of which will be associated with symptoms. Imaging is not always needed for back pain – see your doctor to determine if imaging can help get you on the path to your best possible health!

(Image credit: Lumbar vertebrae anterior by Anatomography via Wikimedia Commons Copyright Creative CommonsAttribution-Share Alike 2.1 Japan)

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

 

May 6, 2014

Oh! The Pain in my Back!

Low back pain by Harrygouvas via Wikimedia Commons Copyright Creative Commons Attribution-ShareAlike 3.0 Unported (CC BY-SA 3.0)Lower back pain is common. In fact, in the US it is a leading reason for a trip to see the doctor. There are many causes for back pain – some of them related to the spine and its components and others related to adjacent structures. Things like kidney stones and diverticulitis can present with back pain. There are also times when the source of back pain is never fully found.

 

When should you see your doctor and when is imaging for back pain appropriate?

 

The good thing about back pain is that the natural course for most is improvement of symptoms by around 4 weeks – whether you have specific treatment or not. If you have severe back pain, if it is associated with other symptoms like pain or nerve changes in one of your legs (numbness, burning sensation or tingling) or if symptoms are not improving, a visit to the doctor is in order.

 

There are published guidelines helping your healthcare provider decide if you will benefit from imaging of the spine. A careful history and physical are key.

 

Why not image everyone with back pain? Imaging the spine in the majority of us will show abnormalities – our discs (those cartilage cushions between the vertebral bodies) will begin to show changes as we get older. This is a natural age-related process related to being upright – the discs are only good for so many miles! The problem with imaging for back pain is we will often see abnormalities of the discs – some can even be large and impressive – but they do not always correlate with your symptoms. Imaging can lead to confusion and over-treatment, and for uncomplicated back pain will likely not affect how your back pain is managed.

 

When will imaging for back pain help most? Imaging is recommended for immediate evaluation of some patients with back pain with history or signs that might indicate a serious problem requiring immediate intervention. These include patients with history or signs that might make cancer (a RARE cause of back pain) more likely – things like a known cancer elsewhere in the body or significant weight loss. Signs that there might be an infection are important. Any symptoms that suggest there might be involvement of the nerves to the lower body may also warrant immediate imaging.

 

Imaging after a trial of physical therapy (usually after a 6 week period) may be indicated in patients who fail to show improvement or have worsening of symptoms. Imaging may also be performed if symptoms persist in patients with history of osteoporosis and concern for new fractures.

 

How do we image and which test do we pick? Those will be explored in our next post on back pain!

 

So, if you have low back pain remember that in the vast majority of patients, symptoms will get better – although it may take a few weeks. A visit to your doctor will help determine if imaging is needed and will help in the management of your pain.

Image Credit: Low back pain by Harrygouvas via Wikimedia Commons Copyright Creative CommonsAttribution-ShareAlike 3.0 Unported (CC BY-SA 3.0).

Diagnostic Imaging Centers blogs on regularly about women’s health atwww.mammographykc.com and general radiology atwww.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

August 29, 2013

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